H1N1: overview and perspectives

The swine origin influenza virus A/CALIFORNIA/04/2009 (H1N1) was first detected in Mexico and determined the 2009 influenza pandemic. In August 2010, World Health Organization (WHO) declared the beginning of the post-pandemic period. This last pandemic was distinctly different from previous ones. The virus emerged from genetic rearrangement in non-human mammalian host. Moreover, its inter-species transmission is fully reported. However, it affected human population differently from previous pandemic viruses (1918, 1957, 1968), with increased morbidity and mortality among children and young adults. Currently, the virus has a seasonal pattern in the same way as influenza A H3N2 and influenza B, maintaining the same pathogenicity profile, clinical spectrum and sensitivity to antiviral agents. The strain was included in the annual trivalent seasonal vaccine formulation, mainly for risk groups, which are more vulnerable to complications caused by different influenza strains.O vírus influenza de origem suína, A/California/04/2009 (H1N1), foi inicialmente detectado no México e determinou a pandemia de influenza de 2009. Em agosto de 2010, a Organização Mundial da Saúde (OMS) declarou o início da fase pós-pandêmica. As características dessa última pandemia foram marcadamente diferentes das anteriores. O vírus emergiu de rearranjos genéticos originários em hospedeiro mamífero não humano, demonstrou transmissibilidade interespécies e afetou a população humana de forma diferente dos vírus pandêmicos anteriores (1918, 1957 e 1968) com maior morbidade e mortalidade em crianças e adultos jovens. Atualmente, o vírus apresenta padrão sazonal da mesma forma que o influenza A H3N2 e o influenza B, mantendo, até o momento, o mesmo perfil de patogenicidade, espectro clínico e sensibilidade a antivirais. A cepa foi incluída na vacina sazonal trivalente anual recomendada, principalmente para proteção dos grupos de risco mais vulneráveis a complicações pelas diferentes cepas de influenza.Universidade Federal de São Paulo (UNIFESP) Departamento de MedicinaUNIFESP, Depto. de MedicinaSciEL

Development of a prototype immunochromatographic test for rapid diagnosis of respiratory adenovirus infection

Human adenoviruses comprise an important group of etiologie agents that are responsible for various diseases in adults and children, such as respiratory, ocular, gastroenteric, and urinary infections. In immunocompromised and organ-transplanted individuals, these agents can cause generalized infections. Rapid diagnostic methods for detecting these infectious agents are not widely available.& para;& para;The aim of this work was to produce monoclonal and polyclonal anti-adenovirus antibodies to be used in a rapid diagnostic test for respiratory infections.& para;& para;Adenovirus hexons were satisfactorily purified by ultracentrifugation and chromatography. After virus purification, anti-hexon monoclonal antibodies were produced and characterized, following classical methods. Antibodies were specific for adenoviruses 2,3,5, and 41. The proposed immunochromatographic test was standardized using colloidal gold.& para;& para;The standardization of the rapid test was sufficient to detect adenovirus antigens (in nasopharyngeal lavage samples) with sensitivity of 100% and specificity of 85% when compared to direct immunofluorescence.& para;& para;The immunochromatographic assay prototype was sufficiently sensitive to detect B (3), C (2 and 5), and F (41) adenovirus samples. Although based on preliminary data, the test demonstrated the same performance as direct immunofluorescence, but with the advantage of being a point-of-care test. Further studies are still needed to confirm its effectiveness in clinical practice. (C) 2017 Sociedade Brasueira de Infectologia. Published by Elsevier Editera Ltda.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed São Paulo, Dept Med, Lab Virol, Disciplina Infectol, São Paulo, SP, BrazilUniv Fed São Paulo, Inst Biociencias, Dept Microbiol, Lab Adenovirus, São Paulo, SP, BrazilInst Biociencias, Dept Microbiol, Lab Micol, São Paulo, SP, BrazilInst Butantan, Lab Bacteriol, São Paulo, SP, BrazilUniv Fed São Paulo, Dept Med, Lab Virol, Disciplina Infectol, São Paulo, SP, BrazilUniv Fed São Paulo, Inst Biociencias, Dept Microbiol, Lab Adenovirus, São Paulo, SP, BrazilFAPESP: 2011/50100-6Web of Scienc

SARS-COV-2, the new coronavirus: a reflection about “One Health” and the importance of travel medicine when new pathogens emerge

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Risk factors for poor immune response to influenza vaccination in elderly people

Influenza vaccination of elderly people is efficacious and cost effective for the prevention of influenza and its complications. Some studies have pointed out low immunogenicity in this group. Health status has been poorly investigated as a risk factor that may influence the immune response to influenza vaccine. We established an immunization response study of a highly-matched elderly population in a nursing home. One-hundred-twenty subjects of Ashkenazian origin had their vaccine-induced antibody response assessed. Good response was obtained in 30.8% (37/120), and 31.7% (38/120) did not react. A lack of good response was found to be associated with dementia (P=0.016) in a multivariate analysis. In addition to dementia, malnutrition was frequently observed among poor responders, suggesting that these factors should be considered in vaccination studies. Chemoprophylaxis in addition to vaccination for elderly presenting dementia should be considered, particularly for those people living nursing homes.Federal University of São Paulo Department of Infectious Diseases Laboratory of Clinical VirologyFederal University of São Paulo Federal University of São PauloUNIFESP, Department of Infectious Diseases Laboratory of Clinical VirologyUNIFESP, UNIFESPSciEL

Infections with human coronaviruses NL63 and OC43 among hospitalised and outpatient individuals in São Paulo, Brazil

The incidence and clinical features of human coronaviruses (HCoVs) among Brazilian patients with respiratory illness are not well known. We investigated the prevalence of HCoVs among Brazilian outpatients and hospitalised patients with respiratory illnesses during 2009 and 2010. To identify the HCoVs, pancoronavirus and species-specific reverse-transcriptase polymerase chain reaction assays were performed. Five of 394 samples were positive for HCoVs (1.2%): 1/182 (0.5%) outpatients and 4/212 (1.8%) hospitalised patients. The OC43 and NL63 HCoVs were identified. Two patients were admitted to the intensive care unit. Underlying chronic disease was reported in cases and one diabetic adult died. HCoVs can cause lower respiratory infections and hospitalisation. Patients with pre-existing conditions and respiratory infections should be evaluated for HCoV infections.Universidade Federal de São Paulo (UNIFESP) Departamento de Medicina Laboratório de Virologia ClínicaUNIFESP, Depto. de Medicina Laboratório de Virologia ClínicaSciEL

Infecções respiratórias em crianças menores de dois anos de idade submetidas a profilaxia com palivizumabe

OBJECTIVE: To identify the viruses involved in acute respiratory tract infections and to analyze the rates of hospitalization and death in children on palivizumab prophylaxis.METHODS:Prospective cohort of 198 infants up to one year old who were born before 29 weeks of gestational age and infants under two years old with hemodynamically unstable cardiopathy or chronic pulmonary disease who received prophylactic palivizumab against severe respiratory syncytial virus infections in 2008. During the study period, in each episode of acute respiratory tract infection, nasopharyngeal aspirate was collected to identify respiratory syncytial virus, adenovirus, parainfluenza 1, 2 and 3, influenza A and B by direct immunofluorescence, rhinovirus and metapneumovirus by polymerase chain reaction preceded by reverse transcription. Data regarding hospitalization and deaths were monitored.RESULTS:Among the 198 studied infants, 117 (59.1%) presented acute respiratory tract infections, with a total of 175 episodes. Of the 76 nasopharyngeal aspirates collected during respiratory tract infections, 37 were positive, as follow: rhinovirus (75.7%), respiratory syncytial virus (18.9%), parainfluenza (8.1%), adenovirus 2 (2.7%), metapneumovirus (2.7%) and three samples presented multiple agents. Of the 198 children, 48 (24.4%) were hospitalized: 30 (15.2%) for non-infectious etiology and 18 (9.1%) for respiratory causes. Among these 18 children, one case of respiratory syncytial virus was identified. Two deaths were reported, but respiratory syncytial virus was not identified.CONCLUSIONS:During the prophylaxis period, low frequency of respiratory syncytial virus infections and low rates of hospitalization were observed, suggesting the benefit of palivizumab prophylaxis.OBJETIVO:Identificar los virus implicados en los cuadros de infecciones agudas de trato respiratorio y analizar las tasas de internación y de óbito en niños sometidos a la profilaxis con palivizumabe.MÉTODOS:Cohorte prospectiva con 198 niños con menos de un año nacidas antes de 29 semanas de edad gestacional y niños con menos de dos años con cardiopatía hemodinámicamente inestable o enfermedad pulmonar crónica que recibieron palivizumabe para profilaxis contra infecciones graves por el virus sincitial respiratorio, en 2008. En el periodo de estudio, en cada episodio de infección aguda del trato respiratorio, se recogió aspirado de nasofaringe para identificar virus sincitial respiratorio, adenovirus, parainfluenza 1,2 y 3, influenza A y B por técnica del anticuerpo fluorescente directa, rinovirus y metapneumovirus por reacción en cadena de la polimerasa precedida por transcriptasa inversa. Se monitorean internaciones y óbitos en ese grupo.RESULTADOS:De los 198 niños seguidos, 117 (59,1%) presentaron infecciones agudas de trato respiratorio, totalizando 175 episodios. De 76 aspirados de nasofaringe recogidos en la vigencia de infecciones de trato respiratorio, 37 fueron positivos, encontrándose: rinovirus (75,7%), virus sincitial respiratorio (18,9%), parainfluenza (8,1%), adenovirus (2,7%), metapneumovirus (2,7%) y múltiples agentes en tres muestras. De los 198 niños, 48 (24,4%) fueron internados, siendo 30 (15,2%) por etiología no respiratoria y 18 (9,1%) por problemas respiratorios; entre los 18 casos, uno fue por virus sincitial respiratorio. Dos niños evolucionaron a óbito, no habiendo sido identificado el virus sincitial respiratorio.CONCLUSIONES:En la vigencia de profilaxis, se observó frecuencia baja de infecciones por el virus sincitial respiratorio y bajo índice de hospitalizaciones, sugiriendo beneficio de la profilaxis con palivizumabe.OBJETIVO:Identificar os vírus envolvidos nos quadros de infecções agudas de trato respiratório e analisar as taxas de internação e de óbito em crianças submetidas à profilaxia com palivizumabe.MÉTODOS:Coorte prospectiva com 198 crianças menores de um ano nascidas antes de 29 semanas de idade gestacional e crianças menores de dois anos com cardiopatia hemodinamicamente instável ou doença pulmonar crônica que receberam palivizumabe para profilaxia contra infecções graves pelo vírus sincicial respiratório, em 2008. No período do estudo, em cada episódio de infecção aguda do trato respiratório, coletou-se aspirado de nasofaringe para identificar vírus sincicial respiratório, adenovírus, parainfluenza 1, 2 e 3, influenza A e B por imunofluorescência direta, rinovírus e metapneumovírus por reação em cadeia de polimerase precedida de transcriptase reversa. Monitoraram-se internações e óbitos nesse grupo.RESULTADOS: Das 198 crianças acompanhadas, 117 (59,1%) apresentaram infecções agudas de trato respiratório, totalizando 175 episódios. De 76 aspirados de nasofaringe coletados na vigência de infecções do trato respiratório, 37 foram positivos, encontrando-se: rinovírus (75,7%), vírus sincicial respiratório (18,9%), parainfluenza (8,1%), adenovírus (2,7%), metapneumovírus (2,7%) e múltiplos agentes em três amostras. Das 198 crianças, 48 (24,4%) foram internadas, sendo 30 (15,2%) por etiologia não respiratória e 18 (9,1%) por problemas respiratórios; entre os 18 casos, um foi por vírus sincicial respiratório. Duas crianças evoluíram para óbito, não tendo sido identificado o vírus sincicial respiratório.CONCLUSÕES:Na vigência de profilaxia, observou-se frequência baixa de infecções pelo vírus sincicial respiratório e baixo índice de hospitalizações, sugerindo benefício da profilaxia com palivizumabe.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Pandemic H1N1 illness prognosis: evidence from clinical and epidemiological data from the first pandemic wave in São Paulo, Brazil

OBJECTIVES: The pandemic of 2009 H1N1 influenza A emerged in February 2009, with high morbidity and mortality, and rapidly spread globally. São Paulo was among the most affected areas in Brazil. This study compares the clinical and epidemiological characteristics of influenza-like illness between outpatients and hospitalized patients and evaluates the impact of oseltamivir therapy on the outcome of 2009 H1N1 influenza A patients. METHODS: This is a case series study comparing the clinical and epidemiological characteristics of influenza-like illness between outpatients attended at Hospital São Paulo in August 2009 (the peak of the first pandemic wave) and those patients hospitalized between May and September 2009 (the entire first pandemic wave). RESULTS: The 1651 patients evaluated were predominantly female (927×686, p<0.001) and aged 31.71±16.42 years, with 148 reporting chronic pulmonary disease. Dyspnea was presented by 381 (23.4%) patients and was more frequent among those aged 30 years or more (p<0.001). Hospitalization occurred at 3.73±2.85 days, and antiviral treatment started 2.27±2.97 days after the onset of first symptoms. A delay of more than 5 days in starting oseltamivir therapy was independently associated with hospitalization (p<0.001), a stay in the ICU (p<0.001) and a higher risk of dying (OR = 28.1, 95% CI 2.81-280.2, p = 0.007). CONCLUSION: The 2009 pandemic of H1N1 influenza A affected young adults, presented a significant disease burden and produced severe cases with a significant fatality rate. However, promptly starting specific therapy improved the outcome.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de Virologia ClínicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaHospital São Paulo Unidade de Doenças InfecciosasUniversidade de São Paulo Faculdade de MedicinaUNIFESP, EPM, Laboratório de Virologia ClínicaUNIFESP, EPM, Depto. de MedicinaHospital São Paulo Unidade de Doenças InfecciosasSciEL

Occurrence of influenza among patients hospitalized for suspicion of influenza A (H1N1) infection in 2010 at a sentinel hospital in São Paulo, Brazil

In 2010, 96 patients suspected of being infected with the influenza A (H1N1) virus were hospitalized at the Hospital São Paulo, located in the city of São Paulo, Brazil. Of those 96 patients, 4 (4.2%) were found to be infected with influenza A virus-3 with influenza A (H1N1) and 1 with seasonal influenza A-and 2 patients (2.1%) were found to be infected with influenza B virus. Most (63.5%) of the suspected cases occurred in children, as did half of the positive cases. The second wave of influenza A (H1N1) infection was weaker in São Paulo. The decrease in the number of hospitalizations for H1N1 infection in 2010 might be attributable to vaccination.Em 2010, 96 pacientes com suspeita de infecção por influenza A (H1N1) foram hospitalizados no Hospital São Paulo, na cidade de São Paulo (SP). Desses, 4 pacientes (4,2%) foram diagnosticados com influenza A - 3 com influenza A (H1N1) e 1 com influenza sazonal - e 2 pacientes (2,1%) foram diagnosticados com influenza B. A maioria dos casos suspeitos (63,5%) e metade dos casos positivos ocorreram em crianças. A segunda onda de influenza A (H1N1) foi mais fraca em São Paulo. A vacinação pode ter contribuído para a redução das internações devido a essa infecção em 2010.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de Medicina Unidade de Doenças InfecciosasUNIFESP, Depto. de Medicina Unidade de Doenças InfecciosasSciEL