Degradation of dye-containing textile effluents by enzymatic catalysis

Tese de doutoramento. Engenharia Química. Faculdade de Engenharia. Universidade do Porto. 201

Isso é coisa de miúdas!: representações sociais de crianças dos 4 aos 6 anos acerca dos géneros masculino e feminino

Relatório de Estágio apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Educação Pré- EscolarO presente relatório, de natureza crítica e reflexiva, é o culminar do processo vivenciado na Prática Profissional Supervisionada (PPS) (Módulo II), a qual ocorreu numa sala de Jardim de Infância (JI), do setor privado, numa instituição situada em Lisboa, entre 26 de setembro de 2016 e 3 de fevereiro de 2017. Durante a prática em JI surgiu a problemática em estudo - Representações sociais têm as crianças entre os 4 e os 6 anos relativamente ao género feminino e masculino – numa conversa entre crianças sobre o que vestiriam para a festa do Magusto. Em termos metodológicos procurei compreender num quadro de investigação-ação que representações sociais têm as crianças entre os 4 e os 6 anos relativamente ao género feminino e masculino, tendo como objetivo principal o de as colocar numa posição de diálogo e de confronto de conceções acerca do que é ser homem e do que é ser mulher, possibilitando o (re)pensar da sua participação social como cidadãos, seja em contexto de JI, familiar ou outros. Procurei, assim, também compreender que papel pode ter o educador de infância na construção da identidade de género. A investigação desenvolveu-se com recurso a técnicas e instrumentos diferentes como: a observação participante (notas de campo), questionário, gravação via áudio, foto-palavras, produções das crianças, análise documental (revisão de literatura, documentos oficiais e legislação). Os dados recolhidos apontam para a existência de representações sociais estereotipadas sobre o género masculino e feminino nos diálogos entre as crianças, evidenciando uma notória segregação entre sexos. Contudo, algumas das crianças mostraram-se disponíveis para alterarem o seu discurso. Ou seja, as crianças que apresentavam uma visão estereotipada ao longo das conversas eram confrontadas por outras crianças com outras ideias/constatações, (re)formulando a sua perspetiva e negociando-a com os pares. Assim sendo, as crianças tomaram posicionamentos (Buss-Simão, 2012) diferentes, assumindo, trocando ou abandonando as suas representações sociais relativamente ao género masculino e feminino. O trabalho desenvolvido permitiu-me ainda constatar que o(a) educador(a) de infância pode contribuir para a construção de identidade de género das crianças, assumindo essencialmente um papel de adulto que medeia diálogos e atitudes, que organiza e planeia momentos específicos para essa finalidade, motivando, auxiliando e participando.ABSTRACT The present thesis, of a critical and a reflection review, is the culmination of the process experienced in the Supervised Professional Practice (PPS,) (Module II), which took place in a qualified room of Kindergarten (JI), of the private sector, in an institution in Lisbon, between September 36, 2016 and 3 of February, 2017. During the practice in JI, the problematic under study appeared - Social representations have as children between 4 and 6 years of age regarding the female and male gender - in a conversation between children about what they wear for a “Magusto” party. In methodological terms, I tried to understand in an action-research framework which social representations have children between 4 and 6 years old regarding the female and male gender, with the main objective of putting them in a position of dialogue and confrontation of conceptions about the Which is to be a man and what it is to be a woman, making it possible to (re) think of their social participation as citizens, whether in the context of JI, family or others. I have also tried to understand what role the child educator can play in the construction of gender identity. The research was developed using different techniques and instruments such as: participant observation (field notes), questionnaire, audio recording, photo-words, children's productions, documentary analysis (literature review, official documents and legislation). The data collected point to the existence of stereotyped social representations about the masculine and feminine gender in the dialogues among the children, showing a notorious segregation between the sexes. However, some of the children were available to change their speech. That is, children who presented a stereotyped vision during the conversations were confronted by other children with other ideas / findings, (re) formulating their perspective and negotiating with peers. Thus, children took different positions (Buss-Simão, 2012), assuming, exchanging or abandoning their social representations regarding the masculine and feminine gender. The work developed allowed me to observe that the childhood educator can contribute to the construction of gender identity of children, essentially assuming an adult role that mediates dialogues and attitudes, which organizes and plans specific moments for motivating, assisting and participating.N/

Antiviral resistance: influenza B

Currently circulating influenza viruses are resistant to adamantanes and except for a low number of sporadic cases most are sensitive to neuraminidase inhibitors (NI). Adamantanes are ineffective against influenza B viruses and although NI-resistant influenza B viruses have been rarely reported, recently in the United States was identified one cluster of influenza B viruses with reduced susceptibility to NI and with the I221V substitution in the active site of the neuraminidase. Despite the low prevalence of oseltamivir-resistant influenza viruses, the constant evolution of influenza requires the monitoring of antiviral resistance among these viruses in the community. This is very important for the clinical management of severe influenza cases as to the detection of novel genetic markers associated with antiviral resistance. This study reports the antiviral susceptibility to neuraminidase inhibitors of influenza B viruses isolated in Portugal during the 2010/2011, 2011/2011 and 2012/2013 seasons. Over the period of 3 influenza seasons, 146 influenza B viral strains were selected for phenotypic fluorescent assays in order to assess their susceptibility to NI, oseltamivir and zanamivir. For this purpose, was determined the NI concentration required to inhibit 50% of each influenza virus neuraminidase activity (IC50). The IC50 baseline of influenza B viruses was calculated for both oseltamivir and zanamivir using the Robust Excel programme. The neuraminidase gene segments were also monitored for the presence of the main molecular markers, associated with the resistance to neuraminidase inhibitors in influenza B viruses. All analysed influenza B strains proved to be susceptible to oseltamivir and zanamivir. In the 2010/2011 season the determined IC50 values ranged from 0 to 70 nM for oseltamivir and from 0 to 11nM to zanamivir. The zanamivir IC50 median value was about 8-fold lower than oseltamivir IC50 median value. Statistical analysis revealed the presence of one outlier (B/Lisboa/13/2010, 71.08nM) for oseltamivir (2-fold reduction in susceptibility) and four minor outliers (B/Lisboa/15/2010: 9.52 nM; B/Lisboa/19/2010: 9.25 nM; B/Lisboa/51/2010: 10.94 nM and B/Lisboa/53/2010: 9.62 nM) for zanamivir (3-fold reduction in susceptibility) comparing to the median IC50 value. During the 2011/2012 season IC50 values ranged from 23.0 to 38.38 nM (oseltamivir) and from 2.97 to 9.07nM (zanamivir). This season were not found minor or major outliers. The IC50 values obtained in 2012/2013 ranged from 7.91 to 84.84 nM (oseltamivir) and from 1.48 to 5.88 nM (zanamivir). During this last season were found 6 minor and 3 major outliers for oseltamivir and 13 minor outliers for zanamivir. Along the three seasons, the median IC50 values for both NI were higher among the B/Victoria than B/Yamagata viruses. None of the actually known mutations associated with resistance of influenza B viruses to NI was found in the neuraminidase gene (R150K, D197E/N/Y, I221T/V, N294S, R374K and G407S). Influenza B viruses isolated in Portugal during the last three seasons were susceptible to the neuraminidase inhibitors. Portuguese influenza B strains revealed higher susceptibility to zanamivir than to oseltamivir, as observed in other countries. The oseltamivir IC50 values were also different between viruses from the B/Victoria and B/Yamagata lineages, however this was not statistically demonstrated due to the small number of analysed viruses. Among B/Yamagata strains the oseltamivir and zanamivir IC50 values were higher in 2011/2012 than in 2010/2011 and 2012/2013 seasons

Molecular epidemiology of Respiratory Syncytial Virus between 2010-2015, in Portugal

Background: Respiratory syncytial virus is one of the major causes of respiratory infection and complications in younger children and elderly. This study has, for the first time, investigated the genetic diversity of RSV A and RSV B detected since 2010, in influenza like illness (ILI) cases reported in the scope of the Portuguese Influenza Surveillance Programme (NISP). Methods: During 2010-2015, nasopharyngeal swabs (NPS) sent to the National Influenza Reference Laboratory from sentinel and non-sentinel network were tested for RSV A and RSV B by real time multiplex RT-PCR. Nucleotide sequence of a fragment of the hypervariable C-terminal region of the G protein gene and the phylogenetic analysis was performed for an half of detected RSV. Results: Over the study period were detected 114 (5.2%) RSV in 2187 tested NPS. Of these 67 (59%) were from subtype A and 47 (41%) from subtype B. Circulation of RSV preceded or was coincident with the influenza epidemic period. RSV A was predominant in each winter with exception for 2014/2015 winter when RSV B was predominantly detected. Of the RSV positive samples, 58 (51%) were successfully sequenced and genetically characterized: 26 (45%) RSV A and 32 (55%) RSV B. RSV A clustered in two genotypes. A majority (n= 22; 85%) belonged to ON1 genotype and 4 (15%) viruses belonged to NA1 genotype. Only ON1 genotype was detected after 2012/2013 season. RSV B clustered in two genotypes: a majority (n=22; 67%) belonged to BA9 genotype and 11 (33%) clustered in BA10 genotype. BA9 genotype was detected over all the study period, although BA10 was only detected in 2012/2013, and 2014/2015 seasons. Conclusion: Our study highlights the importance of RSV in ILI cases, showing a seasonal circulation each winter season during influenza epidemic. RSV accounted for 5.2% of the cases reported in the scope of influenza surveillance, assuming a huge importance in young children and older ones. Molecular data for RSVA revealed co circulation of NA1 and ON1 till 2012, and after this period ON1 was exclusively detected suggesting a strain replacement by this antigenically advantageous genotype. Globally ON1 is also predominantly detected. For RSVB subtype was observed a co circulation of the BA9 and BA10 genotypes. BA derived genotypes, first identified in 1999 in Buenos Aires are predominant in many countries since then

Antiviral susceptibility of influenza A viruses isolated between 2009-2013, in Portugal

Monitoring the influenza antiviral susceptibility had become an important issue in the recent years. The influenza A viruses are naturally susceptible to Neuraminidase inhibitors (NAI) and M2 inhibitors (adamantanes). The increased resistance to oseltamivir and adamantanes (since 2006), the availability and clinical use of influenza antivirals enhanced the need for a close monitoring for loss of susceptibility. Since 2009, at Portuguese National influenza Centre, was developed in the scope of the National Influenza Surveillance Programme a systematic monitoring of antiviral susceptibility (oseltamivir, zanamivir and adamantine). This study shows the results of antiviral susceptibility to NAI and M2 inhibitors for influenza A viruses characterized during 4 winter seasons (2009 to 2013). The phenotypic method, NA inhibition assay, considered the “gold standard” method to determine the susceptibility to oseltamivir and zanamivir, measuring the 50% inhibitory concentrations (IC50) was performed during the study period for a selection of 119 influenza A viruses: 26 and 60 AH1pdm09 from 2009/10 and 2012/13 season, respectively, and 33 AH3 viruses from 2011/12, plus 2 AH3 from the last season were also analysed. Genotypic screening methods were performed for the most common NAI inhibition-reducing substitution, H275Y in AH1pdm09 viruses (n= 340). Matrix gene sequencing, for adamantanes susceptibility surveillance, and neuraminidase gene sequencing were performed for 64 and 119 strains, respectively. In the study period all AH1pdm09 and AH3 viruses, carried the S31N substitution in the M2 protein, which confers resistance to the adamantanes to 100% of the isolates. For the AH1pdm09 the IC50 for oseltamivir ranged from 0.45 to 2.82 (2009/2010) and from 0.15 to 3.27 (2012/2013). The resistance to oseltamivir was identified in 3 AH1pdm09 viruses that carried the H275Y substitution. Two of these viruses were isolated from patients with chronic diseases treated with oseltamivir, a pregnant woman 26 years old with a fatal outcome and an 8 years old child. One of the oseltamivir-resistant virus showed an IC5o value 250-fold higher (IC5o= 502.48) comparing to the susceptible viruses. The AH1pdm09 IC5o values for zanamivir ranged from 0.32 to 3.88 (2009/2010) and from 0.29 to 2.99 (2012/2013). The median IC50 values for oseltamivir and zanamivir were stable between 2009 and 2013. None of the AH1pdm09 isolates presented the other substitutions (D119N, I223R, N295S) associated with reduced susceptibility to NAI. The AH3 viruses analysed in 2011/2012 season showed IC5o values for oseltamivir that ranged from 0.19 to 0.90 and for zanamivir from 0.39 to 0.84. The median IC50 values for oseltamivir and zanamivir were 0.41±1.55 and 0.59±1.21 respectively. In the last season 2012/2013 only two AH3 isolates were analysed and the IC5o values were in the same range of the 2011/2012 AH3 viruses. Since 2009 all the AH3 viruses are susceptible to oseltamivir and zanamivir. None of the AH3 viruses presented the amino acid substitutions known to reduce susceptibility to NAI (E119V/I, R229K, N294S and H274Y). Influenza A viruses isolated in Portugal since 2009 are resistant to adamantanes, which are no longer indicated for influenza A treatment. Otherwise, the resistance to oseltamivir was only observed in a reduced number of strains and all the viruses show susceptibility to zanamivir. The use of conventional sequence analysis and genotypic screening methods for monitoring the molecular markers of antiviral resistance in influenza A virus provides a valuable tool for an early detection of antiviral resistant strains

Programa Nacional de Vigilância da Gripe: relatório da época 2013/2014

Na época de vigilância 2013/2014 a atividade gripal foi moderada com taxa de incidência máxima de 88,3 casos de SG por 100 000 habitantes na semana 4/2013. O período epidémico teve a duração de 6 semanas, registou-se entre as semanas 2/2014 e 8/2014. Os vírus que predominantemente circularam foram os vírus influenza do tipo A. Os vírus influenza dos subtipos A(H1)pdm09 e A(H3), co-circularam durante a época e foram detectados no decorrer de praticamente todo o inverno. Os vírus do tipo B foram detetados em pequeno número e de forma esporádica, principalmente na fase final da época de gripe. Os vírus influenza apresentam elevada homologia com as estirpes incluídas na vacina antigripal da presente época. Foram detetados casos de infeção respiratória grave em unidades de cuidados intensivos, pela Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe, e pelo estudo da vigilância dos casos confirmados de gripe admitidos em Unidades de Cuidados Intensivos, essencialmente associados ao vírus influenza A(H1)pdm09. Durante a época de gripe o número observado de óbitos por “todas as causas” esteve sempre dentro dos limites da linha de base. Não se observou mortalidade semanal em excesso durante o outono e inverno de 2013-2014

Phylogeny of influenza A(H1)pdm09 viruses, detected in Portugal between 2009 and 2016

Background: Influenza A(H1)pdm09 viruses show a constant antigenic pattern since its emergence in the 2009 pandemics. However, since then, these viruses have been increasing their genetic diversity. This fact supports the need for continuous monitoring of genetic characteristics of influenza A(H1)pdm09 viruses, which can suddenly acquire new antigenic properties or decrease their susceptibility to antiviral drugs. Methods: From the 2009 pandemic until 2016, the Portuguese NIC has detected 1634 influenza A(H1)pdm09 viruses in the scope of the Portuguese Influenza Surveillance Programme. During this period, 586 viruses were isolated and characterised antigenically by HI assays. Genetic characterisation was also performed for 195 viruses by HA1 subunit sequencing. Results: All studied influenza A(H1)pdm09 viruses revealed no antigenic diversity, being antigenically similar to the vaccine strain A/California/7/2009. In the pandemic season viruses belonged to a single genetic group 1 (A/Hong Kong/2212/2010). In the 2010/2011 season, Portuguese pandemic viruses showed some genetic diversity, being distributed by 4 genetic groups (3,4,5, and 6). During these 2 seasons, viruses presented one or two amino acid changes in antigenic sites, comparing to A/California/7/2009 vaccine strain. During 2011-2013, were detected H1 virus from group 7 (A/St. Petersburg/100/2011). Most influenza H1pdm viruses circulating in 2012/2013 belonged to the subgroup 6C (represented by A/Estonia/76677/2013) harbouring 2 amino acid substitutions in antigenic sites of hemagglutinin (S185T and S203T). Since 2013/2014 season, all H1pdm viruses clustered in the subgroup 6B (A/South Africa/3626/2013) and their hemagglutinins fixed 3 amino acid changes located in antigenic sites (K163Q, S185T and S203T). During the last season 2015/2016, within 6B group, new H1pdm viruses have emerged giving rise to a new subgroup represented by the strain A/New York/61/2015 (6B.1). Most 2015/2016 viruses present an additional amino acid substitution in HA antigenic sites comparing with the vaccine strain: S71P in 6B group and S162N in 6B.1 subgroup. Conclusions: Most influenza A(H1)pdm09 viruses, since its emergence until today, remain antigenically similar to the H1 vaccine strain - A/California/7/2009. However, over the last 7 seasons, these viruses have diversified into different genetic groups. As expected, is also observed the fixation of an increasing number of amino acid substitutions in antigenic sites. The genetic characterisation, in the scope of virological surveillance of influenza, is crucial to understand possible pathways of evolution and antigenic drift of these viruses.info:eu-repo/semantics/publishedVersio

Vigilância Virológica da Gripe em Portugal no Inverno 2012/2013

Na época de vigilância 2012/2013, o período epidémico foi tardio e de duração semelhante à época anterior. Durante a época de gripe de 2012/2013, verificou-se a co-circulação dos três vírus influenza sazonais com maior destaque para a circulação do vírus influenza A(H1)pdm09 e vírus influenza B, da linhagem Yamagata, num inverno em que a atividade gripal foi moderada e com taxas de incidência de casos de síndroma gripal inferiores às verificadas na passada época de 2011/2012 (69 casos de SG por 105 habitantes). Ao longo do período em estudo, a análise laboratorial revelou a presença de vírus influenza em 549 (43,5%) dos 1262 exsudados da nasofaringe recebidos em 2012/2013. Dos 549 vírus influenza identificados, 267 (48,6%) pertenciam ao tipo A e 282 (51,4%) ao tipo B. Destes 233 (42,4%) vírus pertencem ao subtipo A(H1)pdm09, 35 (6,4%) ao subtipo AH3, 272 (49,6%) à linhagem B/Yamagata e 10 (1,8%) à linhagem B/Victoria. O vírus do subtipo A(H1) sazonal não foi detetado nos casos estudados. Foram detetados casos de gripe entre a semana 40/2012 e 18/2013, sendo que a percentagem de casos positivos para vírus influenza foi superior a 50% durante 7 semanas consecutivas (entre a semana 6 e 12 de 2013), com um máximo de 74 casos casos positivos registado na semana 9/2013 (Março). Durante a época de 2012/2013, a maior percentagem de casos de gripe, foi verificada nas crianças, em idade escolar, com idades compreendidas entre os 5 e 14 anos. As estirpes do vírus influenza A(H3) e A(H1)pdm09, isoladas em cultura celular, apresentam elevada homologia com as estirpes incluídas na vacina antigripal da época 2012/2013 (A/Victoria/361/2011 e A/California/7/2009, respetivamente). As estirpes do vírus influenza B, linhagem Yamagata, evidenciaram uma maior variabilidade antigénica, aproximando-se da estirpe de referência B/Massachusetts/2/2012 (futura estirpe vacinal 2013/2014). A análise genética, relativa à subunidade HA1 do gene da hemaglutinina, revelou que os vírus influenza B/Yamagata detetados se distribuem pelos grupos genéticos representados pelas estirpes B/Estonia/55669/2011 e B/Winsconsin/1/2010. A maioria dos vírus influenza A(H1)pdm09 caraterizados pertencem ao grupo genético representado pela estirpe A/St. Petersburg/100/2011. Quanto à monitorização da resistência aos antivirais, as estirpes do vírus influenza A(H1)pdm09 e B estudadas revelaram ser susceptíveis aos antivirais oseltamivir e zanamivir

Programa Nacional de Vigilância da Gripe: relatório da época 2012/2013

Com o presente relatório, o Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P., pretende sintetizar e divulgar os resultados obtidos pelo Programa Nacional de Vigilância da Gripe (PNVG) durante a época de 2012/2013, em Portugal. Um dos principais objetivos do PNVG é justamente a recolha, análise e disseminação da informação sobre a atividade gripal em Portugal. Toda a informação obtida pelo Programa Nacional de Vigilância da Gripe (que inclui a identificação e caracterização dos vírus da gripe em circulação em cada época, assim como a identificação de vírus emergentes com potencial pandémico e que constituam um risco para a saúde pública) pretende, em última instância, contribuir para a diminuição da morbilidade e mortalidade associada à infeção e suas complicações, servindo de suporte à orientação de medidas de prevenção e controlo da doença de forma precisa. Na época 2012/2013 foram notificados um total de 1436 casos de síndroma gripal (SG). A atividade gripal foi considerada moderada e o maior número de notificações foi observado entre o final de Janeiro e a primeira quinzena de Março. O período epidémico ocorreu entre as semanas 4/2013 e 11/2013, com um valor máximo de 69,6 casos de SG por 100 000 habitantes na semana 10/2013. A maior parte das notificações corresponderam a indivíduos do género feminino. O grupo etário mais representado foi o correspondente à população jovem/adulta com idades compreendidas entre os 15 e os 44 anos. A febre, o mal-estar e a debilidade ou prostração foram os sintomas/sinais mais frequentemente referidos nos casos notificados. A análise laboratorial a 1262 exsudados da nasofaringe revelou a presença de vírus influenza em 43,5% destes casos. Dos 549 vírus influenza identificados, 272 (49,5%) eram do tipo B (linhagem Yamagata) enquanto que 232 (42,3%) vírus pertenciam ao subtipo A(H1)pdm09. Estes vírus co-circularam durante a época 2012/2013, e foram detetados em circulação simultânea no decorrer de praticamente todo o inverno, especialmente entre as semanas 1/2013 e 16/2013. Foram também detetados em pequeno número e de forma esporádica 35 (6,4%) vírus influenza do subtipo AH3 e 10 (1,8%) vírus influenza da linhagem B/Victoria. O vírus do subtipo A(H1) sazonal não foi detetado nos casos estudados. Nos casos de síndroma gripal notificados para cada grupo etário, a maior percentagem de casos de gripe verificou-se em crianças com idade compreendida entre os 5 e os 14 anos (61,8%; 94/162). A vacina antigripal foi administrada a 10,4% (131/1265) dos casos de SG notificados (com informação do estado vacinal), com a maior proporção de casos vacinados observada no grupo etário dos idosos (≥65 anos). Entre os casos de gripe, a vacina antigripal tinha sido administrada a 17 casos (3,6%; 17/471), sendo que 15 deles se encontravam potencialmente imunizados, e estiveram associados na sua maioria a casos de infeção pelos vírus influenza A(H1)pdm09 e influenza B/Yamagata. O diagnóstico diferencial de vírus respiratórios detetou a presença em maior frequência de Rhinovírus humano, seguido de Vírus Sincicial Respiratório. A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe (RPLDG), constituída essencialmente por laboratórios hospitalares, realiza o diagnóstico laboratorial do vírus da gripe e permite um conhecimento mais preciso, da etiologia das infeções respiratórias agudas graves, constituindo por isso, um complemento valioso para o PNVG. Dos casos de internamento em UCI reportados pela RPLDG, 38,8% (121/312) estavam associados a infeção pelo vírus da gripe, sendo o vírus A(H1)pdm09 o responsável pela maioria destas infeções (62,8%; 76/121). Os vírus da gripe detetados durante 2012/2013, quer na vigilância clínica e laboratorial (n=549/1262), quer através da RPLDG (n=165, recebidos no LNRVG) foram objecto de análise complementar por parte do Laboratório Nacional de Referência para o Vírus da Gripe/INSA. A análise antigénica realizada revelou que os vírus influenza do tipo A foram semelhantes às estirpes vacinais 2012/2013 para os subtipos A(H3) e A(H1)pdm09. A maioria dos vírus influenza B/Yamagata evidenciaram uma deriva antigénica relativamente à estirpe vacinal para a época 2012/2013, aproximando-se da estirpe B/Massachusetts/2/2012 (estirpe que integrará a vacina antigripal 2013/2014). Os vírus predominantes na época em análise (influenza B/Yamagata e A(H1)pdm09) revelaram também alguma diversidade genética, tendo sido registadas algumas substituições de aminoácidos em locais antigénicos da glicoproteína viral hemaglutinina que podem estar na origem da sua deriva antigénica. A monitorização da resistência aos antivirais nas 355 estirpes do vírus influenza analisadas feno- e/ou genotípicamente (265 vírus A(H1)pdm09 e 90 vírus influenza B) revelou serem todas susceptíveis aos inibidores da neuraminidase. No que respeita a monitorização semanal do impacto da epidemia de gripe na mortalidade por “todas as causas”, na presente época não se observou qualquer influencia da epidemia de gripe

Influenza in pregnant women during 3 seasons, between 2013-2016 in Portugal

Background: Since the 2009 pandemic, pregnant women (PW) have been assumed has a high risk group for increased morbidity and mortality linked to influenza infection. From 2013 to 2016, the Portuguese Influenza Surveillance Programme integrates an obstetric unit network that reports influenza-like illness (ILI) cases and collects nasopharyngeal samples for influenza surveillance and diagnosis. This study aims to characterize cases of influenza infection in pregnant women during 2013-2016 in Portugal. Methods: Between 2013 and 2016, cases of ILI in PW were compared with ILI in childbearing age women (NPW), between 15 and 44 years. In study period were reported 634 ILI cases (220 ILI in 2013/14, 152 in 2014/15 and 262 in 2015/16) of each 149 in PW. Influenza and other respiratory viruses diagnosis were performed by multiplex RT-PCR. Data regarding symptoms, hospitalization, vaccination and antiviral treatment were recorded. Results: During the overall study period the proportion of influenza confirmed cases were similar in PW and NPW, 51% and 54% respectively. The analysis by (sub)type of influenza virus revealed that A(H1)pdm09 season was detected 1.3 times more frequently in PW than in NPW during 2013/14, situation not so evident during 2015/16 season, with low ILI incidence rates. B/Yamagata viruses were identified in PW in a proportion 1.5 times higher than in NPW (2014/15 season). Influenza A(H3) was detected in higher proportion in NPW, 2 to 4 times higher, in 2013/14 and 2014/15 seasons, respectively, when compared with PW. The other respiratory viruses were found in higher percentage among PW, with a positive rate between 55% and 68% during the 3 seasons. RSV, parainfluenza vírus and human metapneumovirus have a higher prevalence in PW, while human rhinovirus reach the higher percentage among NPW. In 660 women ILI cases that reported vaccination status, vaccine coverage was higher in NPW (6.3%;29/463) compared to PW (4.1%;6/143). Vaccine failures were registered in 45% (13/29) cases in NPW and in 67% in PW (4/6). Information on antiviral treatment was reported in 406 ILI cases. Antivirals were prescribed in 8.6% (28/235) of NPW and in 13.6% (11/81) of PW. Were reported 10 PW with need of hospitalization, 6 of these cases positive for influenza A(H1)pdm09 and 1 positive forrhinovirus. None of hospitalized PW were vaccinated. Conclusions: Study shows that PW must still considered a high risk group for influenza and other respiratory viruses infection. Study highlight that influenza A and B presents a higher frequency of infection in PW compared to NPW that might be associated with increased risk for complications. Reinforcement of vaccination campaign will be a challenge in influenza prevention, nevertheless, influenza vaccination is free and highly recommended in Portugal for PW risk group.info:eu-repo/semantics/publishedVersio