Influenza virus type/subtype and different infection profiles by age group during 2017/2018 season

DDI-INSA em colaboração com a Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Influenza has a major impact in hospitalization during each influenza season. We analysed the influenza type/subtype distribution by age group and medical care wards (ambulatory, hospital, intensive care unit). Material and Methods: During 2017/2018 season, 14 hospitals from Portugal mainland and Atlantic Island (Azores and Madeira) reported to the National Influenza Centre 13747 cases of respiratory infection, all tested for influenza type and/or subtype. Epidemiological data: age, sample collection, hospital dwelling service and patient outcome were reported. Results: From the 13747 reported cases, 3717(27%) were influenza positive of which 2033 (55%) were influenza B, 722 (19%) A unsubtyped, 505 (14%) AH3, 442 (12%) AH1pdm09 and 15(0,1%) mixed infections. Influenza A was detected in 71% (204/208) of toddlers(<5 years) although in the remaining age groups influenza B was detected in more than 50% of the confirmed flu cases. Influenza B was the predominant virus in hospitalized and ICU influenza cases between 5-14 years (69% and 75%, respectively) and played a major role in elderly (65+ years) hospitalized and ICU cases(57% and 67%, respectively). AH1pdm09 virus was detected in 30% of the influenza confirmed ICU patients, 2.1 times more than in hospitalized cases in other wards and 3.3 times more than influenza AH1pdm09 cases in ambulatory care. Influenza mixed infection were detected sporadically,mainly in hospitalized and ICU patients. From 2080 known outcomes, 40(1.9%) patients deceased, influenza was confirmed in 11(28%) of these cases. Conclusions: Cocirculation of different influenza virus type/subtype may indicate different infection profiles by age groups and should guide influenza preventive/treatment measures.N/

Influenza seroprotection correlates with predominant circulating viruses during 2014/15 and 2015/16 seasons in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBACKGROUND: Population immune profile for influenza is highly affected by circulating influenza viruses, thus changing the risk of infection for influenza. This study aims to assess influenza immunity in the Portuguese population by age groups, during 2014 and 2015 and establish a relationship between seroprotection and circulating influenza viruses in 2014/15 and 2015/16 seasons. METHODS: Two cross-sectional studies were developed based on a convenience serum sample collected in June 2014 (n=626) and July 2015 (n=675) in hospitals from mainland and Azores and Madeira.Serums equally represent all age groups. Antibody titers were evaluated by HI assay for strains recommended for seasonal influenza vaccine northern hemisphere,2014/15 and 2015/2016. Seroprevalences were estimated for each strain by age group and the association with seasonal cumulative influenza-like illness (ILI) rates for influenza virus during both seasons was analised. RESULTS: In June 2014 the highest seroprotection was observed for influenza A(H3) (39.0%; 95% CI: 36.2-43.8%) and A(H1)pdm09 (29.7; 95% CI: 26.3-33.4%), with higher levels in children 5-14 years old. In 2014/2015 a dominant circulation of influenza B/Yamagata was observed with high incidence rates in individuals under 65 years old, the ones that had lower seroprotection. Although before the start of the season high protection for A(H3) was observed, the circulation of the new drift A(H3) strains had gained an immunological advantage,in accordance with A(H3) elevated incidence rates observed during 2014/15. In July 2015 the highest seroprotection was observed for influenza B/ Yamagata (55.1%; 95% CI: 51.4-58.9%), 2.4 times the estimated 2014.This increase was even more pronounced in younger (≤ 4 years old), 6.3 times increase in 2015.This fact is in agreement with the predominant influenza B virus detected and the high ILI incidence rate observed in children during 2014/2015 epidemic. Seroprotection levels for influenza A in July 2015 were not significantly different from 2014.During 2015/16 season, influenza A(H1N1)pdm09 was predominant, with high incidence rate in < 65 year old. Influenza B/Victoria lineage,although detected at low levels increased in frequency, in agreement with the lowest level of seroprotection detected in the general population before the start of 2015/2016 season (21.8%; 95% CI: 18.7-24.0%). CONCLUSIONS There was a correlation between virus circulation, incidence rates for each age group and the previous seroprotection for seasonal influenza viruses.Our study highlights the value of measuring the serological profile for influenza to establishe risk groups for infection for which an increase preventive measures, including vaccination, should be fostered.info:eu-repo/semantics/publishedVersio

Influenza severe cases in hospitals, between 2014 and 2016 in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Since 2009, the Portuguese Laboratory Network (PLNID) for Influenza Diagnosis has integrated 15 Laboratories in mainland and Atlantic Islands of Azores and Madeira. This PLNID added an important contribute to the National Influenza Surveillance Program regarding severe and hospitalized influenza cases. The present study aims to describe influenza viruses detected in influenza like illness (ILI) cases: outpatients (Outp), hospitalized (Hosp), and intensive care units (ICU), between 2014 and 2016. Methods: The PLNID performs influenza virus diagnosis by biomolecular methodologies. Weekly reports to the National Influenza Reference Laboratory ILI cases tested for influenza. Reports include data on detecting viruses, hospital assistance, antiviral therapeutics, and information on death outcome. Were reported during two winter seasons 8059 ILI cases,being 3560 cases in 2014/15 (1024 in Outp, 1750 Hosp, and 606 in ICU) and 4499 cases in 2015/2016 (1933 in Outp, 1826 Hosp, and 740 in ICU). Results: The higher percentage of influenza positive cases were detected in Outp in both seasons, 18% during 2014/15 and 20% in 2015/16. In 2014/15,influenza cases were more frequent in individuals older than 65 years old and these required more hospitalizations,even in ICU. In 2015/16,the influenza cases were mainly detected in individuals between 15-64 years old. A higher proportion of influenza positive cases with hospitalization in ICU were observed in adults between 45-64 years old.During the study period,the predominant circulating influenza viruses were different in the two seasons: influenza B and A(H3) co-circulated in 2014/15,and influenza A(H1)pdm09 was predominant during 2015/16. Even when influenza A is notthe dominant virus, A(H3) and A(H1)pdm09 subtypes correlate with higher detection rate in hospitalized cases (Hosp and UCI), with higher frequencies in adults older than 45. Influenza B,detected in higher proportion in outpatients, was frequently relatedwith influenza cases in younger age groups: 0-4 and 5-14 years old. Conclusions: This study highlights the correlation of theinfluenza virus type/subtype that circulates in each season with the possible need for hospitalization and intensive care in special groups of the population. Circulation of influenza A subtypes can cause more frequentdisease in individuals older than 45, with need of hospitalization including intensive care. On the other hand, influenza B is more frequently associated with less severe cases and with infection in children and younger adults. Influenza B circulation might predict lower number of hospitalizations.The identification of influenza type in circulation,byPLNID ineach season, could guide action planning measures in population health care.info:eu-repo/semantics/publishedVersio

Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe: inverno 2013/2014

A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe (RPLDG) integra, atualmente, 15 laboratórios maioritariamente hospitalares e é coordenada pelo Laboratório Nacional de Referência para o Vírus da Gripe (LNRVG) do Departamento de Doenças Infecciosas do Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P. A RPLDG realiza o diagnóstico laboratorial do vírus da gripe assim como de outros vírus respiratórios, permitindo um conhecimento mais preciso da etiologia das infeções respiratórias, particularmente em casos hospitalizados de infeção respiratória aguda grave, constituindo um complemento valioso para o PNVG. Os casos de SG provenientes de emergências hospitalares e casos de Infecção Respiratória Aguda Grave, incluindo casos com internamento em unidade de cuidados intensivos, foram notificados pelos laboratórios da Rede ao LNRVG. Dos 15 laboratórios da Rede, 13 notificaram casos de doença respiratória durante a época de 2013/2014. Os dados recolhidos foram inseridos em suporte informático tendo as bases de dados sido agregadas numa base de dados comum submetida a um processo de validação de congruência de dados. Os dados analisados correspondem ao período que decorreu entre a semana 38 de 2013 e a semana 21 de 2014. Foram notificados pelos Laboratórios da Rede um total de 3790 casos de infeção respiratória. O maior número de notificações foi observado no mês de janeiro e fevereiro (semanas 2/2014 a 8/2014), com um pico de ocorrência na semana 4/2014 com a notificação de 454 casos de infeção respiratória. O vírus da gripe foi detetado em 822 casos de infeção respiratória. O vírus influenza A foi identificado em 807 (98,2%) dos casos positivos, destes 403 (49,0%) pertencem ao subtipo A(H1)pdm09, 98 (12,0%) ao subtipo A(H3) e 306 (37,0%) vírus influenza A não foram subtipados. O vírus influenza B foi detetado em 14 (2,0%) casos. Foi identificada 1 infecção mista por vírus influenza A(H1)pdm09 e A(H3) (0,1%). A maior percentagem de casos de gripe foi observada em indivíduos entre os 15 e os 64 anos sendo o vírus influenza A(H1)pdm09 o predominantemente detetado. Nas crianças com menos de 4 anos o vírus influenza foi detetado numa proporção reduzida, apenas em 8,8% dos casos analisados laboratorialmente, sendo o agente mais detetado neste grupo etário, o vírus sincicial respiratório (dados não mostrados). A Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe permitiu a deteção dos vírus da gripe em meio hospitalar, incluindo doentes em internamento e UCI. Os vírus influenza A foram predominantes e detetados em maior percentagem nos jovens e adultos

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Laboratório de Imunologia e Biologia Molecular (Serviço de Imunoalergologia do Centro Hospitalar de Setúbal). Laboratório de Análises Clínicas Dr. Joaquim Chaves [Relatório de estágio]

Relatório de estágio de mestrado, Análises Clínicas, Universidade de Lisboa, Faculdade de Farmácia, 2017O estágio no âmbito do VIII Mestrado em Análises clínicas decorreu no período de 1 de março de 2016 a 31 de agosto de 2016, em dois laboratórios diferentes, pelo que este relatório está dividido em duas partes. Na primeira parte irei descrever a atividade desenvolvida no laboratório de Imunologia e Biologia Molecular (LIBM) do Centro Hospitalar de Setúbal que decorreu em regime laboral de 35 horas semanais, sob a orientação da Dr.ª Maria João Peres, assistente principal da carreira dos técnicos superiores de saúde e farmacêutica especialista, compreendendo as áreas laboratoriais Pré-analítica, Imunologia e Biologia Molecular. A segunda parte corresponderá à atividade desenvolvida no Dr. Joaquim Chaves, Laboratório de Análises Clínicas (JCLAC) em regime pós-laboral e que abrangeu o core laboratorial - área de Hematologia e Química Clinica, sob a orientação do farmacêutico especialista Dr. Carlos Cardoso. Na globalidade, este estágio permitiu realizar e observar metodologias desenvolvidas em diferentes plataformas analíticas, para determinação de uma enorme variedade de parâmetros laboratoriais. Neste relatório irei dar uma explicação resumida das metodologias utilizadas, dos parâmetros analíticos e do seu valor semiológico.The internship for the 8th Master’s in clinical analysis took place between 1st March and 31st August 2016, in two different laboratories, which is why the report is divided into two parts. In the first part, I will describe the work undertaken in the immunology and molecular biology laboratory of Setúbal Hospital, during a 35-hour weekly schedule, under the guidance of Dr. Maria João Peres, health and pharmaceutical specialist in the pre-analytical, immunology and molecular biology laboratory areas. The second part focusses on the work done at the Dr. Joaquim Chaves clinical analysis laboratory after working hours, which included the laboratory core areas of hematology and clinical chemistry, under the guidance of the specialist pharmacist, Dr. Carlos Cardoso. Overall, this internship allowed the observation and practice of methodologies that were developed with different analytical platforms, to determine a wide variety of laboratory parameters. In this report, I will give a brief explanation of the methodologies used, analytical parameters and their diagnostic value.O envelhecimento da população mundial é um dos principais desafios das sociedades modernas. Ao nível da saúde, torna-se cada vez mais necessário adotar estratégias, para que o envelhecimento ocorra de forma saudável e ativa. Os custos com a saúde têm aumentado substancialmente, nos países desenvolvidos, e têm sido relacionados com o aumento das necessidades de cuidados de saúde, nos indivíduos mais idosos. Essa consciencialização tem permitido maior investimento na investigação dos processos biológicos de envelhecimento. A perda de capacidades, muitas vezes associada ao envelhecimento, tem uma fraca relação com a idade cronológica dos indivíduos. Apesar das necessidades de cuidados de saúde nos indivíduos idosos e das suas incapacidades não serem aleatórias, não há uma pessoa idosa “típica”. Depende do seu percurso de vida e podem ser modificadas por intervenções adequadas e precoces, do ponto de vista social, psicológico e de saúde. O conhecimento dos mecanismos fisiológicos do envelhecimento normal pode levar à descoberta de novos biomarcadores de envelhecimento, de forma a determinar a idade biológica dos indivíduos. Sabendo de que forma o envelhecimento afeta os diferentes sistemas orgânicos e as possíveis alterações nos parâmetros bioquímicos, será possível detetar precocemente as alterações que conduzam a condições patológicas, incapacidade ou fragilidade. Por outro lado, é também fundamental diferenciar entre uma alteração decorrente do normal processo de envelhecimento e uma alteração potencialmente patológica, de forma a minimizar procedimentos médicos desnecessários e avaliar corretamente o risco. Este trabalho consiste numa pequena revisão dos aspetos biológicos do envelhecimento e as suas implicações na bioquímica clínica.The ageing of the world’s population is one of modern societies’ greatest challenges, making the need to adopt new strategies crucial to facilitate healthy and active ageing. Health costs have risen in developed countries, primarily due to the health care needs of elderly people and being aware of this has allowed greater investment in research regarding the biological processes of ageing. Knowledge of the physiological mechanisms of normal ageing may lead to the discovery of new biomarkers, thus determining the biological age of individuals. Knowing how ageing affects the different organ systems and how biochemical markers vary, it will be possible to detect changes that lead to pathological conditions, disability or frailty at an earlier stage. Furthermore, it is crucial to differentiate between changes that stem from the normal ageing process and those that are potentially pathological, in order to minimise unnecessary clinical procedures and assess risk correctly. This work consists of a short review of the biological aspects of ageing and its implications in clinical biochemistry

Allergic primary sensitization to lupine seed

A reacção ao tremoço manifesta-se predominantemente como uma sindrome oral alérgica (SOA), na sequência da ingestão. Reacção cruzada com o tremoço está também descrita

Enterovirus D68 diagnosed in severe respiratory and neurological illness in children during 2015-2016 season in Portugal

Em colaboração com o Laboratório de Doenças Evitáveis pela Vacinação (DDI), com o Centro Hospitalar de Setúbal e com o Centro Hospitalar Lisboa CentralAbstract of the presentation: Journal of Clinical Virology 82S (2016) S1–S142. (Abstract no: 289)Background: Enterovirus D68 (EV-D68) was first isolated in 1962, and since then associated with respiratory illness. The report of severe respiratory and neurological disease including deaths associated to EV-D68 in United States and Canada during August 2014 highlighted the need of epidemiological information regarding EV-D68 circulation. In Europe information was scarce, available only for few countries. In Portugal there was no data available and was critical to know the epidemiology of EV-D68, especially in children hospitalized with severe respiratory or neurological disease. This study aims to identify EV-D68 in Enterovirus positive respiratory samples in children under 18 with clinical diagnosis of severe respiratory infection or neurological illness. Methods: During 2015/16 winter season, between November/2015 and March/2016, 29 EV positive cases were reported to the National Influenza and Other Respiratory Virus Reference Laboratory (NIC) by two hospitals located in Lisbon and Setubal districts. EV diagnosis was performed in hospitals by biomolecular methods using commercial kits (real time multiplex-PCR, FTD Respiratory pathogens 21 and CLART Pneumovir, Genomica, respectively). EV-D68 was diagnosed by an in house real-time PCR [1]. Virus isolation in RD cell line and phylogenentic analysis of the VP1/VP3 genomic regions will enable the identification of genetic groups in circulation. All samples were irreversibly anonymized. Demographic and clinical data were collected. Results: EV-D68 was confirmed in 20 respiratory samples previously positive for EV (69%; 20/29). Samples were collected from children with age ranging from 2 months to 6 years old, both genders (9 female; 11 male) with diagnosis of severe respiratory or neurological illness. Eighteen cases were hospitalized (90%; 18/20). Bronchiolitis and pneumonia were the most frequently reported diagnosis, corresponding to 70% (14/20). Two cases have neurologic diagnosis. EV-D68 was identified throughout all study period with the higher number of positive cases detected during January 2016, in week 3. Virus isolation and genetic characterization are under way with expected results in virus phylogeny and evaluation on similarity with recent circulating strains in United States, Canada and European countries. Conclusions: EV-D68 was detected in a high positive rate (69%) among EV positive cases. This positive rate of EV-D68 was higher compared to the positivity rate of 10,2 %, calculated in a European study during 2014 [2]. This finding could be linked to the selection of severe and hospitalized patients in present study, highlighting the involvement of EV-D68 with severe respiratory disease in children. The identification of EV-D68 is also crucial in respiratory samples in children with clinical diagnosis of neurological illness. This study is the first attempt to describe the prevalence of EV-D68 in severe paediatric cases, in Portugal. The strength of EV-D68 surveillance in paediatric and adult population at the national level will be important to understand the epidemiology of EV-D68, age-related susceptibility and association with disease severity.info:eu-repo/semantics/publishedVersio

Molecular characterization of respiratory syncycial virus during 2015-2016 season in Portugal

Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Respiratory syncytial virus (RSV) is one of the most frequent and important respiratory viral agent that causes respiratory infection complications in younger children and elderly. RSV has an autumn / winter seasonality. Genetic diversity in both of RSV A and B subtypes increased in last years with the spread of new genotypes. This study aims to describe the genetic variability of RSV during 2015/2016 season in Portugal and correlate the circulating genotypes with detected ones in previous seasons. Will also be evaluated the association between genotype, clinical diagnosis and age. Methods: During 2015/16 winter season, between November/2015 and February/2016, 45 RSV were genetically characterized. RSV positive respiratory samples were collected in two settings: children under 5 years old diagnosed by hospital laboratories from the Portuguese Laboratory Network for the Diagnosis of Influenza Infection, and all age Influenza-like illness (ILI) patients reported by primary care health services and diagnosed by the National Influenza Reference Laboratory. All samples were irreversibly anonymized. Demographic and clinical data were collected. RSV detection was performed by real-time PCR and other biomolecular methods. RSV genotype was assigned by the nucleotide sequence of the hypervariable C-terminal region of the G protein gene and the phylogenetic analysis was performed in MEGA 6.0. Results: From 45 RSV genetically characterized, 31 (69%) were reported by hospitals, patients age ranged from newborn to 4 years old. From these, 25 (81%; 25/31) patients were hospitalized, being the bronchiolitis the most frequent diagnosis. While 14 (31%) RSV cases came from primary care health services, patients age ranged from 3 to 83 and all had a clinical diagnosis of ILI. Were included patients from both genders in equal proportions. RSV A and B co-circulated during 2015/2016 season. Were genetically characterized 21 (47%) RSV A and 24 (53%) RSV B. 90% (19/21) of RSV A clustered in ON1 genotype, the others 2 clustered with NA1 genotype. All RSV B present a BA-like genotype, 70% (17/24) were similar to BA9 and 30% (7/24) clustered with BA10 genotype. Conclusions: During 2015/2016 season was observed a co-circulation of RSVA and RSVB. In present study ON1genotype was predominant in circulation among RSVA, this was also detected as the major RSVA genotype at the global level. Only two RSVA belonged to NA1 genotype. In Portugal, NA1 was in circulation during 2010-2012 period. Undetected since 2012, it seems to reappear during 2015/16 season. All RSVB characterized belonged to BA genotypes, the majority clustered within BA9 genotype. BA10 genotype was also identified in circulation at low frequency. BA9 and BA10 were being found in co-circulation since 2011/12. No association was found between age, clinical diagnosis and RSVA and B genotypes. RSV has an important impact in children in high-risk groups highlighting the need off a continuous RSV surveillance each winter.info:eu-repo/semantics/publishedVersio

Severe RSV infections in children and elderly during 2017/2018 winter season

DDI_INSA em colaboração com o DEP-INSA e a Rede Portuguesa de Laboratórios para o Diagnóstico da GripeBackground: Respiratory syncytial virus (RSV) is one of the most frequent and important respiratory viral agent that causes respiratory infection complications in younger children and elderly. RSV has an autumn / winter seasonality detected in cocirculation with influenza and other respiratory viruses. Material and Methods: During 2017/2018 season, 14 hospitals from Portugal mainland and Atlantic Island tested 4278 swabs for influenza, respiratory syncytial virus (RSV) and other respiratory viruses (oRV). Data on age and hospital service were recorded. Samples were collected from patients with mild to severe respiratory infections. Severity was correlated with the need for hospitalization. The study aimed to determine the age groups that had experienced severe RSV infections during the 2017/2018 season with the need of hospitalization, including in intensive care units (ICU). Results: Between October/2017-May/2018 were tested 4278 swabs for influenza, RSV and oRV (picornavirus, adenovirus, bocavirus, metapneumovirus, parainfluenzavirus, coronavirus). A total of 43%(1830) swabs were positive, from these 35%(639) were outpatients, 61%(1112) were hospitalized and 4% (79) were at ICU. The prevalence found were: Influenza 63%(1157), RSV 15%(266), oRV 13%(247) and 9%(160) of the cases were mixed infections. Influenza was detected in more than 70% of the positives swabs in patients aged above 15 years old. The oRV played a major role in respiratory infections in children, 0-4 and 5-14 years old, detected in 23% and 21% of the cases ,respectively. RSV was the predominant virus identified in toddlers, under 4 years old (29% of the positive samples and in 85% of codetection ). Among elderly 65+, RSV was confirmed in 13% of the respiratory infections. In hospitalized adults 65+, although influenza was detected in 80% of the positive swabs, RSV was 3.5 times more frequently detected than oRV, higher than the observed in outpatients (RSV 1.6 times more frequent than oRV). In hospitalized patients under 5 years old, RSV were detected in 31% of the positive swabs being 1.3 and 1.5 times more frequently than influenza and oRV, respectively. In ICU, 40%(32) of the cases were under 5 years old, influenza was confirmed in only 3% and RSV in 22% of the cases. 35%(28) ICU cases had 65+years old, influenza was confirmed in 57% and RSV in 14% of these patients. Conclusions: During 2017/2018, RSV was detected in severe respiratory infections. In young children (≤4 years old) RSV was the most frequently detected respiratory virus. In elderly 65+, besides influenza, RSV was frequently associated with severe respiratory infections. Prevention measures for RSV severe infections are essential not only in children but also among the elderly.N/