Seroprevalence of pandemic (H1N1) 2009 influenza and effectiveness of 2010/2011 influenza vaccine during 2010/2011 season in Beijing, China

Please cite this paper as: Yang et al. (2011) Seroprevalence of pandemic (H1N1) 2009 influenza and effectiveness of 2010/2011 influenza vaccine during 2010/2011 season in Beijing, China. Influenza and Other Respiratory Viruses 6(6), 381–388. Background In the post‐pandemic period, pandemic (H1N1) 2009 virus was expected to circulate seasonally and was introduced into trivalent influenza vaccine during 2010/2011 season in the Northern Hemisphere. Objectives The aim of this study was to examine the evolution of herd immunity against pandemic (H1N1) 2009 virus in Beijing, China, during 2010/2011 season and effectiveness of the 2010/2011 trivalent vaccine. Methods Two serological surveys were conducted before and after 2010/2011 season in Beijing. A case–control study was used to investigate vaccine effectiveness against influenza‐like illness (ILI) and lower respiratory tract infection (LRI). Results A total of 4509 and 4543 subjects participated in the pre‐ and post‐season surveys, respectively. The standardized seroprevalence of pandemic (H1N1) 2009 influenza increased from 22·1% pre‐season to 24·3% post‐season (P < 0·001). Significant elevation in seroprevalence appeared in the ≥60 years age‐group (P < 0·001), but not in others. The 2010/2011 trivalent vaccine contributed to the higher post‐seasonal seroprevalence in unvaccinated individuals (P = 0·024), but not in those vaccinated with monovalent pandemic vaccine (P = 0·205), as well as in those without prior immunity versus those with immunity. The adjusted effectiveness of the 2010/2011 trivalent vaccine was 79% protection against ILI (95% CI, 61–89%) and 95% against LRI (95% CI: 59–99%). Conclusions A slight increase in herd immunity against pandemic (H1N1) 2009 influenza was observed in Beijing, China, during the 2010/2011 season. Prior vaccination and immunity had a suppressive impact on immune response toward this novel influenza virus, elicited by 2010/2011 trivalent vaccine. This trivalent vaccine conferred good protection against ILI and LRI.     

Cross-protection between antigenically distinct H1N1 swine influenza viruses from Europe and North America

Please cite this paper as: De Vleeschauwer et al. (2011) Cross‐protection between antigenically distinct H1N1 swine influenza viruses from Europe and North America. Influenza and Other Respiratory Viruses 5(2), 115–122. Background An avian‐like H1N1 swine influenza virus (SIV) is enzootic in swine populations of Western Europe. The virus is antigenically distinct from H1N1 SIVs in North America that have a classical swine virus‐lineage H1 hemagglutinin, as does the pandemic (H1N1) 2009 virus. However, the significance of this antigenic difference for cross‐protection among pigs remains unknown. Objectives We examined protection against infection with a North American triple reassortant H1N1 SIV [A/swine/Iowa/H04YS2/04 (sw/IA/04)] in pigs infected with a European avian‐like SIV [A/swine/Belgium/1/98 (sw/B/98)] 4 weeks earlier. We also examined the genetic relationships and serologic cross‐reactivity between both SIVs and with a pandemic (H1N1) 2009 virus [A/California/04/09 (Calif/09)]. Results After intranasal inoculation with sw/IA/04, all previously uninfected control pigs showed nasal virus excretion, high virus titers in the entire respiratory tract at 4 days post‐challenge (DPCh) and macroscopic lung lesions. Most pigs previously infected with sw/B/98 tested negative for sw/IA/04 in nasal swabs and respiratory tissues, and none had lung lesions. At challenge, these pigs had low levels of cross‐reactive virus neutralizing and neuraminidase inhibiting (NI) antibodies to sw/IA/04, but no hemagglutination‐inhibiting antibodies. They showed similar antibody profiles when tested against Calif/09, but NI antibody titers were higher against Calif/09 than sw/IA/04, reflecting the higher genetic homology of the sw/B/98 neuraminidase with Calif/09. Conclusions Our data indicate that immunity induced by infection with European avian‐like H1N1 SIV affords protection for pigs against North American H1N1 SIVs with a classical H1, and they suggest cross‐protection against the pandemic (H1N1) 2009 virus.     

福建省甲型H1N1流感病毒分离及首例分离株全基因组序列分析

目的分离甲型HIN1流感病毒,分析福建省首例病毒分离株全基因组序列和遗传特征,为研究病毒进化、致病性、流行规律提供科学依据。方法采用MDCK细胞和Real—time PCR法进行病毒分离、鉴定;提取病毒RNA,通过RT-PCR扩增其8个基因片段,测定核苷酸序列,利用生物信息软件拼接全基因组序列;分析重要基因位点,利用GENBANK中相关序列对首例病毒分离株A／Fujian／01／2009（H1N1）进行基因进化树分析。结果从82例甲型H1N1流感确诊病例标本中分离出50株甲型H1N1流感病毒,第一代分离阳性率60．98％。在福建省首次获得甲型H1N1流感病毒株及全基因组序列。基因组序列分析证明：该毒株与2009年大流行株高度同源,其基因组存在四源重组现象;氨基酸位点分析其对达菲药物敏感,对金刚烷胺类药物耐药;相对于猪流感代表株A／Swine／Iowa／15／1930（HIN1）存在6个HA抗原决定簇位点变异。结论MD—CK细胞对甲型H1N1流感病毒具有较高敏感性;福建省首例甲型H1N1流感病例分离病毒株与北美流行株高度同源;相对于以往古典型猪流感代表株出现了HA蛋白抗原性漂移;为今后进一步开展甲型H1N1流感病毒分子生物学研究奠定基础。     

Genetic composition of contemporary swine influenza viruses in the West Central region of the United States of America

Please cite this paper as: Evseenko et al. (2011) Genetic composition of contemporary swine influenza viruses in the West Central region of the United States of America. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2010.00189.x. Background Because of continuous circulation in different animal species and humans, influenza viruses have host‐specific phenotypic and genetic features. Reassortment of the genome segments can significantly change virus phenotype, potentially generating virus with pandemic potential. In 2009, a new pandemic influenza virus emerged. Objectives In this study, we attempted to find precursor viruses or genes of pandemic H1N1 influenza 2009 among 25 swine influenza viruses, isolated in the West Central region of the United States of America (USA), between 2007 and 2009. The Phylogenetically Similar Triple‐Reassortant Internal Genes (PSTRIG) cassette of all the viruses studied here as well as the PSTRIG cassette of pandemic H1N1 viruses have close but equidistant phylogenetic relationships to the early triple‐reassortant swine H3N2 influenza A isolated in the USA in 1998. Methods Samples (nasal swabs and lung tissue lavage) were taken from swine with or without clinical signs of respiratory disease via farmer‐funded syndromic surveillance. All studied viruses were isolated in Madin–Darby Canine Kidney cell cultures from the above‐mentioned samples according to standard protocols recommended for influenza virus isolation. Sequences were obtained using BigDye Terminator v3.1 Cycle Sequencing kit. Phylogenetic trees were built with MEGA 4.0 software using maximum composite likelihood algorithm and neighbor‐joining method for tree topology reconstruction. Results Among the 25 viruses studied, we have not found any gene segments of Eurasian origin. Our results suggest that pandemic H1N1 viruses diverged and are not directly descended from swine viruses that have been circulating in USA since 1998.     

Differentiated swine airway epithelial cell cultures for the investigation of influenza A virus infection and replication

Please cite this paper as: Bateman et al. (2013) Differentiated swine airway epithelial cell cultures for the investigation of influenza A virus infection and replication. Influenza and Other Respiratory Viruses 7(2) 139–150. Background Differentiated human airway epithelial cell cultures have been utilized to investigate cystic fibrosis, wound healing, and characteristics of viral infections. These cultures, grown at an air–liquid interface (ALI) in media with defined hormones and growth factors, recapitulate many aspects of the in vivo respiratory tract and allow for experimental studies at the cellular level. Objectives To optimize growth conditions for differentiated swine airway epithelial cultures and to use these cultures to examine influenza virus infection and replication. Methods Primary swine respiratory epithelial cells were grown at an air–liquid interface with varying amounts of retinoic acid and epidermal growth factor. Cells grown with optimized concentrations of these factors for 4 weeks differentiated into multilayer epithelial cell cultures resembling the lining of the swine respiratory tract. Influenza virus infection and replication were examined in these cultures. Results/Conclusions Retinoic acid promoted ciliogenesis, whereas epidermal growth factor controlled the thickness of the pseudoepithelium. The optimal concentrations for differentiated swine cell cultures were 1·5 ng/ml epidermal growth factor and 100 nm retinoic acid. Influenza A viruses infected and productively replicated in these cultures in the absence of exogenous trypsin, suggesting that the cultures express a protease capable of activating influenza virus hemagglutinin. Differences in virus infection and replication characteristics found previously in pigs in vivo were recapitulated in the swine cultures. This system could be a useful tool for a range of applications, including investigating influenza virus species specificity, defining cell tropism of influenza viruses in the swine respiratory epithelium, and studying other swine respiratory diseases.     

Epidemiological and clinical features of respiratory viral infections in hospitalized children during the circulation of influenza virus A(H1N1) 2009

Please cite this paper as: Zuccotti et al. (2011) Epidemiological and clinical features of respiratory viral infections in hospitalized children during the circulation of influenza virus A(H1N1) 2009. Influenza and Other Respiratory Viruses 5(6), e528–e534. Background Seasonal influenza viruses and respiratory syncytial virus (RSV) are primary causes of acute respiratory tract infections (ARTIs) in children. New respiratory viruses including human metapneumovirus (hMPV), human bocavirus (hBoV), and influenza 2009 A(H1N1) virus have a strong impact on the pediatric population. Objectives To evaluate epidemiological and clinical features of ARTIs in hospitalized children. Methods From December 1, 2008, to December 31, 2009, all children under age fifteen (n = 575) hospitalized for ARTIs were investigated for influenza A (subtype H1N1, H3N2, and 2009 H1N1) and B, RSV A and B, hMPV, and hBoV by PCR. Results Fifty‐one percent of samples were positive for these respiratory viruses. The frequencies of virus detection were RSV 34·1%, hBoV 6·8%, hMPV 5%, seasonal influenza A 5%, and seasonal influenza B 0%. From April 2009, 11·6% of collected samples were influenza 2009 A(H1N1) positive. Respiratory syncytial virus activity peaked in January, hBoV in February, and hMPV in April. Seasonal influenza A was detected only between January and April 2009, while influenza 2009 A(H1N1) peaked in November. Respiratory syncytial virus and hMPV were mainly associated with lower respiratory tract infections (LRTIs) and with necessity of O₂ administration. The 2009 pandemic influenza was more frequently detected in elder children (P < 0·001) and was associated with higher, longer‐lasting fevers compared with other viral infections (P < 0·05). Conclusions All considered viruses were involved in LRTIs. The primary clinical relevance of RSV and a similar involvement of both seasonal influenza and emerging viruses investigated were observed on the pediatric population.     

Severity of pandemic H1N1 2009 influenza virus infection may not be directly correlated with initial viral load in upper respiratory tract

Please cite this paper as: Wu et al. (2012) Severity of pandemic H1N1 2009 influenza virus infection may not be directly correlated with initial viral load in upper respiratory tract. Influenza and Other Respiratory Viruses 6(5), 367–373. Background Recent studies have demonstrated that rapid influenza diagnostic tests (RIDTs) have a relatively low sensitivity in detecting severe cases of pandemic H1N1 2009 influenza virus (pH1N1) infection. We hypothesized that viral load in upper respiratory specimens obtained on presentation may not be correlated with disease severity. Methods We conducted a prospective study to compare patterns of viral shedding using nasopharyngeal swab specimens, according to the number of days of post‐symptom onset and post‐antiviral therapy, between patients with and without complications. Results From July 15, 2009 through July 23, 2010, we collected and processed a total of 141 nasopharyngeal swab specimens from 64 inpatients and outpatients with laboratory‐confirmed pH1N1 infection. These included 46 patients without any complications (uncomplicated group) and 18 patients who required hospital admission (complicated group). The mean initial viral load was higher in the uncomplicated group than in the complicated group (3·4 ± 1·6 log₁₀ copies/μl versus 1·9 ± 1·7, P = 0·02). However, prolonged viral shedding was only detected in the complicated group (44% by day 7 of antiviral therapy). By multivariate analysis, we found that age (OR, 1·1; 95% CI, 1·0–1·1) and initial nasopharyngeal viral load (OR, 0·5; 95% CI, 0·3–0·8) were significant factors associated with complications. Conclusion Given that patients with severe pH1N1 infection may have relatively lower initial viral load in the upper respiratory tract, cautious interpretation of negative RIDT results is particularly warranted in this patient population.     

Influenza virus infection mimicking an acute abdomen in a female adolescent

We report an adolescent with respiratory symptoms admitted for clinical signs of an acute abdomen. The only diagnostic finding was influenza A viral RNA detected in an upper respiratory tract specimen. Influenza should be considered in the differential diagnosis of children with respiratory illness and abdominal pain during influenza season.     

Evaluation of Wondfo influenza A&B fast test based on immunochromatography assay for rapid diagnosis of influenza A H1N1

Influenza viruses cause significant morbidity and mortality in both children and adults during local outbreaks or epidemics. Therefore, a rapid test for influenza A&B would be useful. This study was conducted to evaluate the clinical performance of the Wondfo influenza A&B test for rapid diagnosis of influenza A H1N1 Infection. The rapid testing assay could distinguish infection of influenza A and B virus. The reference viral strains were cultured in MDCK cells while TCID50 if the viruses were determined. The analytical sensitivity of the Wondfo kit was 100 TCID50/ml. The Wondfo kit did not show cross reactivity with other common viruses. 1928 suspected cases of influenza A (H1N1) virus infection were analyzed in the Wondfo influenza A&B test and other commercially available products. Inconsistent results were further confirmed by virus isolation in cell culture. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100%, 98.23%, 92.45%, and 100% for flu A, and 96.39%, 99.95%, 98.77%, and 99.84% for flu B respectively. 766 suspected cases of influenza A (H1N1) virus infection were analyzed in the Wondfo influenza A&B test and RT-PCR. The sensitivity, specificity, PPV and NPV were 56.5%, 99.75%, 99.52% and 71.04% for flu A, 25.45%, 99.86%, 93.33% and 94.54% for flu B respectively. These results indicate that the Wondfo influenza A&B test has high positive and negative detection rates. One hundred fifty-six specimens of influenza A (H1N1) confirmed by RT-PCR were analyzed by the Wondfo influenza A&B test and 66.67% were positive while only 18.59% were positive by the reference kit. These results indicate that our rapid diagnostic assay may be useful for analyzing influenza A H1N1 infections in patient specimen.     

Respiratory virus infections among hospitalized patients with suspected influenza A H1N1 2009 virus during the first pandemic wave in Brazil

IntroductionDuring the first pandemic wave of the influenza A H1N1 2009 virus, morbidity was particularly high in Brazil. Hospitalizations resulting from severe respiratory disease due to suspected influenza-like illness created an opportunity to identify other respiratory viruses causing lower respiratory infections.ObjectiveThe purpose of this study was to assess viral etiologies among samples collected during the first pandemic wave of H1N1 2009 from hospitalized patients with suspected cases in a Brazilian Sentinel Hospital. Patients and methods: Viral etiologies were investigated in samples from 98 children and 61 adults with fever, cough and dyspnea who were admitted to São Paulo Sentinel Hospital with suspected H1N1 infection.ResultsFrom August to November 2009, in 19.5% (31/159) of the samples 2009 H1N1 virus was detected with 23% (14/61) in adults (median age 25 years, range: 14-55 years) and 18.4% (17/92) in children (median age 5 years, range: 4 months - 11 years). Among the negative samples, a wide range of causative etiologic agents was identified. Human rhinovirus was the most frequent virus (23.91%) in children and human metapneumovirus (11.48%) was the second most frequent in adults, following 2009 H1N1 virus (22.95%).ConclusionsThese data highlight the need to diagnose other viral infections that can co-circulate with influenza and may have been neglected by physicians as causes of severe respiratory diseases.     

Influenza A and B in a cohort of outpatient children and adolescent with influenza like-illness during two consecutive influenza seasons

IntroductionInfluenza is an important cause of morbimortality worldwide. Although people at the extremes of age have a greater risk of complications, influenza has been more frequently investigated in the elderly than in children, and inpatients than outpatients. Yearly vaccination with trivalent or quadrivalent vaccines is the main strategy to control influenza.ObjectivesDetermine the clinical and molecular characteristics of influenza A and B infections in children and adolescents with influenza-like illness (ILI).MethodsA cohort of outpatient children and adolescents with ILI was followed for 20 months. Influenza was diagnosed with commercial multiplex PCR platforms.Results179 patients had 277 episodes of ILI, being 79 episodes of influenza A and 20 episodes of influenza B. Influenza A and B cases were mild and had similar presentation. Phylogenetic tree of influenza B viruses showed that 91.6% belonged to the B/Yamagata lineage, which is not included in trivalent vaccines.ConclusionsInfluenza A and B are often detected in children and adolescents with ILI episodes, with similar and mild presentation in outpatients. The mismatch between the circulating influenza viruses and the trivalent vaccine offered in Brazil may have contributed to the high frequency of influenza A and B in this population.     

The relative clinical impact of 2009 pandemic influenza A (H1N1) in the community compared to seasonal influenza in the Netherlands was most marked among 5-14 year olds

Please cite this paper as: van Gageldonk‐Lafeber et al. (2011) The relative clinical impact of 2009 pandemic influenza A (H1N1) in the community compared to seasonal influenza in the Netherlands was most marked among 5–14 year olds. Influenza and Other Respiratory Viruses 5(6), e513–e520. Background So far, most pandemic influenza reports were based on case studies focusing on severe disease. For public health policy, it is essential to consider the overall impact of the pandemic, including mild diseases. Objectives The aim of our study is to gain insight into the epidemiology of 2009 pandemic influenza in the community and to estimate the relative impact of pandemic compared to seasonal influenza. Methods The relative impact of pandemic influenza in the general population was assessed as the influenza‐like illness (ILI) incidence during the pandemic season compared with that during regular seasons. Influenza‐like illness incidences and virus diagnostics were derived from continuous sentinel surveillance systems. The incidence of hospital admissions, based on the mandatory notification of pandemic influenza, was used to relate the impact of severe disease to that in the community. Results The overall incidence of general practitioners‐attended ILI was 96 consultations per 10 000 persons. Highest incidences were reported in children and lowest in persons aged ≥65 years. For 5–14 year olds, the incidence during the pandemic was higher than during all preceding seasons. Samples originating from 5 to 19 year olds were statistically significant more often positive for pandemic influenza A (H1N1) 2009 virus as compared with samples from 0 to 4 year olds. Moreover, the incidence of hospital admission owing to pandemic influenza was highest in the youngest children. Conclusions Our study showed that while the absolute incidences of 2009 pandemic influenza were highest in children aged 0–4 years, the relative clinical impact in the community compared to seasonal influenza in previous years was most noticeable in healthy children 5–14 years of age.     

Experimental inoculation of pigs with pandemic H1N1 2009 virus and HI cross-reactivity with contemporary swine influenza virus antisera

Please cite this paper as: Vincent et al. (2010) Experimental inoculation of pigs with pandemic H1N1 2009 virus and HI cross-reactivity with contemporary swine influenza virus antisera. Influenza and Other Respiratory Viruses 4(2), 53–60 Background A novel A/H1N1 was identified in the human population in North America in April 2009. The gene constellation of the virus was a combination from swine influenza A viruses (SIV) of North American and Eurasian lineages that had never before been identified in swine or other species. Objectives The objectives were to (i) evaluate the clinical response of swine following experimental inoculation with pandemic H1N1 2009; (ii) assess serologic cross-reactivity between H1N1 2009 and contemporary SIV antisera; and (iii) develop a molecular assay to differentiate North American-lineage SIV from H1N1 2009. Methods Experiment 1: Weaned pigs were experimentally infected with A/California/04/2009 (H1N1). Experiment 2: The cross-reactivity of a panel of US SIV H1N1 or H1N2 antisera with three isolates of pandemic A/H1N1 was evaluated. Experiment 3: A polymerase chain reaction (PCR)-based diagnostic test was developed and validated on samples from experimentally infected pigs. Results and Conclusions In experiment 1, all inoculated pigs demonstrated clinical signs and lesions similar to those induced by endemic SIV. Viable virus and antigen were only detected in the respiratory tract. In experiment 2, serologic cross-reactivity was limited against H1N1 2009 isolates, notably among virus antisera from the same HA phylogenetic cluster. The limited cross-reactivity suggests North American pigs may not be fully protected against H1N1 2009 from previous exposure or vaccination and novel tests are needed to rapidly diagnose the introduction of H1N1 2009. In experiment 3, an RT–PCR test that discriminates between H1N1 2009 and endemic North American SIV was developed and validated on clinical samples.     

流感样病例流行病学与诊断

流感样病例是一组主要由呼吸道病毒感染的具有发热并咳嗽或咽痛的疾病,是全球各国监测的疾病.流感样病例病原学以流感病毒为主,特别是流感流行季节和暴发性疫情的病例.流感病毒感染与其他呼吸道病毒感染导致的流感样病例临床表现略有差异.流行病学和临床表现是诊断和鉴别诊断流感与其他病毒感染的线索,但病原学确诊有赖于病毒核酸检测.     

An early report from newly established laboratory-based influenza surveillance in Lao PDR

Please cite this paper as: Vongphrachanh P, Simmerman JM, Phonekeo D, Pansayavong V, Sisouk T, Ongkhamme S, Bryce GT, Corwin A, Bryant JE. An early report from newly established laboratory-based influenza surveillance in Lao PDR. Influenza and Other Respiratory Viruses 4(2), 47–52. Background Prior to 2007, little information was available about the burden of influenza in Laos. We report data from the first laboratory-based influenza surveillance system established in the Lao People’s Democratic Republic. Methods Three hospitals in the capital city of Vientiane began surveillance for influenza-like illness (ILI) in outpatients in 2007 and expanded to include hospitalized pneumonia patients in 2008. Nasal/throat swab specimens were collected and tested for influenza and other respiratory viruses by multiplex ID-Tag^TM respiratory viral panel (RVP) assay on a Luminex® 100× MAP IS instrument (Qiagen, Singapore). Results During January 2007 to December 2008, 287 of 526 (54·6%) outpatients with ILI were positive for at least one respiratory virus. Influenza was most commonly identified, with 63 (12·0%) influenza A and 92 (17·5%) influenza B positive patients identified. In 2008, six of 79 (7·6%) hospitalized pneumonia patients were positive for influenza A and four (5·1%) were positive for influenza B. Children <5 years represented 19% of viral infections in outpatients and 38% of pneumonia inpatients. Conclusion Our results provide the first documentation of influenza burden among patients with febrile respiratory illness and pneumonia requiring hospitalization in Laos. Implementing laboratory-based influenza surveillance requires substantial investments in infrastructure and training. However, continuing outbreaks of avian influenza A/H5N1 in poultry and emergence of the 2009 influenza A(H1N1) pandemic strain further underscore the importance of establishing and maintaining influenza surveillance in developing countries.     

Detection of 2009 pandemic influenza A(H1N1) virus Infection in different age groups by using rapid influenza diagnostic tests

Please cite this paper as: Gao et al. (2011) Detection of 2009 pandemic influenza A(H1N1) virus Infection in different age groups by using rapid influenza diagnostic tests. Influenza and Other Respiratory Viruses 6(3), e30–e34. Background The performance of rapid influenza diagnostic tests (RIDTs) in detecting influenza A(H1N1) 2009 has varied widely. Evaluations of RIDTs among infected individuals across all age groups have not been described in depth. Objectives Determine RIDT clinical sensitivity in comparison with influenza detection using real‐time RT‐PCR among patients infected with influenza A(H1N1) 2009 across all age groups. Study design This study analyzed respiratory specimens received by the New Hampshire Public Health Laboratories (NHPHL) from September 1, 2009, through December 31, 2009. RIDT performance was evaluated among different age groups of patients determined to be infected with influenza A (H1N1) 2009, and the association between age and RIDT sensitivity was determined. Results Of 1373 specimens examined, 269 tested positive for influenza A(H1N1) 2009 by real‐time RT‐PCR (rRT‐PCR) and had RIDT results available. Overall clinical sensitivity and specificity of RIDTs were 53·9 and 98·5%, respectively. By age group, clinical sensitivity was 85·7% in patients <2 years old, 60·3% in patients between 2‐ and 39 years old, and 33·3% in patients aged 40 and older. Logistic regression analysis indicated that increasing age was negatively associated with RIDT performance. Conclusion Rapid influenza diagnostic test sensitivity decreased significantly with increasing age. Findings from this study may impact a clinician’s interpretation of RIDT test results and ultimately have implications in clinical decision‐making.     

Infection by rhinovirus: Similarity of clinical signs included in the case definition of influenza IAn/H1N1

Introduction

Although new influenza virus (IAn/H1N1) infections are mild and indistinguishable from any other seasonal influenza virus infections, there are few data on comparisons of the clinical features of infection with (IAn/H1N1) and with other respiratory viruses. The incidence, clinical aspects and temporal distribution of those respiratory viruses circulating during flu pandemic period were studied.

Methods

Respiratory samples from patients with acute influenza-like symptoms were collected from May 2009 to December 2009. Respiratory viruses were detected by conventional culture methods and genome amplification techniques.

Results

Although IAn/H1N1 was the virus most frequently detected, several other respiratory viruses co-circulated with IAn/H1N1 during the pandemic period, especially rhinovirus. The similarity between clinical signs included in the clinical case definition for influenza and those caused by other respiratory viruses, particularly rhinovirus, suggest that a high percentage of viral infections were clinically diagnosed as case of influenza.

Conclusions

Our study offers useful information to face future pandemics caused by influenza virus, indicating that differential diagnoses are required in order to not overestimate the importance of the pandemic.     

Emergence of Oseltamivir-Resistant Pandemic H1N1 in an Immunocompetent Child with Severe Status Asthmaticus

Introduction. Pandemic influenza A (H1N1) may cause severe illness in pediatric patient with chronic lung disease. Case Report. We describe the emergence of oseltamivir resistance in an immunocompetent child with status asthmaticus triggered by pandemic influenza A (H1N1). This case highlights the possible relationship between influenza viral load and risk of resistance emergence in children with asthma. Influenza vaccination should continue to be emphasized as the mainstay of prevention in children with chronic lung disease. Conclusion. Influenza virus can lead to severe status asthmaticus and can develop oseltamivir resistance in immunocompetent children.