Inhaled zanamivir for the prevention of influenza in families. Zanamivir Family Study Group

BACKGROUND: As prophylaxis against influenza in families, amantadine and rimantadine have had inconsistent effectiveness, partly because of the transmission of drug-resistant variants from treated index patients. We performed a double-blind, placebo-controlled study of inhaled zanamivir for the treatment and prevention of influenza in families. METHODS: We enrolled families (with two to five members and at least one child who was five years of age or older) before the 1998-1999 influenza season. If an influenza-like illness developed in one member, the family was randomly assigned to receive either inhaled zanamivir or placebo. The family member with the index illness was treated with either 10 mg of inhaled zanamivir (163 subjects) or placebo (158) twice a day for 5 days, and the other family members received either 10 mg of zanamivir (414 subjects) or placebo (423) once a day as prophylaxis for 10 days. The primary end point was the proportion of families in which at least one household contact had symptomatic, laboratory-confirmed influenza. RESULTS: The proportion of families with at least one initially healthy household contact in whom influenza developed was smaller in the zanamivir group than in the placebo group (4 percent vs. 19 percent, P<0.001); the difference represented a 79 percent reduction in the proportion of families with at least one affected contact. Zanamivir provided protection against both influenza A and influenza B. A neuraminidase-inhibition assay and sequencing of the neuraminidase and hemagglutinin genes revealed no zanamivir-resistant variants. Among the subjects with index cases of laboratory-confirmed influenza, the median duration of symptoms was 2.5 days shorter in the zanamivir group than in the placebo group (5.0 vs. 7.5 days, P=0.01). Zanamivir was well tolerated. CONCLUSIONS: When combined with the treatment of index cases, prophylactic treatment of family members with once-daily inhaled zanamivir is well tolerated and prevents the development of influenza. In this study there was no evidence of the emergence of resistant influenza variants.     

Effect of rimantadine on the immune response to influenza A infections

The effects of rimantadine on lymphocyte responses to mitogens CON-A and PHA, natural killer cell activity, and the development of serum and local antibodies were studied during an epidemic outbreak of influenza A (H3N2). Twenty-three families consisting of 38 adults and 46 children had a member who developed a flu-like illness and were randomly assigned to receive placebo or rimantadine either as treatment or post exposure prophylaxis. Nasal washings for virus isolation and IgG and IgA determination were collected on days 1, 5, and 10 of illness. Blood samples for immunologic studies were obtained on days 1 and 5 of clinical illness and on day 21. No differences in lymphocyte responses to CON-A and PHA or in natural-killer cell activity were noted between placebo and rimantadine groups. The development of neutralizing antibodies to influenza H3N2 was also not affected by rimantadine. However, the presence of IgA in nasal secretions was significantly diminished in the rimantadine group compared to the placebo group (0/9 vs. 6/9, P less than 0.005). The findings indicate that rimantadine had no adverse affect on the systemic immune system. However, local immune response was diminished in individuals taking rimantadine possibly due to the presence of less immunogen resulting from reduction of virus in secretions of individuals taking antivirals.     

A comparison of acetaminophen and rimantadine in the treatment of influenza A infection in children

Rimantadine was compared with acetaminophen in a double-blind randomly assigned therapeutic trial in 63 children presenting with influenzal symptoms. Forty-nine of the children were proven to have influenza A by culture on presentation. Forty-three of the cultures, 88%, were influenza A/H1N1 strains. Both drugs were well tolerated. Rimantadine lowered the amount of virus shed in the first 2 days after initiation of therapy. Clinical resolution of illness was not different between the two therapeutic modalities. In individuals who shed virus for 4 days, strains recovered on the last day were relatively resistant to rimantadine.     

Rimantadine and arbidol sensitivity of influenza viruses that caused epidemic morbidity rise in Russia in the 2004-2005 season

The study of the activity of arbidol against epidemic influenza A and B virus strains (2002-2005) in the cultured MDCK cells showed the higher sensitivity of enzyme immunoassay than that of hemagglutination test. The influenza A virus strains tested, including those resistant to rimantadine (5 microg/ml), were sensitive to arbidol (10 microg/ml). The population of influenza B virus strains was heterogeneous in this indicator, 43% of the strains being less sensitive to arbidol. There was an increase in the number of rimantadine-resistant influenza A(H3N2) virus strains (10-18%) in our country during 3 epidemic seasons. The sequencing analysis of protein M2-endoding gene revealed the amino acid replacement of serine by asparagine in position 31, which is characteristic of rimantadine-resistant strains. Arbidol in combination with rimantadine potentiated the effect of viral reproduction in the cultured cells, as compared with the effect produced by the same concentrations of the drugs used alone.     

Deproteinization of influenza virus in the presence of rimantadine

Virion deproteinization and viral RNA transport to the isolated cell nuclei have been studied in the presence of rimantadine with rimantadine-sensitive influenza viruses fowl plague (H7N7), A/Krasnodar/101/59 (H2N2) and rimantadine-resistant influenza strains (WSN/H1N1 and A/Krasnodar/101/59-R). Rimantadine failed to affect deproteinization during incubation with the isolated cellular plasma membranes as well as the transport to isolated cell nuclei of the viral RNA of either sensitive or resistant strains of influenza virus. Using photosensitive viruses (labelled with neutral red) rimantadine exerted dissimilar effects on deproteinization of the sensitive and resistant influenza virus strains. The possible effects of rimantadine on influenza virus deproteinization is discussed.     

New adamantane derivatives and ways of overcoming the resistance of influenza A viruses to rimantadine and amantadine

The amino acid and peptide derivatives of 1-adamantane carboxylic acid and rimantadine (18 compounds) have been first synthesized and investigated for their activity against influenza A virus (H1N1, H1N1v). In a series of obtained adamantine derivatives, some compounds have been found to be able to inhibit rimantadine-resistant influenza A virus strains. Thus, the antiviral properties of rimantadine can be restored.     

Utilization of the embryonated egg for in vivo evaluation of the anti-influenza virus activity of neuraminidase inhibitors

Previous studies have shown that embryonated egg provides a convenient and easy to use system for in vivo screening of anti-influenza virus inhibitors. However, it is not known whether this model is suitable for testing neuraminidase (NA) inhibitors, too. Therefore, the present study describes the evaluation of the ion-channel blockers amantadine and rimantadine in comparison with the NA inhibitors oseltamivir and zanamivir by using the influenza A virus hen’s egg model. The treatment was started immediately before or after the challenge dose was placed on the chorioallantoic membrane (CAM). Differences between the survival rate of treated and untreated chick embryos infected with influenza A virus were analyzed statistically. As result, the survival rate of chick embryos could be significantly increased when the treatment with amantadine, rimantadine, oseltamivir, or zanamivir was started before the CAM was inoculated with one egg infective dose 50% (EID₅₀) influenza A virus. When the drugs were administered shortly after viral inoculation, significant antiviral efficacy was shown for rimantadine, oseltamivir, and zanamivir. Antiviral efficacy could be demonstrated exclusively for both oseltamivir and zanamivir after the embryos were infected with higher challenge doses of 10² EID₅₀influenza A virus. In conclusion, the NA inhibitors oseltamivir and zanamivir have a significantly better antiviral activity against influenza A virus than amantadine and rimantadine tested in embryonated hen’s eggs. Therefore, this model can be a valuable alternative approach for in vivo pre-testing anti-influenza virus activity of NA inhibitors.     

Prophylactic efficacy of intranasal alpha 2-interferon against rhinovirus infections in the family setting

In a double-blind evaluation of alpha 2-interferon as prophylaxis against naturally acquired respiratory infections, 120 adult members of 46 Australian families used 325 courses of intranasal spray during a six-month period, applying 5 million IU to the anterior nasal mucosa daily for seven days when respiratory symptoms developed in another member of the family. Used in this way, the alpha 2-interferon was well tolerated, and the rate of minor nasal bleeding (12 percent) did not increase with repeated courses. By comparison with the control group of 109 members of 49 families who used 319 seven-day courses of placebo spray, the users of alpha 2-interferon experienced 33 percent fewer days with nasal symptoms and 41 percent fewer episodes of "definite" respiratory illness. The users of alpha 2-interferon who were exposed to rhinovirus infections experienced 76 percent fewer days with symptoms and 86 percent fewer "definite" illnesses than their counterparts who used placebo. All of the observed clinical benefits, which suggested prevention of 6.8 "definite" respiratory illnesses per 100 courses of medication used, could be explained by a protective effect against illness associated with rhinoviruses that was not demonstrated for influenza A or B or coronavirus 229E.     

Occurrence of amantadine- and rimantadine-resistant influenza A virus strains during the 1980 epidemic

The sensitivities to amantadine and rimantadine of influenza A virus epidemic strains were assayed by the haem-adsorption reduction test in mouse Ehrlich ascites cells in comparison with prototype strains and a rimantadine-resistant mutant. Besides a majority of sensitive strains, two relatively resistant epidemic strains were identified. The possible origin of resistant strains and their importance for medical practice are discussed.     

Evaluation of antiviral substances against influenza A virus strains by the haemadsorption reduction test

The haemadsorption reduction test with Ehrlich mouse ascites tumour cells proved to be a simple method for testing the sensitivity of influenza A virus strains to antiviral substances. Ribavirin and 2-deoxy-D-glucose were poorly effective in this system while all virus strains except A/PR/8/34 (H0N1) were highly sensitive to amantadine and rimantadine, the latter being the strongest inhibitor.     

Epidemiological investigation of the first locally acquired case of COVID-19 identified by influenza surveillance—Taiwan,February 2020

BackgroundCOVID-19 and influenza have similar clinical presentations that can range from mild to severe disease. The World Health Organization recommends that countries use existing influenza surveillance to monitor COVID-19 transmission in communities. We aim to describe the surveillance and investigation of COVID-19 at the early stage of the pandemic in Taiwan.MethodsIn February 2020, the Taiwan Centers for Disease Control enhanced COVID-19 surveillance through its existing influenza surveillance. We retrospectively tested patients for SARS-CoV-2 who had symptoms of severe complicated influenza but were negative in influenza testing. We conducted an epidemiological investigation and contact tracing for the index patient and secondary cases to prevent virus transmission.ResultsWe identified the first COVID-19 patient on February 15 through enhanced COVID-19 surveillance. He had no history of traveling abroad and an unclear history of contact with COVID-19 cases. He presented with influenza-like illness on January 27 and was hospitalized from February 3 to 15. We identified 39 close contacts of the index patient, including 11 family members and 28 healthcare workers. In total, four close family contacts of the index patient tested positive for SARS-CoV-2. An additional 84 close contacts of the four secondary cases were identified and traced; none was diagnosed with COVID-19.ConclusionsWe recommend enhancing COVID-19 surveillance by testing patients with influenza-like illness. To prevent the spread of COVID-19, we recommend using appropriate personal protective equipment when in close contact with patients who present with influenza-like illness or when caring for patients with pneumonia of unknown etiology.     

Outbreak of influenza virus A/H1N1 in a hospital ward for immunocompromised patients

In February 2008, five patients were infected with the H1N1 subtype of influenza A virus in one hospital ward for immunocompromised patients at a hospital in North Rhine-Westphalia, Germany. All of these patients had an established haematologic disease and tested positive either for viral RNA or antigen shortly after the beginning of respiratory illness. In three of the patients, influenza virus was repeatedly detected, and four of the patients died in coincidence with the virus infection. Sequencing of the amplified (HA1) haemagglutinin yielded identical nucleotide sequences in isolates from three of the patients, whereas one nucleotide difference was found in the isolate of the fourth patient, resulting in an amino acid substitution (G153R). To investigate the source of infection, the medical staff (n = 104) of the hospital unit was tested and found negative for influenza virus RNA and antigen in pharyngeal lavages. Testing for influenza virus antibodies by immunofluorescence assay revealed that 12 staff members were positive for influenza virus A IgA antibodies. These findings suggest that wild-type influenza virus infections occurred within the medical staff at the same time the patients were infected and that the staff might have contributed to the circulation of virus in the hospital ward.     

The replication of influenza A viruses in organ cultures of human nasal polyps

Summary Organ cultures of human nasal polyps were shown to support the replication of five out of seven human influenza A viruses and three out of six avian strains with varying degrees of efficiency. The ability to replicate was independent of the antigenic formula of the virus. The structure of nasal polyps closely resembled that of normal nasal mucosa and infection with influenza A virus resulted in histological changes analogous to those seen in natural infections. This system provides anin vitro method for more detailed studies of influenza A virus and possibly other respiratory virus infections of man.With 1 Figure     

北京市首例人感染H9N2禽流感病例的流行病学调查

目的 分析2016年12月北京市朝阳区确诊的l例人感染H9N2禽流感病例流行病学特征.方法 访谈病例发病前后的相关知情人,调查病例发病经过和可能感染来源.采集病例、密切接触者及环境标本,应用实时荧光定量PCR(real-timePCR)方法,检测甲型流感病毒及H9N2禽流感病毒特异的核酸片段.对病例咽拭子标本和l件阳性环境标本中的H9N2禽流感病毒血凝素(Hemagglutinin,HA)基因进行序列测定和分析.结果 病例表现为轻症流感样病例症状,发病前15天曾有活禽市场暴露史.该市场环境标本中H9N2禽流感病毒阳性率为18.2％ (2/11).病例咽拭子标本与市场环境标本中病毒的HA基因高度同源,氨基酸相似度为100％,在进化关系上同属于欧亚系的Y280分支.4名密切接触者在医学观察期内未出现过发热、咳嗽等呼吸道症状.结论 病例感染来源与活禽市场环境暴露有关.加强流感监测以及活禽市场的管理对于防控人感染禽流感疫情具有重要意义.     

The properties of the epidemic influenza viruses A and B strains circulating in Russia in the 2004-2005 epidemic season

The epidemic upsurge of influenza morbidity in Russia in 2004-2005 was caused by the active circulation of influenza A(H3N2) and B viruses. A hundred and sixty-six epidemic strains were studied. All the strains were isolated in the MCK cell culture. Influenza A(H3N2) viruses (n=77) were antigenic variants of the reference A/Fujian/411/ 2002 and A/California/7/2004 strains. Three influenza A(H1N1) viral strains that were antigenic variants of A/New Caledonia/20/99 strains were isolated in sporadic cases. Influenza B virus strains (n=83) were antigenic variants of the reference B/Shanghai/361/02--lineage B/Yamagata/l6/88. In addition, 3 antigenic variants of B/Hong Kong/ 330/2002 (lineage B/Victoria/2/87) strains were isolated. Nine (20%) strains resistant to rimantadine at a concentration of 5 microg/ml were identified. Chromatographic analysis of B/Shanghai/361/02 and BIHong Kong/330/01 viral protein M1 trypsin hydrolysates revealed differences in the profiles of chromatograms of influenza A virus proteins M1. Examination of 121 pair sera from patients revealed an increase in antibodies to influenza A(H3N2) viruses in 10-21% of cases and to influenza B viruses in 20-36% of cases.     

Epidemic strains influenza viruses A and B in the 2005-2006 season in Russia

Investigations indicated that the epidemic upsurge of influenza morbidity in the 2005-2006 season in Russia was caused by the active circulation of influenza viruses A and B. The Center for Ecology and Epidemiology of Influenza, D. I. Ivanovsky Institute of Virology, Russian Academy of Medical Sciences, studied 182 epidemic strains. A hundred and thirteen influenza viruses A(H3N2) were similar to the reference A/California/07/2004 or were its antigenic variants. Thirteen influenza virus A(H1N1) strains that were antigenic variants of the reference A/New Caledonia/20/99 were isolated in sporadic cases. Influenza viruses B were similar to B/Malaysia/2506/2004--lineage B/Victoria/2/87). All the strains were isolated in the MDCK cell culture. Comparative study of the sensitivity of the chicken embryo (CE) and MDCK isolation system to the 1999-2006 epidemic strains showed that CE tropism was least pronounced in influenza viruses A(H3N2). Analysis of the 2002-2006 strains demonstrated that influenza viruses A reacted actively with human erythrocytes of the blood groups 0(I) and A(II) and very slightly with chicken ones. Eighty-five influenza virus A(H3N2) strains from the 2005-2006 epidemic season were investigated for rimantadine susceptibility. The frequency of rimantadine-resistant influenza virus A(H3N2) strains was 38.0%. Studies of 79 paired sera from patients revealed a rise of antibodies to influenza viruses A(H3N2) and B in 25.9-33.3 and 20.7-23.8% of cases, respectively. There was an increase in antibodies to influenza viruses A and B in the sera collected from donors in Moscow and its region in September 2005 to June 2006.     

Respiratory syncytial virus infections within families.

To examine intrafamily spread of respiratory syncytial virus infections and their associated illnesses, 36 families with 188 members were studied during an outbreak of such infections. Nurses visited every three to four days to obtain specimens for viral isolation and interview household members. The virus infected 44.4 per cent of families, and 21.9 per cent of all members. All age groups had appreciable attack rates (with a range of 16.8 per cent in adults to 29.4 per cent in infants). In infected families, 45.9 per cent of members became infected, including 10 of 16 infants. Secondary attack rate for all ages was 27 per cent, and that for infants 45.4 per cent. An infant's older sibling appeared most likely to introduce the virus into the family. Associated acute respiratory illnesses occurred in 94.9 per cent of cases, and appeared more severe than those not associated with respiratory syncytial virus. When the virus was introduced into a family the high attack rate produced an illness of age-related severity.     

The effects of experimentally induced respiratory virus infections on performance

Studies of experimentally induced respiratory infections and illnesses showed that influenza impaired performance on a visual search task but had no effect on a simple motor task, whereas colds impaired the motor task but not the search task. The effect of influenza on the search task was observed in both volunteers with significant clinical symptoms and volunteers who were shown, by virological techniques, to be infected but who had no significant clinical illness. Performance was also impaired during the incubation period of this illness, which confirms that subclinical influenza virus infections can have behavioural effects. In contrast to influenza, the effects of colds were restricted to volunteers who had significant clinical symptoms, and the impairments in performance were observed only when the symptoms were apparent.