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Hardhantyo M, Djasri H, Nursetyo AA, Donna B, Ariani M, Pangaribuan H, Yogadhita GY, Yulianti A, Adipradipta BR. Evidence-Based Policy Recommendations for Public Health Emergency Operation Centers in Regional Settings: A Case Study in Indonesia. Public Health Rev 2023; 44:1604899. [PMID: 37601901 PMCID: PMC10435730 DOI: 10.3389/phrs.2023.1604899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background: Public health emergencies require integration between multiple stakeholders in different sectors to monitor the situation and carry out an appropriate response. As a country with a large land area consisting of thousands of islands, Indonesia's centralized Public Health Emergency Operation Center (PHEOC) system is currently unable to effectively contain diseases. A PHEOC system reform is required to accommodate Indonesia's circumstances, particularly at the regional level. We have outlined potential models at the sub-national level for PHEOC based on existing evidence. Policy Options and Recommendations: Based on existing evidence of PHEOC models internationally, we have formulated three policy models for regional-level PHEOC. These models (the ad hoc agency model, the independent agency model, and the Province Health Office (PHO)-based model) entail different chains of command, and each has its own benefits. Conclusion: We recommend that the Ministry of Health in Indonesia adopt the third PHEOC policy model, in which the chain of command lies under the PHO. This is the most practical approach, as the PHO has the authority to mobilize units and access resources in response to imminent public health emergencies. Further training and capacity-building are required to support the PHO as the commander of the regional PHEOC.
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Affiliation(s)
- Muhammad Hardhantyo
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Health Science, Universitas Respati Yogyakarta, Yogyakarta, Indonesia
| | - Hanevi Djasri
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Aldilas Achmad Nursetyo
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bella Donna
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Madelina Ariani
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Happy Pangaribuan
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gde Yulian Yogadhita
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andriani Yulianti
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bernadeta Rachela Adipradipta
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Rehman S, Rantam FA, Batool K, Shehzad A, Effendi MH, Witaningrum AM, Bilal M, Elziyad Purnama MT. Emerging threats and vaccination strategies of H9N2 viruses in poultry in Indonesia: A review. F1000Res 2022; 11:548. [PMID: 35844820 PMCID: PMC9253659 DOI: 10.12688/f1000research.118669.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Avian influenza virus subtype H9N2 was first documented in Indonesia in 2017. It has become prevalent in chickens in many provinces of Indonesia as a result of reassortment in live bird markets. Low pathogenic avian influenza subtype H9N2 virus-infected poultry provides a new direction for the influenza virus. According to the latest research, the Indonesian H9N2 viruses may have developed through antigenic drift into a new genotype, posing a significant hazard to poultry and public health. The latest proof of interspecies transmission proposes that the next human pandemic variant will be the avian influenza virus subtype H9N2. Manipulation and elimination of H9N2 viruses in Indonesia, constant surveillance of viral mutation, and vaccine updates are required to achieve effectiveness. The current review examines should be investigates/assesses/report on the development and evolution of newly identified H9N2 viruses in Indonesia and their vaccination strategy.
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Affiliation(s)
- Saifur Rehman
- Division of Veterinary Public Health Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
- Laboratory of Virology and Immunology Division of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
- Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Islamic, 40050, Pakistan
| | - Fedik Abdul Rantam
- Laboratory of Virology and Immunology Division of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Khadija Batool
- Medicine, Service Institute of Medical Sciences, Lahore,, Punjab, 40050, Pakistan
| | - Aamir Shehzad
- Laboratory of Virology and Immunology Division of Microbiology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Mustofa Helmi Effendi
- Division of Veterinary Public Health Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Adiana Mutamsari Witaningrum
- Division of Veterinary Public Health Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Muhammad Bilal
- Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Islamic, 40050, Pakistan
| | - Muhammad Thohawi Elziyad Purnama
- Division of Veterinary Anatomy, Department of Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
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Rehman S, Rantam FA, Batool K, Rahman A, Effendi MH, Rahmahani J, Jamal M. Knowledge, attitude, and practices associated with avian influenza among undergraduate university students of East Java Indonesia: A cross-sectional survey. F1000Res 2022; 11:115. [PMID: 35340276 PMCID: PMC8921684 DOI: 10.12688/f1000research.74196.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Several public health strategic actions are required for effective avian influenza (AI) prevention and control, as well as the development of a communication plan to keep undergraduate students sufficiently informed on how to avoid or reduce exposure. The aim of the survey was to measure the level of knowledge, attitudes and practices (KAPs) toward AI among undergraduate university students in East Java, Indonesia, and observe the correlation between KAPs and the factors associated with the control and prevention of AI. Methods: A cross-sectional survey was conducted among undergraduate students to collect information about AI-related KAPs. Students were selected from three faculties of Universitas Airlangga Surabaya Indonesia (Faculty of Veterinary Medicine, Faculty of Fisheries and Marine, and Faculty of Science and Technology). Students voluntarily responded to a pre-designed questionnaire.
Results: A total of 425 students (222 female; and 203 male), of ages ranging from 18 years (n=240) to 20-30 years (n=185), responded to the survey. This cohort consisted of 157 students from the Faculty of Fisheries and Marine, 149 from the Faculty of Veterinary Medicine, and 119 from the Faculty of Science and Technology. The results indicated that appropriate knowledge was obtained by 76.94% of students; significantly higher levels were seen in Faculty of Veterinary Medicine students as compared to the other two faculties (p<0.05). 72.89% of students documented positive attitudes; veterinary medicine students had significantly more positive attitudes than other faculties (p<0.05). Proactive behaviors were observed in 56.90% of students. The aggregate scores for KAPs were 6.93 ± 0.77 (range: 0-9) for knowledge, 7.6 ± 1.25 (range: 0-10) for attitude, and 9.1 ± 1.5 (range: 0-12) for practice.
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Affiliation(s)
- Saifur Rehman
- Division of Veterinary Public Health Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Fedik Abdul Rantam
- Laboratory of Virology and Immunology Division of Microbiology, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Khadija Batool
- Medicine, Service Institute of Medical Sciences Lahore Pakistan, Surabaya, Islamic, 40050, Pakistan
| | - Attaur Rahman
- College of Animal Husbandry and Veterinary Sciences, Abdul Wali Khan University Mardan, Mardan, 23200, Pakistan
| | - Mustofa Helmi Effendi
- Division of Veterinary Public Health Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Jola Rahmahani
- Laboratory of Virology and Immunology Division of Microbiology, Universitas Airlangga, Surabaya, East Java, 60115, Indonesia
| | - Muhsin Jamal
- Department of Microbiology, Abdul Wali Khan University, Mardan, Pakistan
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Better Pandemic Influenza Preparedness through Adjuvant Technology Transfer: Challenges and Lessons Learned. Vaccines (Basel) 2021; 9:vaccines9050461. [PMID: 34063131 PMCID: PMC8148163 DOI: 10.3390/vaccines9050461] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/26/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022] Open
Abstract
Adequate global vaccine coverage during an influenza pandemic is essential to mitigate morbidity, mortality, and economic impact. Vaccine development and production needs to be sufficient to meet a vast global demand, requiring international cooperation and local vaccine production capacity, especially in resource-constrained countries. The use of adjuvants is one approach to augment the number of available vaccine doses and to overcome potential vaccine shortages. Appropriately selected adjuvant technologies can decrease the amount of vaccine antigen required per dose, may broaden or lengthen the conferred protection against disease, and may even allow protective single-dose vaccination. Here we describe a technology transfer collaboration between Switzerland and Indonesia that led to the establishment of a vaccine formulation platform in Surabaya which involved the transfer of equipment and expertise to enable research and development of adjuvanted vaccine formulations and delivery systems. This new Indonesian capability aims to facilitate local and regional access to know-how relating to adjuvanted vaccine formulations, thus promoting their application to local vaccine developers. In this review, we aim to share the “lessons learned” from this project to both support and inspire future scientific collaborations of a similar nature.
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Mehrbod P, Eybpoosh S, Farahmand B, Fotouhi F, Khanzadeh Alishahi M. Association of the host genetic factors, hypercholesterolemia and diabetes with mild influenza in an Iranian population. Virol J 2021; 18:64. [PMID: 33766078 PMCID: PMC7993858 DOI: 10.1186/s12985-021-01486-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Variation in host genetic factors may result in variation in the host immune response to the infection. Some chronic diseases may also affect individuals' susceptibility to infectious diseases. The aim of this study was to evaluate the association of the host genetic factors mostly involved in inflammation, as well as hypercholesterolemia and diabetes with mild flu in an Iranian population. METHODS In this cross-sectional study, nasopharyngeal swab samples were collected from 93 patients referred to primary care centers of Markazi, Semnan, and Zanjan provinces (central Iran) due to flu-like symptoms between March 2015 and December 2018. Of these, PCR test identified 49 influenza A/H1N1 and 44 flu-negative individuals. Twelve single-nucleotide polymorphisms (SNPs) in RPAIN, FCGR2A, MBL-2, CD55, C1QBP, IL-10, TNF-α and an unknown gene were genotyped using iPLEX GOLD SNP genotyping analysis. Hypercholesterolemia and diabetes status was determined based on the physician diagnosis. Association of the host genetic variants, hypercholesterolemia and diabetes with mild A/H1N1 flu was assessed with univariable and multivariable logistic regression analysis as implemented in Stata software (v.14). Statistical tests were considered as significant at 0.05 levels. RESULTS Frequency of diabetes and hypercholesterolemia, as well as participants mean age was significantly higher in the flu-negative rather than the flu-positive group. Of 12 SNPs, nine did not show any significant association with mild flu in our study (rs1801274, rs1800451, rs2564978, rs361525, rs1800450, rs1800871, rs1800872, rs1800896, rs1800629). Possessing G vs. A allele in two SNPs (rs3786054 and rs8070740) was associated with a threefold increase in the chance of mild flu when compared to flu-negative patients (95% CI: 1.1, 22.0). Possessing C allele (vs. A) in the rs9856661 locus also increased the chance of mild flu up to 2 folds (95% CI: 1.0, 10.0). CONCLUSION The results showed that possessing the G allele in either rs3786054 or rs8070740 loci in C1QBP and RPAIN genes, respectively, increased the risk of H1N1 infection up to 3.3 folds, regardless of the patient's age, BMI, diabetes, and hypercholesterolemia. Complementary functional genomic studies would shed more light on the underlying mechanism of human immunity associated with these genetic markers. The identified genetic factors may have the same role in susceptibility to similar respiratory infections with RNA viruses, like SARS, MERS and COVID-19. Future genetic association studies targeting these RNA viruses, especially COVID-19 is recommended. Studies on other ethnic groups would also shed light on possible ethnic variations in genetic susceptibility to respiratory RNA viruses. Trial registry IR.PII.REC.1399.063.
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Affiliation(s)
- Parvaneh Mehrbod
- Influenza and Respiratory Viruses Department, Pasteur Institute of Iran, Tehran, Iran
| | - Sana Eybpoosh
- Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Behrokh Farahmand
- Influenza and Respiratory Viruses Department, Pasteur Institute of Iran, Tehran, Iran
| | - Fatemeh Fotouhi
- Influenza and Respiratory Viruses Department, Pasteur Institute of Iran, Tehran, Iran
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Pawestri HA, Eggink D, Isfandari S, Thanh TT, Rogier van Doorn H, Setiawaty V, de Jong MD. Viral Factors Associated With the High Mortality Related to Human Infections With Clade 2.1 Influenza A/H5N1 Virus in Indonesia. Clin Infect Dis 2021; 70:1139-1146. [PMID: 31321436 PMCID: PMC7052542 DOI: 10.1093/cid/ciz328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/24/2019] [Indexed: 01/26/2023] Open
Abstract
Background Since their emergence in Indonesia in 2005, 200 human infections with clade 2.1 highly pathogenic avian influenza A/H5N1 virus have been reported, associated with exceptionally high mortality (84%) compared to regions affected by other genetic clades of this virus. To provide potential clues towards understanding this high mortality, detailed clinical virological analyses were performed in specimens from 180 H5N1 patients, representing 90% of all Indonesian patients and 20% of reported H5N1-infected patients globally. Methods H5N1 RNA was quantified in available upper- and lower-respiratory tract specimens as well as fecal and blood samples from 180 patients with confirmed infection between 2005 and 2017. Mutations in the neuraminidase and M2 genes that confer resistance to oseltamivir and adamantanes were assessed. Fatal and nonfatal cases were compared. Results High viral RNA loads in nasal and pharyngeal specimens were associated with fatal outcome. Mortality increased over time during the study period, which correlated with increasing viral RNA loads on admission. Furthermore, the prevalence of amantadine resistance–conferring M2 mutations increased over time, and viral loads were higher in patients infected with viruses that harbored these mutations. Compared to observations from other regions, viral RNA was detected more frequently in feces (80%) and particularly in blood (85%), and antiviral responses to oseltamivir appeared less pronounced. Conclusions These observations confirm the association of viral load with outcome of human H5N1 infections and suggest potential differences in virulence and antiviral responses to oseltamivir that may explain the exceptionally high mortality related to clade 2.1 H5N1 infections in Indonesia.
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Affiliation(s)
- Hana A Pawestri
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Dirk Eggink
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Siti Isfandari
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Vivi Setiawaty
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
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Finch CL, Zhang A, Kosikova M, Kawano T, Pasetti MF, Ye Z, Ascher JR, Xie H. Pregnancy level of estradiol attenuated virus-specific humoral immune response in H5N1-infected female mice despite inducing anti-inflammatory protection. Emerg Microbes Infect 2019; 8:1146-1156. [PMID: 31364945 PMCID: PMC6711175 DOI: 10.1080/22221751.2019.1648184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Estradiol, a major female steroid produced during pregnancy, has been reported to protect ovariectomized animals against H1N1 influenza infections via its anti-inflammatory effects. However, it remains unclear why pregnant women with high gestational estradiol levels are highly susceptible to influenza infections. This study was aimed to investigate the effects of pregnancy level of estradiol on female immunity against H5N1 infection in Balb/c mice. A sex-dependent susceptibility to H5N1 infection (higher morbidity and higher mortality) was observed in both pregnant and non-pregnant female mice as compared to male mice. Subcutaneous implantation of estradiol pellets increased serum estradiol concentrations of non-pregnant female mice to the pregnancy level. These mice were protected from H5N1 infection through downregulation of pulmonary pro-inflammatory cytokines. However, the production of virus-specific antibodies after infection was significantly delayed in estradiol-implanted mice when compared to placebos. Virus-specific IgG-secreting and IL-4-secreting cells were also reduced in estradiol-implanted mice. Similarly, lower antibody titers to seasonal vaccine antigens were found in pregnant women as compared to non-pregnant females without hormone usage. Our results indicate that estradiol levels equivalent to those found during pregnancy have divergent effects on female immunity against influenza, highlighting the importance of vaccination during pregnancy to prevent severe influenza infections.
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Affiliation(s)
- Courtney L Finch
- a Division of Viral Products, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Anding Zhang
- a Division of Viral Products, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Martina Kosikova
- a Division of Viral Products, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Toshiaki Kawano
- a Division of Viral Products, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Marcela F Pasetti
- b Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore , MD , USA
| | - Zhiping Ye
- a Division of Viral Products, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Jill R Ascher
- c Division of Veterinary Services, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
| | - Hang Xie
- a Division of Viral Products, Center for Biologics Evaluation and Research, United States Food and Drug Administration , Silver Spring , MD , USA
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Bulu PM, Robertson ID, Geong M. A targeted investigation to demonstrate the freedom of West Timor from HPAI H5N1. Prev Vet Med 2018; 150:47-51. [PMID: 29406083 DOI: 10.1016/j.prevetmed.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
In early 2004 highly pathogenic avian influenza (HPAI) H5N1 virus caused major outbreaks of disease in poultry in Indonesia. The disease was first reported in West Timor in eastern Indonesia in the same year, resulting in the death of approximately one hundred chickens from both commercial and backyard farms; however no evidence of disease has subsequently been reported in West Timor since 2007. A targeted survey was undertaken in 2013 in 2 districts of West Timor. Three hundred village and commercial poultry (292 chickens and 8 Muscovy ducks) from 10 villages and 5 live bird markets (LBMs) were sampled between August and October 2013. Swabs of the cloaca and trachea of the sampled birds were tested using the Anigen® Rapid Test (Bionote). All samples were negative on testing (0%; 95%CI: 0.0-1.2%). From these results it was concluded with a high level of confidence (100%, 95%CI: 99.988, 100) that this population is not infected, and these results, along with a lack of clinical evidence of disease, support the conclusion that West Timor was free from HPAI infection at the time of the survey.
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Affiliation(s)
- Petrus Malo Bulu
- College of Veterinary Medicine, School of Veterinary and Life Sciences Murdoch University, South Street Murdoch, Perth, Western Australia, 6150, Australia; Politeknik Pertanian Negeri Kupang, Jln Adisucipto Penfui Kupang, West Timor, East Nusa Tenggara, Indonesia.
| | - Ian D Robertson
- College of Veterinary Medicine, School of Veterinary and Life Sciences Murdoch University, South Street Murdoch, Perth, Western Australia, 6150, Australia; China-Australia Joint Research and Training Center for Veterinary Epidemiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, People's Republic of China.
| | - Maria Geong
- Animal Health & Veterinary Services, Provincial Department of Livestock - Nusa Tenggara Timur, Kupang, West Timor, Indonesia.
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Agunos A, Pierson FW, Lungu B, Dunn PA, Tablante N. Review of Nonfoodborne Zoonotic and Potentially Zoonotic Poultry Diseases. Avian Dis 2017; 60:553-75. [PMID: 27610715 DOI: 10.1637/11413-032416-review.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Emerging and re-emerging diseases are continuously diagnosed in poultry species. A few of these diseases are known to cross the species barrier, thus posing a public health risk and an economic burden. We identified and synthesized global evidence for poultry nonfoodborne zoonoses to better understand these diseases in people who were exposed to different poultry-related characteristics (e.g., occupational or nonoccupational, operational types, poultry species, outbreak conditions, health status of flocks). This review builds on current knowledge on poultry zoonoses/potentially zoonotic agents transmitted via the nonfoodborne route. It also identifies research gaps and potential intervention points within the poultry industry to reduce zoonotic transmission by using various knowledge synthesis tools such as systematic review (SR) and qualitative (descriptive) and quantitative synthesis methods (i.e., meta-analysis). Overall, 1663 abstracts were screened and 156 relevant articles were selected for further review. Full articles (in English) were retrieved and critically appraised using routine SR methods. In total, eight known zoonotic diseases were reviewed: avian influenza (AI) virus (n = 85 articles), Newcastle disease virus (n = 8), West Nile virus (WNV, n = 2), avian Chlamydia (n = 24), Erysipelothrix rhusiopathiae (n = 3), methicillin-resistant Staphylococcus aureus (MRSA, n = 15), Ornithonyssus sylvarium (n = 4), and Microsporum gallinae (n = 3). In addition, articles on other viral poultry pathogens (n = 5) and poultry respiratory allergens derived from mites and fungi (n = 7) were reviewed. The level of investigations (e.g., exposure history, risk factor, clinical disease in epidemiologically linked poultry, molecular studies) to establish zoonotic linkages varied across disease agents and across studies. Based on the multiple outcome measures captured in this review, AI virus seems to be the poultry zoonotic pathogen that may have considerable and significant public health consequences; however, epidemiologic reports have only documented severe human cases clustered in Asia and not in North America. In contrast, avian Chlamydia and MRSA reports clustered mainly in Europe and less so in North America and other regions. Knowledge gaps in other zoonoses or other agents were identified, including potential direct (i.e., nonmosquito-borne) transmission of WNV from flocks to poultry workers, the public health and clinical significance of poultry-derived (livestock-associated) MRSA, the zoonotic significance of other viruses, and the role of poultry allergens in the pathophysiology of respiratory diseases of poultry workers. Across all pathogens reviewed, the use of personal protective equipment was commonly cited as the most important preventive measure to reduce the zoonotic spread of these diseases and the use of biosecurity measures to reduce horizontal transmission in flock populations. The studies also emphasized the need for flock monitoring and an integrated approach to prevention (i.e., veterinary-public health coordination with regard to diagnosis, and knowledge translation and education in the general population) to reduce zoonotic transmission.
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Affiliation(s)
- Agnes Agunos
- A Public Health Agency of Canada, Guelph, Ontario, Canada N1G5B2
| | - F William Pierson
- B Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061
| | - Bwalya Lungu
- C Department of Food Science and Technology, University of California, Davis, CA 95616
| | - Patricia A Dunn
- D Animal Diagnostic Laboratory (PADLS-PSU), Pennsylvania State University, University Park, PA 16802
| | - Nathaniel Tablante
- E Virginia-Maryland College of Veterinary Medicine, University of Maryland, College Park, MD 20740
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David SC, Lau J, Singleton EV, Babb R, Davies J, Hirst TR, McColl SR, Paton JC, Alsharifi M. The effect of gamma-irradiation conditions on the immunogenicity of whole-inactivated Influenza A virus vaccine. Vaccine 2017; 35:1071-1079. [PMID: 28109709 DOI: 10.1016/j.vaccine.2016.12.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/25/2016] [Accepted: 12/16/2016] [Indexed: 11/27/2022]
Abstract
Gamma-irradiation, particularly an irradiation dose of 50kGy, has been utilised widely to sterilise highly pathogenic agents such as Ebola, Marburg Virus, and Avian Influenza H5N1. We have reported previously that intranasal vaccination with a gamma-irradiated Influenza A virus vaccine (γ-Flu) results in cross-protective immunity. Considering the possible inclusion of highly pathogenic Influenza strains in future clinical development of γ-Flu, an irradiation dose of 50kGy may be used to enhance vaccine safety beyond the internationally accepted Sterility Assurance Level (SAL). Thus, we investigated the effect of irradiation conditions, including high irradiation doses, on the immunogenicity of γ-Flu. Our data confirm that irradiation at low temperatures (using dry-ice) is associated with reduced damage to viral structure compared with irradiation at room temperature. In addition, a single intranasal vaccination with γ-Flu irradiated on dry-ice with either 25 or 50kGy induced seroconversion and provided complete protection against lethal Influenza A challenge. Considering that low temperature is expected to reduce the protein damage associated with exposure to high irradiation doses, we titrated the vaccine dose to verify the efficacy of 50kGy γ-Flu. Our data demonstrate that exposure to 50kGy on dry-ice is associated with limited effect on vaccine immunogenicity, apparent only when using very low vaccine doses. Overall, our data highlight the immunogenicity of influenza virus irradiated at 50kGy for induction of high titre antibody and cytotoxic T-cell responses. This suggests these conditions are suitable for development of γ-Flu vaccines based on highly pathogenic Influenza A viruses.
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Affiliation(s)
- Shannon C David
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Josyane Lau
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Eve V Singleton
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Rachelle Babb
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Justin Davies
- Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW 2234, Australia
| | - Timothy R Hirst
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia; Gamma Vaccines Pty Ltd, Mountbatten Park, Yarralumla, ACT 2600, Australia
| | - Shaun R McColl
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - James C Paton
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia
| | - Mohammed Alsharifi
- Research Centre for Infectious Diseases, and Department of Molecular and Cellular Biology, School of Biological Sciences, University of Adelaide, Adelaide, SA 5005, Australia; Gamma Vaccines Pty Ltd, Mountbatten Park, Yarralumla, ACT 2600, Australia.
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Mangiri A, Iuliano AD, Wahyuningrum Y, Praptiningsih CY, Lafond KE, Storms AD, Samaan G, Ariawan I, Soeharno N, Kreslake JM, Storey JD, Uyeki TM. Physician's knowledge, attitudes, and practices regarding seasonal influenza, pandemic influenza, and highly pathogenic avian influenza A (H5N1) virus infections of humans in Indonesia. Influenza Other Respir Viruses 2016; 11:93-99. [PMID: 27554302 PMCID: PMC5155649 DOI: 10.1111/irv.12428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 01/13/2023] Open
Abstract
Indonesia has reported highest number of fatal human cases of highly pathogenic avian influenza (HPAI) A (H5N1) virus infection worldwide since 2005. There are limited data available on seasonal and pandemic influenza in Indonesia. During 2012, we conducted a survey of clinicians in two districts in western Java, Indonesia, to assess knowledge, attitudes, and practices (KAP) of clinical diagnosis, testing, and treatment of patients with seasonal influenza, pandemic influenza, or HPAI H5N1 virus infections. Overall, a very low percentage of physician participants reported ever diagnosing hospitalized patients with seasonal, pandemic, or HPAI H5N1 influenza. Use of influenza testing was low in outpatients and hospitalized patients, and use of antiviral treatment was very low for clinically diagnosed influenza patients. Further research is needed to explore health system barriers for influenza diagnostic testing and availability of antivirals for treatment of influenza in Indonesia.
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Affiliation(s)
- Amalya Mangiri
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunita Wahyuningrum
- Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron D Storms
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gina Samaan
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - Iwan Ariawan
- Center for Health Research, Universitas Indonesia, Jakarta, Indonesia
| | - Nugroho Soeharno
- Center for Health Research, Universitas Indonesia, Jakarta, Indonesia
| | - Jennifer M Kreslake
- Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Douglas Storey
- Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Rimi NA, Sultana R, Ishtiak-Ahmed K, Rahman MZ, Hasin M, Islam MS, Azziz-Baumgartner E, Nahar N, Gurley ES, Luby SP. Understanding the failure of a behavior change intervention to reduce risk behaviors for avian influenza transmission among backyard poultry raisers in rural Bangladesh: a focused ethnography. BMC Public Health 2016; 16:858. [PMID: 27552983 PMCID: PMC4995615 DOI: 10.1186/s12889-016-3543-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The spread of the highly pathogenic avian influenza (HPAI) H5N1 virus among poultry and humans has raised global concerns and has motivated government and public health organizations to initiate interventions to prevent the transmission of HPAI. In Bangladesh, H5N1 became endemic in poultry and seven human H5N1 cases have been reported since 2007, including one fatality. This study piloted messages to increase awareness about avian influenza and its prevention in two rural communities, and explored change in villagers' awareness and behaviors attributable to the intervention. METHODS During 2009-10, a research team implemented the study in two rural villages in two districts of Bangladesh. The team used a focused ethnographic approach for data collection, including informal interviews and observations to provide detailed contextual information about community response to a newly emerging disease. They collected pre-intervention qualitative data for one month. Then another team disseminated preventive messages focused on safe slaughtering methods, through courtyard meetings and affixed posters in every household. After dissemination, the research team collected post-intervention data for one month. RESULTS More villagers reported hearing about 'bird flu' after the intervention compared to before the intervention. After the intervention, villagers commonly recalled changes in the color of combs and shanks of poultry as signs of avian influenza, and perceived zoonotic transmission of avian influenza through direct contact and through inhalation. Consequently the villagers valued covering the nose and mouth while handling sick and dead poultry as a preventive measure. Nevertheless, the team did not observe noticeable change in villagers' behavior after the intervention. Villagers reported not following the recommended behaviors because of the perceived absence of avian influenza in their flocks, low risk of avian influenza, cost, inconvenience, personal discomfort, fear of being rebuked or ridiculed, and doubt about the necessity of the intervention. CONCLUSIONS The villagers' awareness about avian influenza improved after the intervention, however, the intervention did not result in any measurable improvement in preventive behaviors. Low cost approaches that promote financial benefits and minimize personal discomfort should be developed and piloted.
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Affiliation(s)
- Nadia Ali Rimi
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Rebeca Sultana
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Kazi Ishtiak-Ahmed
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Md Zahidur Rahman
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Marufa Hasin
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - M. Saiful Islam
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Eduardo Azziz-Baumgartner
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Nazmun Nahar
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Emily S. Gurley
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Stephen P. Luby
- Program for Emerging Infections (PEI), Infectious Diseases Division (IDD), icddr,b, 68, Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
- Stanford University, Stanford, CA USA
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14
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Liu S, Sha J, Yu Z, Hu Y, Chan TC, Wang X, Pan H, Cheng W, Mao S, Zhang RJ, Chen E. Avian influenza virus in pregnancy. Rev Med Virol 2016; 26:268-84. [PMID: 27187752 DOI: 10.1002/rmv.1884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/19/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Abstract
The unprecedented epizootic of avian influenza viruses, such as H5N1, H5N6, H7N1 and H10N8, has continued to cause disease in humans in recent years. In 2013, another novel influenza A (H7N9) virus emerged in China, and 30% of those patients died. Pregnant women are particularly susceptible to avian influenza and are more likely to develop severe complications and to die, especially when infection occurs in the middle and late trimesters. Viremia is believed to occur infrequently, and thus vertical transmission induced by avian influenza appears to be rare. However, avian influenza increases the risk of adverse pregnancy outcomes, including spontaneous abortion, preterm birth and fatal distress. This review summarises 39 cases of pregnant women and their fetuses from different countries dating back to 1997, including 11, 15 and 13 infections with H7N9, H5N1 and the 2009 pandemic influenza (H1N1), respectively. We analysed the epidemic features, following the geographical, population and pregnancy trimester distributions; underlying diseases; exposure history; medical timelines; human-to-human transmission; pathogenicity and vertical transmission; antivirus treatments; maternal severity and mortality and pregnancy outcome. The common experiences reported in different countries and areas suggest that early identification and treatment are imperative. In the future, vigilant virologic and epidemiologic surveillance systems should be developed to monitor avian influenza viruses during pregnancy. Furthermore, extensive study on the immune mechanisms should be conducted, as this will guide safe, rational immunomodulatory treatment among this high-risk population. Most importantly, we should develop a universal avian influenza virus vaccine to prevent outbreaks of the different subtypes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Jianping Sha
- Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China
| | - Zhao Yu
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yan Hu
- Department of Endocrinology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, China
| | - Ta-Chien Chan
- Centre for Geographic Information Science, Research Centre for Humanities and Social Science, Academia Sinica, Taipei, Taiwan
| | - Xiaoxiao Wang
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Hao Pan
- Department of Infectious Diseases, Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Wei Cheng
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Shenghua Mao
- Department of Infectious Diseases, Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Run Ju Zhang
- Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Enfu Chen
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
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15
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Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey. J Epidemiol Glob Health 2016; 6:77-86. [PMID: 26930154 PMCID: PMC5733133 DOI: 10.1016/j.jegh.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/29/2016] [Accepted: 01/31/2016] [Indexed: 11/24/2022] Open
Abstract
Understanding healthcare-seeking patterns for respiratory illness can help improve estimations of disease burden and inform public health interventions to control acute respiratory disease in Indonesia. The objectives of this study were to describe healthcare-seeking behaviors for respiratory illnesses in one rural and one urban community in Western Java, and to explore the factors that affect care seeking. From February 8, 2012 to March 1, 2012, a survey was conducted in 2520 households in the East Jakarta and Bogor districts to identify reported recent respiratory illnesses, as well as all hospitalizations from the previous 12-month period. We found that 4% (10% of those less than 5 years) of people had respiratory disease resulting in a visit to a healthcare provider in the past 2 weeks; these episodes were most commonly treated at government (33%) or private (44%) clinics. Forty-five people (0.4% of those surveyed) had respiratory hospitalizations in the past year, and just over half of these (24/45, 53%) occurred at a public hospital. Public health programs targeting respiratory disease in this region should account for care at private hospitals and clinics, as well as illnesses that are treated at home, in order to capture the true burden of illness in these communities.
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16
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Zhuang J, Gao P, Pollock Z, Harrod KS, Xu F. Depressed Hypoxic and Hypercapnic Ventilatory Responses at Early Stage of Lethal Avian Influenza A Virus Infection in Mice. PLoS One 2016; 11:e0147522. [PMID: 26808681 PMCID: PMC4725683 DOI: 10.1371/journal.pone.0147522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/24/2015] [Indexed: 01/22/2023] Open
Abstract
H5N1 virus infection results in ~60% mortality in patients primarily due to respiratory failure, but the underlying causes of mortality are unclear. The goal of this study is to reveal respiratory disorders occurring at the early stage of infection that may be responsible for subsequent respiratory failure and death. BALB/c mice were intranasally infected with one of two H5N1 virus strains: HK483 (lethal) or HK486 (non-lethal) virus. Pulmonary ventilation and the responses to hypoxia (HVR; 7% O2 for 3 min) and hypercapnia (HCVR; 7% CO2 for 5 min) were measured daily at 2 days prior and 1, 2, and 3 days postinfection (dpi) and compared to mortality typically by 8 dpi. At 1, 2, and 3 dpi, immunoreactivities (IR) of substance P (SP-IR) in the nodose ganglion or tyrosine hydroxylase (TH-IR) in the carotid body coupled with the nucleoprotein of influenza A (NP-IR) was examined in some mice, while arterial blood was collected in others. Our results showed that at 2 and 3 dpi: 1) both viral infections failed to alter body temperature and weight, V˙CO2, or induce viremia while producing similarly high lung viral titers; 2) HK483, but not HK486, virus induced tachypnea and depressed HVR and HCVR without changes in arterial blood pH and gases; and 3) only HK483 virus led to NP-IR in vagal SP-IR neurons, but not in the carotid body, and increased density of vagal SP-IR neurons. In addition, all HK483, rather than HK486, mice died at 6 to 8 dpi and the earlier death was correlated with more severe depression of HVR and HCVR. Our data suggest that tachypnea and depressed HVR/HCVR occur at the early stage of lethal H5N1 viral infection associated with viral replication and increased SP-IR density in vagal neurons, which may contribute to the respiratory failure and death.
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Affiliation(s)
- Jianguo Zhuang
- Pathophysiology Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM, 87108, United States of America
| | - Peng Gao
- Pathophysiology Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM, 87108, United States of America
| | - Zemmie Pollock
- Pathophysiology Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM, 87108, United States of America
| | - Kevin S. Harrod
- Pathophysiology Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM, 87108, United States of America
| | - Fadi Xu
- Pathophysiology Program, Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive SE, Albuquerque, NM, 87108, United States of America
- * E-mail:
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17
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Peretz J, Pekosz A, Lane AP, Klein SL. Estrogenic compounds reduce influenza A virus replication in primary human nasal epithelial cells derived from female, but not male, donors. Am J Physiol Lung Cell Mol Physiol 2015; 310:L415-25. [PMID: 26684252 DOI: 10.1152/ajplung.00398.2015] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022] Open
Abstract
Influenza causes an acute infection characterized by virus replication in respiratory epithelial cells. The severity of influenza and other respiratory diseases changes over the life course and during pregnancy in women, suggesting that sex steroid hormones, such as estrogens, may be involved. Using primary, differentiated human nasal epithelial cell (hNEC) cultures from adult male and female donors, we exposed cultures to the endogenous 17β-estradiol (E2) or select estrogen receptor modulators (SERMs) and then infected cultures with a seasonal influenza A virus (IAV) to determine whether estrogenic signaling could affect the outcome of IAV infection and whether these effects were sex dependent. Estradiol, raloxifene, and bisphenol A decreased IAV titers in hNECs from female, but not male, donors. The estrogenic decrease in viral titer was dependent on the genomic estrogen receptor-2 (ESR2) as neither genomic ESR1 nor nongenomic GPR30 was expressed in hNEC cultures and addition of the genomic ER antagonist ICI 182,780 reversed the antiviral effects of E2. Treatment of hNECs with E2 had no effect on interferon or chemokine secretion but significantly downregulated cell metabolic processes, including genes that encode for zinc finger proteins, many of which contain estrogen response elements in their promoters. These data provide novel insights into the cellular and molecular mechanisms of how natural and synthetic estrogens impact IAV infection in respiratory epithelial cells derived from humans.
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Affiliation(s)
- Jackye Peretz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrew P Lane
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
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18
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Prasetyo AA, Desyardi MN, Tanamas J, Suradi, Reviono, Harsini, Kageyama S, Chikumi H, Shimizu E. Respiratory viruses and torque teno virus in adults with acute respiratory infections. Intervirology 2015; 58:57-68. [PMID: 25890989 PMCID: PMC7179541 DOI: 10.1159/000369211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To define the molecular epidemiology of respiratory viral infections in adult patients. Methods Nasal and throat swabs were collected from all adult patients with influenza-like illness (ILI), acute respiratory infection (ARI), or severe ARI (SARI) admitted to a tertiary hospital in Surakarta, Indonesia, between March 2010 and April 2011 and analyzed for 19 respiratory viruses and for torque teno virus (TTV) and human gyrovirus (HGyV). Results Respiratory viruses were detected in 61.3% of the subjects, most of whom had ARI (90.8%, OR = 11.39), were hospitalized (96.9%, OR = 22.31), had asthma exacerbation (90.9%, OR = 8.67), and/or had pneumonia (80%, OR = 4.0). Human rhinovirus (HRV) A43 predominated. Influenza A H3N2, human metapneumovirus (HMPV) subtypes A1 and A2, the influenza B virus, human adenovirus B, and human coronavirus OC43 were also detected. All respiratory viruses were detected in the transition month between the rainy and dry seasons. No mixed respiratory virus infection was found. Coinfections of the influenza A H3N2 virus with TTV, HMPV with TTV, HRV with TTV, and human parainfluenza virus-3 with TTV were found in 4.7, 2.8, 19.8, and 0.9% of the samples, respectively. Conclusions This study highlights the need to perform routine detection of respiratory viruses in adults hospitalized with ARI, asthma exacerbation, and/or pneumonia.
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Affiliation(s)
- Afiono Agung Prasetyo
- Department of Microbiology, Faculty of Medicine, Sebelas Maret University, Jl. Ir. Sutami No. 36A, Surakarta 57126 (Indonesia). afie.agp.la @ gmail.com
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19
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Liu MD, Chan TC, Wan CH, Lin HP, Tung TH, Hu FC, King CC. Changing risk awareness and personal protection measures for low to high pathogenic avian influenza in live-poultry markets in Taiwan, 2007 to 2012. BMC Infect Dis 2015; 15:241. [PMID: 26104109 PMCID: PMC4478710 DOI: 10.1186/s12879-015-0987-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background Outbreaks of low and high pathogenic avian influenza (LPAI, HPAI) H5N2 in chickens have occurred in Taiwan since 2003 and 2012, respectively. Fully understanding the different awareness, attitudes and protective behaviors adopted by workers in live-poultry markets (LPMWs) and local community residents (CRs) to face the challenges of LPAI and HPAI is very important to minimize viral adaptations to human populations. Methods A structural questionnaire containing information on respondents’ occupation, personal risk awareness, attitudes toward different policies, and preventative measures was administered. The two-stage survey (before and after HPAI H5N2 outbreaks) was conducted from 2007 to 2012, including: (1) 430 LPMWs and 418 CRs at LPMs from different geographical areas of Taiwan after the government announced outbreaks of LPAI H5N2 during 2007–2009, and (2) 73 LPMWs and 152 CRs at two LPMs in central Taiwan after the HPAI H5N2 outbreaks in 2012. The chi-squared test and logistic regression were applied for univariate and multivariate analyses, respectively. Results Before HPAI-H5N2 outbreaks, higher educated respondents demonstrated greater risk awareness and concerns regarding AI. However, LPM-workers protected themselves less from AI viruses (AIVs) and had lower acceptance of human or avian influenza vaccines. Most importantly, the participants who opposed (versus agreed with) the policy on banning live-poultry slaughtering at LPMs reported lower awareness of government prevention and control policies [Odds Ratio (OR): 0.76, 95 % Confidence Interval (CI): 0.56–1.01] or practiced preventive measures (OR: 0.42, 95 % CI: 0.25–0.70). After HPAI-H5N2 outbreaks, the risk awareness about AI in central Taiwan significantly increased [LPAI to HPAI LPMWs: 34.6 to 65.6 %, p < 0.05; CRs: 44.0 to 76.5 %, p < 0.05] and LPMWs’ belief in the effectiveness of vaccination to prevent human or avian influenza virus infection strikingly decreased (92.3 to 68.5 %, p < 0.05). Conclusions Risk awareness depends on high or low pathogenicity of AIVs, working in LPMs, levels of education, age, and proximity to the sites of severe AI outbreaks. Regardless of novel LPAI or HPAI virus reassortants that pose public health risks, prompt and clear risk communication focusing on both correct information about AIVs and the most appropriate preventive measures are important for effective prevention of human infection. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0987-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming-Der Liu
- College of General Education, Hungkuang University, Taichung (433), Taiwan. .,Center for General Education, National United University, Miaoli (360), Taiwan. .,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei (100), Taiwan.
| | - Ta-Chien Chan
- Research Center for Humanities and Social Science, Academia Sinica, Taipei (115), Taiwan.
| | - Cho-Hua Wan
- Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University (NTU), Taipei (106), Taiwan.
| | - Hsiu-Ping Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei (100), Taiwan.
| | - Tsung-Hua Tung
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei (100), Taiwan.
| | - Fu-Chang Hu
- Institute of Clinical Medicine and School of Nursing, College of Medicine, National Taiwan University, Taipei (100), Taiwan.
| | - Chwan-Chuen King
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei (100), Taiwan.
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The East Jakarta Project: surveillance for highly pathogenic avian influenza A(H5N1) and seasonal influenza viruses in patients seeking care for respiratory disease, Jakarta, Indonesia, October 2011-September 2012. Epidemiol Infect 2015; 143:3394-404. [PMID: 25912029 DOI: 10.1017/s0950268815000771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Indonesia has reported the most human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus worldwide. We implemented enhanced surveillance in four outpatient clinics and six hospitals for HPAI H5N1 and seasonal influenza viruses in East Jakarta district to assess the public health impact of influenza in Indonesia. Epidemiological and clinical data were collected from outpatients with influenza-like illness (ILI) and hospitalized patients with severe acute respiratory infection (SARI); respiratory specimens were obtained for influenza testing by real-time reverse transcription-polymerase chain reaction. During October 2011-September 2012, 1131/3278 specimens from ILI cases (34·5%) and 276/1787 specimens from SARI cases (15·4%) tested positive for seasonal influenza viruses. The prevalence of influenza virus infections was highest during December-May and the proportion testing positive was 76% for ILI and 36% for SARI during their respective weeks of peak activity. No HPAI H5N1 virus infections were identified, including hundreds of ILI and SARI patients with recent poultry exposures, whereas seasonal influenza was an important contributor to acute respiratory disease in East Jakarta. Overall, 668 (47%) of influenza viruses were influenza B, 384 (27%) were A(H1N1)pdm09, and 359 (25%) were H3. While additional data over multiple years are needed, our findings suggest that seasonal influenza prevention efforts, including influenza vaccination, should target the months preceding the rainy season.
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Bui C, Bethmont A, Chughtai AA, Gardner L, Sarkar S, Hassan S, Seale H, MacIntyre CR. A Systematic Review of the Comparative Epidemiology of Avian and Human Influenza A H5N1 and H7N9 - Lessons and Unanswered Questions. Transbound Emerg Dis 2015; 63:602-620. [DOI: 10.1111/tbed.12327] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C. Bui
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
| | - A. Bethmont
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
| | - A. A. Chughtai
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
| | - L. Gardner
- School of Civil and Environmental Engineering; University of New South Wales; Sydney NSW Australia
| | - S. Sarkar
- Section of Integrative Biology; University of Texas at Austin; Austin TX USA
| | - S. Hassan
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
| | - H. Seale
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
| | - C. R. MacIntyre
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
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Daniels P, Wiyono A, Sawitri E, Poermadjaja B, Sims LD. H5N1 highly pathogenic avian influenza in Indonesia: retrospective considerations. Curr Top Microbiol Immunol 2014; 365:171-84. [PMID: 22956392 DOI: 10.1007/82_2012_265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Indonesia is one of the five countries where highly pathogenic avian influenza viruses of the H5N1 subtype (H5N1 HPAI) remain endemic in poultry. Importantly, it is one of the countries where the virus causes human infections. WHO data indicate that as of 2 May 2012, 189 human cases of Influenza A (H5N1) had been reported in Indonesia, with 157 human deaths. These human cases included a small number in which limited human-to-human transmission could have occurred. Hence, there remains a critical need in Indonesia for a more effective One Health approach to the control and prevention of this disease in people and in poultry. This chapter explores a number of aspects of the evolution of this disease in Indonesia, the virus that causes it and the control and preventive measures introduced, focusing on the successes and shortcomings of veterinary and One Health approaches. Indonesia provides many examples of situations where this latter approach has been successful, and others where further work is needed to maximize the benefits from coordinated responses to this disease leading to effective management of the risk to human health.
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Affiliation(s)
- Peter Daniels
- Australian Animal Health Laboratory, CSIRO Animal, Food and Health Sciences, PMB 24, Geelong, 3220, Australia,
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Ferrer E, Alfonso P, Ippoliti C, Abeledo M, Calistri P, Blanco P, Conte A, Sánchez B, Fonseca O, Percedo M, Pérez A, Fernández O, Giovannini A. Development of an active risk-based surveillance strategy for avian influenza in Cuba. Prev Vet Med 2014; 116:161-7. [PMID: 24938174 DOI: 10.1016/j.prevetmed.2014.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/09/2014] [Accepted: 05/25/2014] [Indexed: 11/16/2022]
Abstract
The authors designed a risk-based approach to the selection of poultry flocks to be sampled in order to further improve the sensitivity of avian influenza (AI) active surveillance programme in Cuba. The study focused on the western region of Cuba, which harbours nearly 70% of national poultry holdings and comprise several wetlands where migratory waterfowl settle (migratory waterfowl settlements - MWS). The model took into account the potential risk of commercial poultry farms in western Cuba contracting from migratory waterfowl of the orders Anseriformes and Charadriiformes through dispersion for pasturing of migratory birds around the MWS. We computed spatial risk index by geographical analysis with Python scripts in ESRI(®) ArcGIS 10 on data projected in the reference system NAD 1927-UTM17. Farms located closer to MWS had the highest values for the risk indicator pj and in total 31 farms were chosen for targeted surveillance during the risk period. The authors proposed to start active surveillance in the study area 3 weeks after the onset of Anseriformes migration, with additional sampling repeated twice in the same selected poultry farms at 15 days interval (Comin et al., 2012; EFSA, 2008) to cover the whole migration season. In this way, the antibody detectability would be favoured in case of either a posterior AI introduction or enhancement of a previous seroprevalence under the sensitivity level. The model identified the areas with higher risk for AIV introduction from MW, aiming at selecting poultry premises for the application of risk-based surveillance. Given the infrequency of HPAI introduction into domestic poultry populations and the relative paucity of occurrences of LPAI epidemics, the evaluation of the effectiveness of this approach would require its application for several migration seasons to allow the collection of sufficient reliable data.
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Affiliation(s)
- E Ferrer
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - P Alfonso
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - C Ippoliti
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy
| | - M Abeledo
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - P Calistri
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy
| | - P Blanco
- Instituto de Ecología y Sistemática (IES), Carretera Varona, Km 6, La Habana, Cuba
| | - A Conte
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy
| | - B Sánchez
- Instituto de Ecología y Sistemática (IES), Carretera Varona, Km 6, La Habana, Cuba
| | - O Fonseca
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - M Percedo
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - A Pérez
- Instituto de Medicina Veterinaria, Calle 12 No. 355, e/15 y 17 Vedado, 10400 La Habana, Cuba
| | - O Fernández
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - A Giovannini
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy.
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Davidson S, Crotta S, McCabe TM, Wack A. Pathogenic potential of interferon αβ in acute influenza infection. Nat Commun 2014; 5:3864. [PMID: 24844667 PMCID: PMC4033792 DOI: 10.1038/ncomms4864] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/10/2014] [Indexed: 12/31/2022] Open
Abstract
Influenza symptoms vary from mild disease to death; however, determinants of severity are unclear. Type I interferons (IFNαβ) are recognized as key antiviral cytokines. Here we show that, surprisingly, influenza-infected 129 mice have increased lung damage, morbidity and mortality, yet higher levels of IFNαβ, than C57BL/6 mice. Consistently, IFNα treatment of influenza-infected C57BL/6 mice increases morbidity. IFNαβ receptor deficiency in 129 mice decreases morbidity, lung damage, proinflammatory cytokines and lung-infiltrating inflammatory cells, and reduces expression of the death-inducing receptor DR5 on lung epithelia and its ligand TRAIL on inflammatory monocytes. Depletion of PDCA-1+ cells or interruption of TRAIL-DR5 interaction protects infected 129 mice. Selective lack of IFNαβ signalling in stromal cells abolishes epithelial DR5 upregulation and apoptosis, reducing host susceptibility. Hence, excessive IFNαβ signalling in response to acute influenza infection can result in uncontrolled inflammation and TRAIL-DR5-mediated epithelial cell death, which may explain morbidity and has important implications for treatment of severe disease.
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Affiliation(s)
- Sophia Davidson
- Division of Immunoregulation, MRC National Institute for Medical Research, Mill Hill, London NW7 1AA, UK
| | - Stefania Crotta
- Division of Immunoregulation, MRC National Institute for Medical Research, Mill Hill, London NW7 1AA, UK
| | - Teresa M McCabe
- Division of Immunoregulation, MRC National Institute for Medical Research, Mill Hill, London NW7 1AA, UK
| | - Andreas Wack
- Division of Immunoregulation, MRC National Institute for Medical Research, Mill Hill, London NW7 1AA, UK
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Peng Z, Wu P, Ge L, Fielding R, Cheng X, Su W, Ye M, Shi Y, Liao Q, Zhou H, Zhou L, Li L, Wu J, Zhang S, Yu Z, Wu X, Ma H, Lu J, Cowling BJ, Yu H. Rural villagers and urban residents exposure to poultry in China. PLoS One 2014; 9:e95430. [PMID: 24769673 PMCID: PMC4000224 DOI: 10.1371/journal.pone.0095430] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/26/2014] [Indexed: 11/19/2022] Open
Abstract
Patterns of poultry exposure in rural and urban areas in China have not been systematically evaluated and compared. The objective of our study is to investigate patterns in human exposure to poultry in rural and urban China. We conducted a two-stage household-based clustered survey on population exposure to live/sick/dead poultry in Xiuning and Shenzhen. Half of the rural households (51%) in Xiuning raised poultry, mostly (78%) free-range. Around half of those households (40%) allowed poultry to stay in their living areas. One quarter of villagers reported having contact with sick or dead poultry. In Shenzhen, 37% urban residents visited live poultry markets. Among these, 40% purchased live poultry and 16% touched the poultry or cages during purchase. Our findings indicated that human exposure to poultry was different in rural and urban areas in China. This discrepancy could contribute to the observed differences in epidemiologic characteristics between urban and rural cases of influenza A(H7N9) and A(H5N1) virus infection.
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Affiliation(s)
- Zhibin Peng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Wu
- University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Li Ge
- Xiangyang Center Hospital, Xiangyang, China
| | - Richard Fielding
- University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Xiaowen Cheng
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Weike Su
- Xiuning Center for Disease Control and Prevention, Xiuning, China
| | - Min Ye
- Zhoushan Entry-exit Inspection and Quarantine Bureau, Zhoushan, China
| | - Ying Shi
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiaohong Liao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hang Zhou
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Zhou
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Leilei Li
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiabing Wu
- Anhui Provincial Centers for Disease Control and Prevention, Hefei, China
| | - Shunxiang Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhangda Yu
- Huanshan Center for Disease Control and Prevention, Huangshan, China
| | - Xiaomin Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hanwu Ma
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jianhua Lu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | | | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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Kennedy RB, Ovsyannikova IG, Lambert ND, Haralambieva IH, Poland GA. The personal touch: strategies toward personalized vaccines and predicting immune responses to them. Expert Rev Vaccines 2014; 13:657-69. [PMID: 24702429 DOI: 10.1586/14760584.2014.905744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The impact of vaccines on public health and wellbeing has been profound. Smallpox has been eradicated, polio is nearing eradication, and multiple diseases have been eliminated from certain areas of the world. Unfortunately, we now face diseases such as hepatitis C, malaria or tuberculosis, as well as new and re-emerging pathogens for which we lack effective vaccines. Empirical approaches to vaccine development have been successful in the past, but may not be up to the current infectious disease challenges facing us. New, directed approaches to vaccine design, development, and testing need to be developed. Ideally these approaches will capitalize on cutting-edge technologies, advanced analytical and modeling strategies, and up-to-date knowledge of both pathogen and host. These approaches will pay particular attention to the causes of inter-individual variation in vaccine response in order to develop new vaccines tailored to the unique needs of individuals and communities within the population.
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27
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Mertz D, Kim TH, Johnstone J, Lam PP, Science M, Kuster SP, Fadel SA, Tran D, Fernandez E, Bhatnagar N, Loeb M. Populations at risk for severe or complicated Avian Influenza H5N1: a systematic review and meta-analysis. PLoS One 2014; 9:e89697. [PMID: 24603885 PMCID: PMC3948335 DOI: 10.1371/journal.pone.0089697] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/21/2014] [Indexed: 11/24/2022] Open
Abstract
Background Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic. Objectives To systematically evaluate risk factors for severe outcomes in patients with avian influenza H5N1 infection. Data sources MEDLINE, EMBASE, CINAHL, GlobalHealth, and CENTRAL through March 2011 Eligibility criteria for selecting studies Observational studies of any design published in English, French, Spanish, German or Korean that reported on risk factor-outcome combinations of interest in participants with confirmed H5N1 infections. Outcomes considered included death, ventilator support, hospital and ICU admission, pneumonia, and composite outcomes. Study appraisal Risk of bias was assessed using the Newcastle-Ottawa scale (NOS). Results We identified 20 studies reporting on 999 patients infected with H5N1. The majority of studies (n = 14, 70%) were at intermediate risk of bias, i.e. 4–6 points on the NOS. Females were at increased risk of death (OR 1.75, 95% CI 1.27–2.44), while young age, in particular <5 years of age (OR 0.44, 95% CI 0.25–0.79 for death), was protective. Data on traditional risk factors was scarce and requires further studies. Another major limitation in the published literature was lack of adjustment for confounders. Interpretation Females were at increased risk for complications following H5N1 infection while young age protected against severe outcomes. Research on traditional risk factors was limited and is required.
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Affiliation(s)
- Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
| | - Tae Hyong Kim
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Departments of Internal Medicine, Soon Chun Hyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jennie Johnstone
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Po-Po Lam
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Science
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Stefan P. Kuster
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shaza A. Fadel
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dat Tran
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Eduardo Fernandez
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Neera Bhatnagar
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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28
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Wong JP, Christopher ME, Viswanathan S, Schnell G, Dai X, Van Loon D, Stephen ER. Aerosol and nasal delivery of vaccines and antiviral drugs against seasonal and pandemic influenza. Expert Rev Respir Med 2014; 4:171-7. [DOI: 10.1586/ers.10.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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29
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Sonnberg S, Webby RJ, Webster RG. Natural history of highly pathogenic avian influenza H5N1. Virus Res 2013; 178:63-77. [PMID: 23735535 PMCID: PMC3787969 DOI: 10.1016/j.virusres.2013.05.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 05/03/2013] [Accepted: 05/20/2013] [Indexed: 12/27/2022]
Abstract
The ecology of highly pathogenic avian influenza (HPAI) H5N1 has significantly changed from sporadic outbreaks in terrestrial poultry to persistent circulation in terrestrial and aquatic poultry and potentially in wild waterfowl. A novel genotype of HPAI H5N1 arose in 1996 in Southern China and through ongoing mutation, reassortment, and natural selection, has diverged into distinct lineages and expanded into multiple reservoir hosts. The evolution of Goose/Guangdong-lineage highly pathogenic H5N1 viruses is ongoing: while stable interactions exist with some reservoir hosts, these viruses are continuing to evolve and adapt to others, and pose an un-calculable risk to sporadic hosts, including humans.
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Affiliation(s)
- Stephanie Sonnberg
- Department of Infectious Diseases St. Jude Children's Research Hospital 262 Danny Thomas Drive MS 330, Memphis, TN, 38103 USA
| | - Richard J. Webby
- Department of Infectious Diseases St. Jude Children's Research Hospital 262 Danny Thomas Drive MS 330, Memphis, TN, 38103 USA
| | - Robert G. Webster
- corresponding author, Department of Infectious Diseases St. Jude Children's Research Hospital 262 Danny Thomas Drive MS 330, Memphis, TN, 38103 USA Tel +1 901 595 3400 Fax +1 901 595 8559
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Fisher-Hoch SP, Mathews CE, McCormick JB. Obesity, diabetes and pneumonia: the menacing interface of non-communicable and infectious diseases. Trop Med Int Health 2013; 18:1510-9. [PMID: 24237786 DOI: 10.1111/tmi.12206] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To review current knowledge on the epidemiological, clinical and biological impact of the pandemic of obesity and diabetes on pneumonias. METHODS We conducted a literature review using PubMed and EMBASE, supplemented by various sources. Given the disparate and fragmented nature of the literature, a formal systematic review was not possible. RESULTS In 2008, globally 10% of men and 14% of women were obese and an estimated 371 million had diabetes; half undiagnosed and many obese. Numbers are rising rapidly in low- and middle-income countries where the majority reside, but reliable data are lacking. The most frequent pneumonias in obesity and diabetes are tuberculosis, influenza and pneumococcal, staphylococcal and opportunistic pathogens. Diabetes impacts tuberculosis control and increases drug resistance and mortality. Mortality and morbidity from pneumococcal pneumonia and influenza are increased in obesity and diabetes. In addition to mechanical and physiological effects, there are considerable immunological abnormalities characterised by chronic, low-grade inflammation. Simultaneous up-regulation and dysregulation of both innate and adaptive immune responses impair control and killing of invading organisms. Prevention in those at risk is poorly practised, although screening for tuberculosis in diabetes is beginning in high-burden settings. CONCLUSIONS Pneumonia is a threat globally in obesity and diabetes with increased incidence and severity of disease. There is uncertainty about whether vaccines are equally effective in those with obesity and diabetes. Increased epidemiological, clinical and biological knowledge will be crucial to face this 21st century challenge.
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Affiliation(s)
- Susan P Fisher-Hoch
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Brownsville, TX, USA
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Abstract
Understanding mechanisms by which genetic variants predispose to complications of infectious diseases can lead to important benefits including the development of biomarkers to prioritize vaccination or prophylactic therapy. Family studies, candidate genes in animal models, and the absence of well-defined risks where the complications are rare all can point to genetic predisposition. The most common approach to assessing genetic risk is to conduct an association study, which is a case control study using either a candidate gene approach or a genome wide approach. Although candidate gene variants may focus on potentially causal variants, because other variants across the genome are not tested these studies frequently cannot be replicated. Genome wide association studies need a sizable sample and usually do not identify causal variants but variants which may be in linkage disequilibrium to the actual causal variant. There are many pitfalls that can lead to bias in such studies, including misclassification of cases and controls, use of improper phenotypes, and genotyping errors. These studies have been limited to common genes and rare variants may not be detected. As the use of next generation sequencing becomes more common, it can be anticipated that more variants will be confirmed. The purpose of this review article is to address the issue of genomics in infectious diseases with an emphasis on the host. Although there are a plentitude of studies that focus on the molecular characteristics of pathogens, there are far fewer studies that address the role of human genetics in the predisposition to infection or more commonly its complications. This paper will review both the approaches used to study host genetics in humans and the pitfalls associated with some of these methods. The focus will be on human disease and therefore discussion of the use of animal models will be limited to those where there are genes that have been replicated in humans. The paper will focus on common genetic variants that account for complex traits such as infectious diseases using examples from flaviviruses.
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Affiliation(s)
- Mark Loeb
- Departments of Pathology and Molecular Medicine, Clinical Epidemiology and Biostatistics, and Michael G. DeGrooteInstitute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
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32
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Liao Q, Bai T, Zhou L, Vong S, Guo J, Lv W, Dong L, Xiang N, Li Z, Huai Y, Zhou J, Li X, Chen RY, Xu Z, Uyeki TM, Shu Y, Yu H. Seroprevalence of antibodies to highly pathogenic avian influenza A (H5N1) virus among close contacts exposed to H5N1 cases, China, 2005-2008. PLoS One 2013; 8:e71765. [PMID: 23967241 PMCID: PMC3742513 DOI: 10.1371/journal.pone.0071765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 07/03/2013] [Indexed: 11/18/2022] Open
Abstract
To assess the extent of highly pathogenic avian influenza (HPAI) A (H5N1) virus transmission, we conducted sero-epidemiologic studies among close contacts exposed to H5N1 cases in mainland China during 2005-2008. Blood specimens were collected from 87 household members and 332 social contacts of 23 H5N1 index cases for HPAI H5N1 serological testing by modified horse red-blood-cell hemagglutinin inhibition and microneutralization assays. All participants were interviewed with a standardized questionnaire to collect information about the use of personal protective equipment, illness symptoms, exposure to an H5N1 case during the infectious period, and poultry exposures. Two (2.3%) household contacts tested positive for HPAI H5N1 virus antibody, and all social contacts tested negative. Both seropositive cases had prolonged, unprotected, close contact with a different H5N1 index case, including days of bed-care or sleeping together during the index case's infectious period, and did not develop any illness. None of the 419 close contacts used appropriate personal protective equipment including 17% who reported providing bedside care or having physical contact with an H5N1 case for at least 12 hours. Our findings suggest that HPAI H5N1 viruses that circulated among poultry in mainland China from 2005-2008 were not easily transmitted to close contacts of H5N1 cases.
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Affiliation(s)
- Qiaohong Liao
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Tian Bai
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Lei Zhou
- Public Health Emergency Center, China CDC, Beijing, China
| | - Sirenda Vong
- World Health Organization (WHO) Beijing Office, Beijing, China
| | - Junqiao Guo
- Liaoning Center for Disease Control and Prevention, Shenyang, Liaoning, China
| | - Wei Lv
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Libo Dong
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Nijuan Xiang
- Public Health Emergency Center, China CDC, Beijing, China
| | - Zi Li
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Yang Huai
- US Centers for Disease Control and Prevention’s International Emerging Infections Program, Beijing, China
| | - Jianfang Zhou
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Xiaodan Li
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
| | - Ray Y. Chen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Zhen Xu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Yuelong Shu
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China
- * E-mail: (HJY); (YLS)
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
- * E-mail: (HJY); (YLS)
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Lin TY, Brass AL. Host genetic determinants of influenza pathogenicity. Curr Opin Virol 2013; 3:531-6. [PMID: 23933004 DOI: 10.1016/j.coviro.2013.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
Despite effective vaccines, influenza remains a major global health threat due to the morbidity and mortality caused by seasonal epidemics, as well as the 2009 pandemic. Also of profound concern are the rare but potentially catastrophic transmissions of avian influenza to humans, highlighted by a recent H7N9 influenza outbreak. Murine and human studies reveal that the clinical course of influenza is the result of a combination of both host and viral genetic determinants. While viral pathogenicity has long been the subject of intensive efforts, research to elucidate host genetic determinants, particularly human, is now in the ascendant, and the goal of this review is to highlight these recent insights.
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Affiliation(s)
- Tsai-Yu Lin
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655, United States
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34
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Adisasmito W, Aisyah DN, Aditama TY, Kusriastuti R, Trihono, Suwandono A, Sampurno OD, Prasenohadi, Sapada NA, Mamahit MJN, Swenson A, Dreyer NA, Coker R. Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation. BMC Public Health 2013; 13:571. [PMID: 23786882 PMCID: PMC3720207 DOI: 10.1186/1471-2458-13-571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 04/04/2013] [Indexed: 11/10/2022] Open
Abstract
Background Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world’s highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes. Methods Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival. Results Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days). Conclusions Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.
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Kosasih H, R, N, Klimov A, Xiyan X, Lindstrom S, Mahoney F, Beckett C, Burgess TH, Blair PJ, Uyeki TM, Sedyaningsih ER. Surveillance of influenza in Indonesia, 2003–2007. Influenza Other Respir Viruses 2013; 7:312-20. [PMID: 22804910 PMCID: PMC5779827 DOI: 10.1111/j.1750-2659.2012.00403.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Longitudinal data are limited about the circulating strains of influenza viruses and their public health impact in Indonesia. We conducted influenza surveillance among outpatients and hospitalized patients with influenza-like illness (ILI) across the Indonesian archipelago from 2003 through 2007. METHODOLOGY Demographic, clinical data, and respiratory specimens were collected for 4236 ILI patients tested for influenza virus infection by RT-PCR and viral culture. PRINCIPAL FINDINGS Influenza A and B viruses co-circulated year-round with seasonal peaks in influenza A virus activity during the rainy season (December–January). During 2003–2007, influenza viruses were identified in 20·1% (4236 ⁄ 21 030) of ILI patients, including 20·1% (4015 ⁄ 20 012) of outpatients, and 21·7% (221 ⁄ 1018) of inpatients. One H5N1 case was identified retrospectively in an outpatient with ILI. Antigenic drift in circulating influenza A and B virus strains was detected during the surveillance period in Indonesia. In a few instances, antigenically drifted viruses similar to the World Health Organization (WHO) vaccine strains were detected earlier than the date of their designation by WHO. CONCLUSIONS Influenza A and B virus infections are an important cause of influenza-like illness among outpatients and hospitalized patients in Indonesia. While year-round circulation of influenza viruses occurs, prevention and control strategies should be focused upon the seasonal peak during rainy season months. Ongoing virologic surveillance and influenza disease burden studies in Indonesia are important priorities to better understand the public health impact of influenza in South-East Asia and the implications of influenza viral evolution and global spread.
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Affiliation(s)
- Herman Kosasih
- Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
- U.S. Naval Medical Research Unit (NAMRU), Jakarta, Indonesia
| | - Roselinda
- Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Nurhayati
- U.S. Naval Medical Research Unit (NAMRU), Jakarta, Indonesia
| | - Alexander Klimov
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Xu Xiyan
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Stephen Lindstrom
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Frank Mahoney
- U.S. Centers for Disease Control and Prevention, Jakarta, Indonesia
| | | | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Timothy M. Uyeki
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
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Boni MF, Nguyen TD, de Jong MD, van Doorn HR. Virulence attenuation during an influenza A/H5N1 pandemic. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120207. [PMID: 23382429 PMCID: PMC3675429 DOI: 10.1098/rstb.2012.0207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
More than 15 years after the first human cases of influenza A/H5N1 in Hong Kong, the world remains at risk for an H5N1 pandemic. Preparedness activities have focused on antiviral stockpiling and distribution, development of a human H5N1 vaccine, operationalizing screening and social distancing policies, and other non-pharmaceutical interventions. The planning of these interventions has been done in an attempt to lessen the cumulative mortality resulting from a hypothetical H5N1 pandemic. In this theoretical study, we consider the natural limitations on an H5N1 pandemic's mortality imposed by the virus' epidemiological–evolutionary constraints. Evolutionary theory dictates that pathogens should evolve to be relatively benign, depending on the magnitude of the correlation between a pathogen's virulence and its transmissibility. Because the case fatality of H5N1 infections in humans is currently 60 per cent, it is doubtful that the current viruses are close to their evolutionary optimum for transmission among humans. To describe the dynamics of virulence evolution during an H5N1 pandemic, we build a mathematical model based on the patterns of clinical progression in past H5N1 cases. Using both a deterministic model and a stochastic individual-based simulation, we describe (i) the drivers of evolutionary dynamics during an H5N1 pandemic, (ii) the range of case fatalities for which H5N1 viruses can successfully cause outbreaks in humans, and (iii) the effects of different kinds of social distancing on virulence evolution. We discuss two main epidemiological–evolutionary features of this system (i) the delaying or slowing of an epidemic which results in a majority of hosts experiencing an attenuated virulence phenotype and (ii) the strong evolutionary pressure for lower virulence experienced by the virus during a period of intense social distancing.
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Affiliation(s)
- Maciej F Boni
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
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Sex differences in prophylaxis and therapeutic treatments for viral diseases. Handb Exp Pharmacol 2013:499-522. [PMID: 23027464 DOI: 10.1007/978-3-642-30726-3_22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The intensity and prevalence of viral infections are typically higher in males than in females. In contrast, disease outcome can be worse for females. Males and females also differ in their responses to prophylaxis and therapeutic treatments for viral diseases. In response to vaccines against herpes viruses, hepatitis viruses, influenza viruses, and others, females consistently mount higher humoral immune responses and experience more frequent and severe adverse reactions than males. Males and females also differ in the absorption, metabolism, and clearance of antiviral drugs. The pharmacological effects, including toxicity and adverse reactions, of antiviral drugs are typically greater in females than males. The efficacy of antiviral drugs at reducing viral load also differs between the sexes, with antiviral treatments being better at clearing HIV and hepatitis C virus in females, but showing greater reduction of herpes simplex virus and influenza A virus loads in males. Biological variables, including hormone and genes, as well as gender-specific factors related to access and compliance to drug regimens must be considered when evaluating male-female differences in responses to treatments for viral diseases. Clinicians, epidemiologists, and basic biomedical scientists should design experiments that include both males and females, develop a priori hypotheses that the sexes will differ in their responses to and the outcome of vaccines and antiviral treatments, and statistically analyze outcome data by sex. Knowledge that the sexes differ in response to prophylaxis and therapeutic treatments for viral diseases should influence the recommended course of treatment differently for males and females.
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Setiawaty V, Pangesti KN, Sampurno OD. Establishing a laboratory network of influenza diagnosis in Indonesia: an experience from the avian flu (H5N1) outbreak. Clin Epidemiol 2012; 4:209-12. [PMID: 22936856 PMCID: PMC3426271 DOI: 10.2147/clep.s31004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Indonesia has been part of the global influenza surveillance since the establishment of a National Influenza Center (NIC) at the National Institute of Health Research and Development (NIHRD) by the Indonesian Ministry of Health in 1975. When the outbreak of avian influenza A (H5N1) occurred, the NIC and US Naval Medical Research Unit 2 were the only diagnostic laboratories equipped for etiology confirmation. The large geographical area of the Republic of Indonesia poses a real challenge to provide prompt and accurate diagnosis nationally. This was the main reason to establish a laboratory network for H5N1 diagnosis in Indonesia. Currently, 44 laboratories have been included in the network capable of performing polymerase chain reaction testing for influenza A. Diagnostic equipment and standard procedures of biosafety and biosecurity of handling specimens have been adopted largely from World Health Organization recommendations.
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Affiliation(s)
- Vivi Setiawaty
- National Institute of Health Research and Development, Ministry of Health, the Republic of Indonesia, Jakarta, Indonesia
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LAM TOMMYTSANYUK, HON CHUNGCHAU, LEMEY PHILIPPE, PYBUS OLIVERG, SHI MANG, TUN HEINMIN, LI JUN, JIANG JINGWEI, HOLMES EDWARDC, LEUNG FREDERICKCHICHING. Phylodynamics of H5N1 avian influenza virus in Indonesia. Mol Ecol 2012; 21:3062-77. [DOI: 10.1111/j.1365-294x.2012.05577.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Horby P, Nguyen NY, Dunstan SJ, Baillie JK. The role of host genetics in susceptibility to influenza: a systematic review. PLoS One 2012; 7:e33180. [PMID: 22438897 PMCID: PMC3305291 DOI: 10.1371/journal.pone.0033180] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/06/2012] [Indexed: 12/24/2022] Open
Abstract
Background The World Health Organization has identified studies of the role of host genetics on susceptibility to severe influenza as a priority. A systematic review was conducted to summarize the current state of evidence on the role of host genetics in susceptibility to influenza (PROSPERO registration number: CRD42011001380). Methods and Findings PubMed, Web of Science, the Cochrane Library, and OpenSIGLE were searched using a pre-defined strategy for all entries up to the date of the search. Two reviewers independently screened the title and abstract of 1,371 unique articles, and 72 full text publications were selected for inclusion. Mouse models clearly demonstrate that host genetics plays a critical role in susceptibility to a range of human and avian influenza viruses. The Mx genes encoding interferon inducible proteins are the best studied but their relevance to susceptibility in humans is unknown. Although the MxA gene should be considered a candidate gene for further study in humans, over 100 other candidate genes have been proposed. There are however no data associating any of these candidate genes to susceptibility in humans, with the only published study in humans being under-powered. One genealogy study presents moderate evidence of a heritable component to the risk of influenza-associated death, and while the marked familial aggregation of H5N1 cases is suggestive of host genetic factors, this remains unproven. Conclusion The fundamental question “Is susceptibility to severe influenza in humans heritable?” remains unanswered. Not because of a lack of genotyping or analytic tools, nor because of insufficient severe influenza cases, but because of the absence of a coordinated effort to define and assemble cohorts of cases. The recent pandemic and the ongoing epizootic of H5N1 both represent rapidly closing windows of opportunity to increase understanding of the pathogenesis of severe influenza through multi-national host genetic studies.
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Affiliation(s)
- Peter Horby
- Oxford University Clinical Research Unit-Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.
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Aditama TY, Samaan G, Kusriastuti R, Sampurno OD, Purba W, Misriyah, Santoso H, Bratasena A, Maruf A, Sariwati E, Setiawaty V, Glass K, Lokuge K, Kelly PM, Kandun IN. Avian influenza H5N1 transmission in households, Indonesia. PLoS One 2012; 7:e29971. [PMID: 22238686 PMCID: PMC3251608 DOI: 10.1371/journal.pone.0029971] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disease transmission patterns are needed to inform public health interventions, but remain largely unknown for avian influenza H5N1 virus infections. A recent study on the 139 outbreaks detected in Indonesia between 2005 and 2009 found that the type of exposure to sources of H5N1 virus for both the index case and their household members impacted the risk of additional cases in the household. This study describes the disease transmission patterns in those outbreak households. METHODOLOGY/PRINCIPAL FINDINGS We compared cases (n = 177) and contacts (n = 496) in the 113 sporadic and 26 cluster outbreaks detected between July 2005 and July 2009 to estimate attack rates and disease intervals. We used final size household models to fit transmission parameters to data on household size, cases and blood-related household contacts to assess the relative contribution of zoonotic and human-to-human transmission of the virus, as well as the reproduction number for human virus transmission. The overall household attack rate was 18.3% and secondary attack rate was 5.5%. Secondary attack rate remained stable as household size increased. The mean interval between onset of subsequent cases in outbreaks was 5.6 days. The transmission model found that human transmission was very rare, with a reproduction number between 0.1 and 0.25, and the upper confidence bounds below 0.4. Transmission model fit was best when the denominator population was restricted to blood-related household contacts of index cases. CONCLUSIONS/SIGNIFICANCE The study only found strong support for human transmission of the virus when a single large cluster was included in the transmission model. The reproduction number was well below the threshold for sustained transmission. This study provides baseline information on the transmission dynamics for the current zoonotic virus and can be used to detect and define signatures of a virus with increasing capacity for human-to-human transmission.
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Affiliation(s)
- Tjandra Y. Aditama
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Gina Samaan
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rita Kusriastuti
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Ondri Dwi Sampurno
- National Institute of Health Research and Development, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Wilfried Purba
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Misriyah
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Hari Santoso
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Arie Bratasena
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Anas Maruf
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Elvieda Sariwati
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Vivi Setiawaty
- National Institute of Health Research and Development, Ministry of Health, Salemba, Jakarta, Indonesia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul M. Kelly
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- Population Health Division, Australian Capital Territory Government Health Directorate, Canberra, Australian Capital Territory, Australia
| | - I. Nyoman Kandun
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Salemba, Jakarta, Indonesia
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Yang P, Shi W, Cui S, Zhang Y, Liu X, Wang Q. Infection with multiple avian influenza viruses in a man without poultry-handling practices suggesting an increased probability of emergent pandemic influenza virus in general population. Clin Infect Dis 2011; 54:307. [PMID: 22144542 DOI: 10.1093/cid/cir844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Immunogenetic factors associated with severe respiratory illness caused by zoonotic H1N1 and H5N1 influenza viruses. Clin Dev Immunol 2011; 2012:797180. [PMID: 22110538 PMCID: PMC3216312 DOI: 10.1155/2012/797180] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 09/16/2011] [Indexed: 01/31/2023]
Abstract
Following the 2009 H1N1 pandemic and ongoing sporadic avian-to-human transmission of H5N1 viruses, an emphasis has been placed on better understanding the determinants and pathogenesis of severe influenza infections. Much of the current literature has focused on viral genetics and its impact on host immunity as well as novel risk factors for severe infection (particularly within the H1N1 pandemic). An understanding of the host genetic determinants of susceptibility and severe respiratory illness, however, is currently lacking. By better defining the role of genetic variability in influenza infection and identifying key polymorphisms that impair the host immune response or correlate with protection, we will be able to better identify at-risk populations and new targets for therapeutic interventions and vaccines. This paper will summarize known immunogenetic factors associated with susceptibility or severity of both pH1N1 and H5N1 infections and will also identify genetic pathways and polymorphisms of high relevance for future study.
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Lei F, Shi W. Prospective of Genomics in Revealing Transmission, Reassortment and Evolution of Wildlife-Borne Avian Influenza A (H5N1) Viruses. Curr Genomics 2011; 12:466-74. [PMID: 22547954 PMCID: PMC3219842 DOI: 10.2174/138920211797904052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 07/27/2011] [Accepted: 08/10/2011] [Indexed: 12/24/2022] Open
Abstract
The outbreak of highly pathogenic avian influenza (HPAI) H5N1 disease has led to significant loss of poultry and wild life and case fatality rates in humans of 60%. Wild birds are natural hosts for all avian influenza virus subtypes and over120 bird species have been reported with evidence of H5N1 infection. Influenza A viruses possess a segmented RNA genome and are characterized by frequently occurring genetic reassortment events, which play a very important role in virus evolution and the spread of novel gene constellations in immunologically naïve human and animal populations. Phylogenetic analysis of whole genome or sub-genomic sequences is a standard means for delineating genetic variation, novel reassortment events, and surveillance to trace the global transmission pathways. In this paper, special emphasis is given to the transmission and circulation of H5N1 among wild life populations, and to the reassortment events that are associated with inter-host transmission of the H5N1 viruses when they infect different hosts, such as birds, pigs and humans. In addition, we review the inter-subtype reassortment of the viral segments encoding inner proteins between the H5N1 viruses and viruses of other subtypes, such as H9N2 and H6N1. Finally, we highlight the usefulness of genomic sequences in molecular epidemiological analysis of HPAI H5N1 and the technical limitations in existing analytical methods that hinder them from playing a greater role in virological research.
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Affiliation(s)
- Fumin Lei
- Key Laboratory of the Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Weifeng Shi
- The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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Aditama TY, Samaan G, Kusriastuti R, Purba WH, Misriyah, Santoso H, Bratasena A, Maruf A, Sariwati E, Setiawaty V, Cook AR, Clements MS, Lokuge K, Kelly PM, Kandun IN. Risk factors for cluster outbreaks of avian influenza A H5N1 infection, Indonesia. Clin Infect Dis 2011; 53:1237-44. [PMID: 22016499 DOI: 10.1093/cid/cir740] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND By 30 July 2009, Indonesia had reported 139 outbreaks of avian influenza (AI) H5N1 infection in humans. Risk factors for case clustering remain largely unknown. This study assesses risk factors for cluster outbreaks and for secondary case infection. METHODS The 113 sporadic and 26 cluster outbreaks were compared on household and individual level variables. Variables assessed include those never reported previously, including household size and genealogical relationships between cases and their contacts. RESULTS Cluster outbreaks had larger households and more blood-related contacts, especially first-degree relatives, compared with sporadic case outbreaks. Risk factors for cluster outbreaks were the number of first-degree blood-relatives to the index case (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI]: 1.20-1.86) and index cases having direct exposure to sources of AI H5N1 virus (aOR, 3.20; 95% CI: 1.15-8.90). Risk factors for secondary case infection were being aged between 5 and 17 years (aOR, 8.32; 95% CI: 1.72-40.25), or 18 and 30 years (aOR, 6.04; 95% CI: 1.21-30.08), having direct exposure to sources of AI H5N1 virus (aOR, 3.48; 95% CI: 1.28-9.46), and being a first-degree relative to an index case (aOR, 11.0; 95% CI: 1.43-84.66). Siblings to index cases were 5 times more likely to become secondary cases (OR, 4.72; 95% CI: 1.67-13.35). CONCLUSIONS The type of exposure and the genealogical relationship between index cases and their contacts impacts the risk of clustering. The study adds evidence that AI H5N1 infection is influenced by, and may even depend on, host genetic susceptibility.
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Affiliation(s)
- Tjandra Y Aditama
- Directorate-General Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia
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Lorenzo ME, Hodgson A, Robinson DP, Kaplan JB, Pekosz A, Klein SL. Antibody responses and cross protection against lethal influenza A viruses differ between the sexes in C57BL/6 mice. Vaccine 2011; 29:9246-55. [PMID: 21983155 DOI: 10.1016/j.vaccine.2011.09.110] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 07/22/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
A mouse model was used to determine if protective immunity to influenza A virus infection differs between the sexes. The median lethal dose of H1N1 or H3N2 was lower for naïve females than males. After a sublethal, primary infection with H1N1 or H3N2, females and males showed a similar transient morbidity, but females generated more neutralizing and total anti-influenza A virus antibodies. Immunized males and females showed similar protection against secondary challenge with a homologous virus, but males experienced greater morbidity and had higher lung viral titers after infection with a lethal dose of heterologous virus. Females develop stronger humoral immune responses and greater cross protection against heterosubtypic virus challenge.
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Affiliation(s)
- Maria E Lorenzo
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Poetri O, Bouma A, Claassen I, Koch G, Soejoedono R, Stegeman A, van Boven M. A single vaccination of commercial broilers does not reduce transmission of H5N1 highly pathogenic avian influenza. Vet Res 2011; 42:74. [PMID: 21635732 PMCID: PMC3132710 DOI: 10.1186/1297-9716-42-74] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 06/02/2011] [Indexed: 11/24/2022] Open
Abstract
Vaccination of chickens has become routine practice in Asian countries in which H5N1 highly pathogenic avian influenza (HPAI) is endemically present. This mainly applies to layer and breeder flocks, but broilers are usually left unvaccinated. Here we investigate whether vaccination is able to reduce HPAI H5N1 virus transmission among broiler chickens. Four sets of experiments were carried out, each consisting of 22 replicate trials containing a pair of birds. Experiments 1-3 were carried out with four-week-old birds that were unvaccinated, and vaccinated at day 1 or at day 10 of age. Experiment 4 was carried out with unvaccinated day-old broiler chicks. One chicken in each trial was inoculated with H5N1 HPAI virus. One chicken in each trial was inoculated with virus. The course of the infection chain was monitored by serological analysis, and by virus isolation performed on tracheal and cloacal swabs. The analyses were based on a stochastic SEIR model using a Bayesian inferential framework. When inoculation was carried out at the 28th day of life, transmission was efficient in unvaccinated birds, and in birds vaccinated at first or tenth day of life. In these experiments estimates of the latent period (~1.0 day), infectious period (~3.3 days), and transmission rate parameter (~1.4 per day) were similar, as were estimates of the reproduction number (~4) and generation interval (~1.4 day). Transmission was significantly less efficient in unvaccinated chickens when inoculation was carried out on the first day of life. These results show that vaccination of broiler chickens does not reduce transmission, and suggest that this may be due to the interference of maternal immunity.
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Affiliation(s)
- Okti Poetri
- Faculty of Veterinary Medicine, Department of Farm Animal Health, Utrecht, The Netherlands.
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DHARMAYANTI NILUHPUTUINDI, IBRAHIM FERA, DARMINTO, SOEBANDRIO AMIN. Influenza H5N1 Virus of Birds Surrounding H5N1 Human Cases Have Specific Characteristics on the Matrix Protein. HAYATI JOURNAL OF BIOSCIENCES 2011. [DOI: 10.4308/hjb.18.2.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ope MO, Katz MA, Aura B, Gikunju S, Njenga MK, Ng'ang'a Z, Vulule J, Breiman RF, Feikin DR. Risk factors for hospitalized seasonal influenza in rural western Kenya. PLoS One 2011; 6:e20111. [PMID: 21637856 PMCID: PMC3102693 DOI: 10.1371/journal.pone.0020111] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/12/2011] [Indexed: 11/24/2022] Open
Abstract
Background Risk factors for influenza hospitalization in Africa are unknown, including the role of HIV. Methods We conducted a case-control study of risk factors for hospitalized seasonal influenza among persons in rural western Kenya, a high HIV prevalence area, from March 2006- August 2008. Eligible cases were ≥five years old, admitted to health facilities with respiratory symptoms, and had nasopharyngeal/oropharyngeal swab specimens that tested positive for influenza A or B by real-time reverse transcription-PCR. Three randomly selected age-, sex- and neighborhood-matched controls were enrolled per case. A structured questionnaire was administered and home-based HIV testing was performed. Risk factors were evaluated using conditional logistic regression. Results A total of 64 cases (38 with influenza A and 26 with influenza B) and 190 controls were enrolled. The median age was 16 years (range 5–69 years). Among cases, 24.5% were HIV-infected versus 12.5% of controls (p = 0.004). Among persons ≥18 years old, 13 (59%) of 22 tested cases were HIV-positive compared with 15 (24%) of 62 tested controls (p = 0.005). In multivariable analysis, HIV-infection was associated with hospitalization due to influenza [adjusted Odds Ratio (aOR) 3.56, 95% CI 1.25–10.1]. The mean CD4 count among HIV-infected cases and controls was similar (399 vs. 387, respectively, p = 0.89). Chronic lung disease (aOR 6.83, 95% CI 1.37–34.0) was also associated with influenza hospitalization in multivariable analysis. Active pulmonary tuberculosis was associated with influenza hospitalization in bivariate, but not multivariable, analysis. Conclusions People with HIV infection and chronic lung disease were at increased risk of hospitalized influenza in rural Kenya. HIV infection is common in many parts of sub-Saharan Africa. Influenza vaccine might prevent severe influenza in these risk groups.
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Affiliation(s)
- Maurice O Ope
- Department of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Nairobi, Kenya
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The virulence of 1997 H5N1 influenza viruses in the mouse model is increased by correcting a defect in their NS1 proteins. J Virol 2011; 85:7048-58. [PMID: 21593152 DOI: 10.1128/jvi.00417-11] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The NS1 protein of human influenza A viruses binds the 30-kDa subunit of the cleavage and polyadenylation specificity factor (CPSF30), a protein required for 3' end processing of cellular pre-mRNAs, thereby inhibiting production of beta interferon (IFN-β) mRNA. The NS1 proteins of pathogenic 1997 H5N1 viruses contain the CPSF30-binding site but lack the consensus amino acids at positions 103 and 106, F and M, respectively, that are required for the stabilization of CPSF30 binding, resulting in nonoptimal CPSF30 binding in infected cells. Here we have demonstrated that strengthening CPSF30 binding, by changing positions 103 and 106 in the 1997 H5N1 NS1 protein to the consensus amino acids, results in a remarkable 300-fold increase in the lethality of the virus in mice. Unexpectedly, this increase in virulence is not associated with increased lung pathology but rather is characterized by faster systemic spread of the virus, particularly to the brain, where increased replication and severe pathology occur. This increased spread is associated with increased cytokine and chemokine levels in extrapulmonary tissues. We conclude that strengthening CPSF30 binding by the NS1 protein of 1997 H5N1 viruses enhances virulence in mice by increasing the systemic spread of the virus from the lungs, particularly to the brain.
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