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Pedro Pechirra; Paulo Gonçalves; Patrícia Conde; Raquel Guiomar1; Vítor Duque; João Vaz; Graça Ribeiro2; Rita Cabral; Luísa Mota
Vieira3; Madalena Almeida Santos; Maria José Silvestre4; Ana Rita Pimentel Couto; Jacome Bruges Armas5; Ana Paula Castro;
Maria Helena Ramos6; André Janeiro; Paula Mimoso; Rute Marcelino7; Aida Fernandes; Luís Milho; João Rego; Álvaro Beleza8;
Maria do Rosário Barreto; Dinah Carvalho; Carlos Manuel Ribeiro9; Paula Fernandes; Graça Andrade10; Joana Sobrinho Simões; Mª
do Rosário Costa; João Tiago Guimarães11; Rita Corte Real; Paula Branquinho12; Filomena Caldeira; Manuel Maurílio13
1Laboratório
3Unidade de
Nacional de Referência para o Vírus da Gripe, Instituto Nacional de Saúde Dr. Ricardo Jorge, Portugal; 2Hospitais da Universidade de Coimbra;
Genética e Patologia Moleculares do Hospital do Divino Espírito Santo de Ponta Delgada, EPE; 4Hospital Curry Cabral, E.P.E.; 5Hospital Santo Espírito de
Angra do Heroísmo, Açores; 6Centro Hospitalar do Porto - Hosp. Santo António; 7IMM, Laboratório da Unidade de Diagnóstico Molecular Genomed; 8Laboratório
Regional de Saúde Pública Drª Laura Ayres - Faro; 9Centro Hospitalar Lisboa Norte - Hospital de Santa Maria, Lisboa; 10Hospital Central do Funchal; 11Centro
Hospitalar do Porto - Hosp. São João; 12Centro Hospitalar de Lisboa Central - Hosp. São José; 13Hospital do Espírito Santo, E.P.E. – Évora
Objectives::
Objectives
Results::
Results
During the 2009/10 influenza pandemic, a network of 13
Influenza A(H1N1)2009
laboratories located in mainland Portugal, Madeira and
The 9 laboratories reported a total of 1512 respiratory disease cases, from week 46/2010 to week 16/2011 (peak of 236 cases
Açores was activated for the diagnosis of the new
(15.6%) during week 3/2011), the majority of which (42.5%) were adults between 15-44 years (Figure 1). Influenza A(H1N1)2009 was
influenza A(H1N1)2009 pandemic strain (Despacho do
tested in 1496 cases, 38.2% of which were positive (Figure 2).
Ministério da Saúde nº 16548/2009). During 2010/11 the
Influenza diagnosis on ILI cases reported
250
90,0
detection of other respiratory pathogens, thus contributing
Portugal. This data is published weekly in the influenza
virological
surveillance
bulletin
(http://www.insa.pt/sites/INSA/Portugues/Documents/Grip
600
No. cases reported
%
80,0
500
No. cases reported
to the laboratory diagnosis of respiratory disease in
100,0
70,0
60,0
400
42,5%
50,0
300
40,0
26,9%
30,0
200
14,0%
12,8%
100
20,0
3,2%
10,0
0
e2.pdf). This study describes the results obtained during
n=1496
5-14
15-44
45-64
>=65
A(H1)2009-positive
150
100
50
0,0
0-4
A(H1)2009-negative
200
ILI cases analysed
700
% of reported cases by age group
network also started to implement methodologies for the
0
NI
40 41 42 43 44 45 46 47 48 49 50 51 52 1
2
3
Age group
this period.
Methods:
From the 13 laboratories, 9 reported cases of
respiratory disease during the 2010/11 winter. These
laboratories are not only capable of performing
influenza A(H1)2009 diagnosis but also implemented
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
Figure 2 – Weekly distribution of ILI cases reported and tested for pandemic influenza. Laboratory results are shown.
Signs and Symptoms of influenza
Seasonal influenza viruses
n=507
were also tested on 507
A(H1)pdm
A(H3)
B
Neg
224
267
cases, 16 of which were
14
found positive (2 A(H3) and
14 type B) (Figure 3).
4
Week
Figure 1 – Number and percentage of cases reported by age
group. NI – no information.
Table I – Signs and Symptoms associated with a higher risk of having influenza
Influenza
Sign/symptom
Sudden onset
2
Figure 3 – Number of cases tested for both seasonal and
pandemic influenza. Laboratory results are shown
Odds ratio
(crude)
95% CI
Odds ratio
(adjusted)
95% CI
1.14
0.55-2.39
1.17
0.30-4.52
Fever
3.28
1.27-9.49
6.38
1.95-20.83
(6 laboratories), influenza A (H1 and H3) seasonal
Cough
1.02
0.38-2.87
0.62
0.15-2.51
viruses (4 laboratories), and other infectious agents
Sorethroat
1.41
0.61-3.23
1.41
0.30-6.69
Respiratory
difficulty
0.96
0.28-3.26
0.99
0.23-4.27
methodologies for the detection of influenza B viruses
associated with respiratory disease: adenovirus,
coronavirus, rhinovirus, respiratory syncytial virus,
metapneumovirus, parainfluenza virus, H. influenzae
and S. pneumoniae (3 laboratories).
Other respiratory agents were tested on 284 cases, 12.7% of which
were positive (1 adenovirus, 3 coronavirus, 1 metapneumovirus, 12
rhinovirus, 9 RSV, 1 H. influenza, 1 S. pneumoniae, and 7 mixed
The association analysis between the clinical symptoms
infections) (Figure 4).
(fever, sudden onset, sorethroat, respiratory difficulty) and
9
1
1
Negative
Adenovirus
Conclusions::
Conclusions
Portuguese National Health Authorities are planning to
Coronavirus
7
Negative
249
Positive
35
hMPV
Rhinovirus
RSV
the influenza-positive laboratory result showed a higher
positive correlation with fever (OR 6.38, 95%CI 1.9520.83) (Table I).
H. influenzae
1
develop and implement an integrated surveillance
system for Severe Acute Respiratory Infection in the
12
n=284
3
S. pneumoniae
Mixed Infections
1
Information on influenza vaccination with the 2010/2011
trivalent vaccine was available for 308 (20.4%) of all
Figure 4 – Number of cases tested for other respiratory pathogens
cases reported, 33 (10.7%) of which were vaccinated. All
near future, where the Portuguese network is
vaccinated individuals were negative for influenza.
expected to play a major role. Continuous laboratory
participation and further advances in its diagnostic
Acknowledgments::
Acknowledgments
capabilities are essential to improve the surveillance
The authors would like to thank Dr. Baltazar Nunes (Departamento de Epidemiologia, Instituto Nacional de Saúde Dr. Ricardo Jorge)
of respiratory infection in Portugal.
for his contribution on the statistical analysis.
For further information on this poster please contact: Raquel Guiomar, Laboratório Nacional de Referência para o Vírus da Gripe, [email protected]; Tel.: 00351217519216, Fax.: 00351217526400
Poster no. PO44
14th Annual Meeting of European Society for Clinical Virology,
Funchal, Madeira, 21-24 September 2010