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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