The European I-MOVE Multicentre 2013–2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2)

BackgroundIn the first five I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) influenza seasons vaccine effectiveness (VE) results were relatively homogenous among participating study sites. In 2013–2014, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in six European Union (EU) countries to measure 2013–2014 influenza VE against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated during the season.MethodsPractitioners systematically selected ILI patients to swab within eight days of symptom onset.We compared cases (ILI positive to influenza A(H3N2) or A(H1N1)pdm09) to influenza negative patients. We calculated VE for the two influenza A subtypes and adjusted for potential confounders. We calculated heterogeneity between sites using the I² index and Cochrane's Q test. If the I² was <50%, we estimated pooled VE as (1 minus the OR) × 100 using a one-stage model with study site as a fixed effect. If the I² was >49% we used a two-stage random effects model.ResultsWe included in the A(H1N1)pdm09 analysis 531 cases and 1712 controls and in the A(H3N2) analysis 623 cases and 1920 controls. For A(H1N1)pdm09, the Q test (p = 0.695) and the I² index (0%) suggested no heterogeneity of adjusted VE between study sites. Using a one-stage model, the overall pooled adjusted VE against influenza A(H1N1)pdm2009 was 47.5% (95% CI: 16.4–67.0).For A(H3N2), the I² was 51.5% (p = 0.067). Using a two-stage model for the pooled analysis, the adjusted VE against A(H3N2) was 29.7 (95% CI: −34.4–63.2).ConclusionsThe results suggest a moderate 2013–2014 influenza VE against A(H1N1)pdm09 and a low VE against A(H3N2). The A(H3N2) estimates were heterogeneous among study sites. Larger sample sizes by study site are needed to prevent statistical heterogeneity, decrease variability and allow for two-stage pooled VE for all subgroup analyses.     

职业暴露人群A(H5N1)和甲型H1N1流感血清抗体分析

目的:了解人禽流感A(H5N1)和甲型H1N1流感职业暴露人群中的感染状况。方法:对职业暴露人群进行个案调查,采用血凝抑制法(HI)检测职业暴露人群血清中人禽流感A(H5N1)和甲型H1N1流感抗体。结果:2009年-2010年采集的624份职业暴露人群血清中未检测出人禽流感A(H5N1)抗体,而在2009年采集的血清中有5份检测出甲型H1N1流感抗体,抗体阳性率为1.55%,2010年采集的血清中抗体阳性率为11.96%,其中<29岁阳性率为17.19%,30岁～59岁阳性率为10.87%。结论:职业暴露人群中未检测出A(H5N1)流感抗体,但仍需加强职业暴露人群监测。同时甲型H1N1流感抗体水平较低,缺乏相应的抗体水平保护。     

一起甲型H1N1和H3N2流感病毒混合感染调查研究

目的 从病例临床特征、抗体变化规律及病原学检测等多角度分析一起由甲型H1N1和H3N2流感病毒混合感染引起暴发疫情的流行特征,为有效控制疾病的发生与蔓延提供科学依据.方法 采用回顾性调查和现场流行病学调查方法进行问卷调查,利用RT-PCR和血凝抑制试验分别进行流感病毒和血清抗体检测.结果 45例流感样病例中,确诊40例,其中22例为甲型H1N1流感、12例为季节性H3N2型流感、6例为H1N1和H3N2病毒混合感染.不同病毒感染病例的临床表现差异无统计学意义.序列比对分析显示,混合病毒感染和单一病毒感染者的甲型H1N1和季节性H3N2病毒基因序列没有差异.同时分析表明,所有流感病例的病毒株均对金刚烷胺耐药,对奥司他韦(达菲)有效.患者的双份血清血凝抑制试验检测表明,暴发由甲型H1N1和H3N2流感病毒混合感染引起.结论 这是一起由甲型H1N1和H3N2流感病毒混合感染引起的疫情,甲型H1N1病毒在传播过程中可能较H3N2更具有优势.     

江西省季节性A(H1N1)流感病毒的基因特点及耐药性分析

目的分析江西省2005年-2009年季节性H1N1流感病毒M2以及NA基因的特点,掌握其耐药情况,为流感防控提供参考。方法从江西省流感监测网中随机选择26株季节性A(H1N1)流感病毒,经核酸提取和one-step RTPCR扩增M以及NA基因片段,双向序列测定,采用DNAStar 5.0和Mage 4.0序列分析软件分析M2以及NA基因特征以及耐药性位点。结果除2005年分离的3株病毒和2009年分离的2株病毒的M2基因重要位点未发生变异外,其他21株病毒均发生了S31N的氨基酸替换;2009年的5株分离株均发生H274Y突变外,其他21株病毒NA蛋白催化活性位点和辅助位点均未发生氨基酸替换。结论 2005年分离株均对奥司他韦敏感,部分毒株对金刚烷胺类药物耐药;2006年-2008年的分离株对金刚烷胺类药物耐药,但对奥司他韦敏感;2009年的分离株均对奥司他韦耐药,部分毒株对金刚烷胺类药物也耐药,应加强流感病毒耐药性监测。     

2012 - 2013 年长春地区甲 3( H3N2) 亚型流感病毒 HA1 基因序列分析

目的了解2012—2013年长春地区流感病毒优势流行甲3（H3N2）亚型流感病毒HA1基因序列的特性。方法采用MDCK细胞分离培养流感病毒,提取病毒RNA,进行逆转录和聚合酶链式反应（RT—PCR）,扩增产物用纯化试剂盒纯化后测序,用Mega5．10软件中NeighborJoining方法进行基因种系发生树分析。结果（1）2012—2013年吉林省长春地区流行的H3N2亚型流感毒株核苷酸同源性为95．8％-100．0％,2012年流行的H3N2亚型流感毒株与WHO推荐的2011—2012年疫苗株A／perth／16／2009相比有15个氨基酸发生了变异;2013年流行的H3N2亚型流感毒株与WHO推荐的2012—2013年疫苗株A／Victoria／361／2011相比有13个氨基酸发生了变异。（2）2012年2—3月分离的毒株与2012年11月-2013年3月分离的毒株在进化树上处于两个不同的侧枝上。结论2012—2013年长春地区流行的H3N2亚型流感毒株与WHO推荐的疫苗株A／peah／16／2009、A／Victoria／361／2011相比HA1基因已经发生了一定的变化,不同时间流行的病毒株也有差异。     

利用TaqMan-MGB探针检测A(H3N2)亚型流行性感冒病毒E119V耐药突变

目的 建立快速检测A(H3N2)亚型流行性感冒病毒(简称流感病毒)神经氨酸酶(M)基冈E119V奥司他韦耐药突变位点的双重实时荧光定量逆转录PCR(rRT-PCR)方法.方法 由GenBank获取2000-2012年A(H3N2)亚型流感病毒NA基因序列26条,据此设计特异性靶向NA E119V突变位点的TaqMan-MGB探针进行双重rRT-PCR反应,并利用耐药参考株、临床分离株进行敏感性、特异性和重复性评价.结果 建立了快速检测NA基因E119V位点的双重rRT-PCR检测方法.本方法在A(H3N2)病毒(HA=8)稀释度至10-5仍可检测到荧光信号,病毒滴度的对数与Ct值之间呈线性相关,具有较高的灵敏度;与无耐药突变的A(H3N2)流感病毒及其他呼吸道病毒均无交叉反应,两条TaqMan-MGB探针之问不存在交叉反应,具有很高的特异性,并能够检测耐药株和敏感株混合病毒中的耐药突变,在较高浓度的混合病毒中对耐药突变的检测限是5％,在低浓度混合病毒中的检测限是50％.重复性试验得到H3N2-119E和H3N2-119V两组探针批内平均变异系数(CV)值分别为2.32％和0.57％,批间CV值分别为1.77％和0.97％,具有较好的重复性.对其中20株病毒的NA基因序列进行分析,证实这些毒株的NA基因119位点均为谷氨酸(E),表明本研究设计的方法与序列测定结果一致.结论 建立了基于TaqMan-MGB探针检测A(H3N2)亚型流感病毒E119V耐药突变的双重rRT-PCR方法,该方法灵敏、特异、重复性好,实验过程和结果判读简单易操作.     

流感甲3（H3N2）和甲1（H1N1）型的临床反应的研究

１９９８年２月中旬至３月上旬，广西铁路百色地区某小学发生流感暴发流行，经病毒分离证实为混合型流感暴发流行，发病以甲１（Ｈ１Ｎ１）和甲３（Ｈ３Ｎ２）为主［１］。为此我们对甲１（Ｈ１Ｎ１）和甲３（Ｈ３Ｎ２）两种不同亚型毒株引起临床反应进行研究，结果报告如下。１　对象与方法１１　研究对象　随机抽取该时间内发病的患者双份血清３９人份，分别用流感毒株甲３型（Ａ／Ｓｈａｎｇｄｏｎｇ／９／９３）（Ｈ３Ｎ２），甲１型（Ａ／Ｔａｉｗａｎ／１／８６）（Ｈ１Ｎ１）做血凝抑制试验测定血凝抑制（ＨＩ）抗体滴度。凡ＨＩ…     

《甲型H1N1流诊疗方案(第3版)》发布

为有效应对甲型H1N1流感的流行,科学、规范、有效地开展医疗救治工作,卫生部近日对<甲型H1N1流感诊辽方案(2009年试行版第2版)>进行了修订、完善,研究制定了<甲型H1N1流感诊辽方案(2009年第3版)>.     

中国香港特别行政区的甲型(H5N1)流感

中国香港特别行政区的甲型（Ｈ５Ｎ１）流感徐兆炜１摘译香港卫生署与美国ＣＤＣ协作对香港的甲型（Ｈ５Ｎ１）流感进行了一次病人－对照组调查研究，目的是比较病人和对照组人群的各种不同的接触危险因子。这些因子包括：在发病前一周内有无接触活禽、食品加工和饮食情况...     

Narcolepsy and adjuvanted pandemic influenza A (H1N1) 2009 vaccines – Multi-country assessment

BackgroundIn 2010, a safety signal was detected for narcolepsy following vaccination with Pandemrix, an AS03-adjuvanted monovalent pandemic H1N1 influenza (pH1N1) vaccine. To further assess a possible association and inform policy on future use of adjuvants, we conducted a multi-country study of narcolepsy and adjuvanted pH1N1 vaccines.MethodsWe used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence rates (IR) before and during pH1N1 virus circulation, and after pH1N1 vaccination campaigns in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. Using a case-control study design, we evaluated the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands. In the Netherlands, we also conducted a case-coverage study in children born between 2004 and 2009.ResultsNo changes in narcolepsy IRs were observed in any periods in single study sites except Sweden and Taiwan; in Taiwan incidence increased after wild-type pH1N1 virus circulation and in Sweden (a previously identified signaling country), incidence increased after the start of pH1N1 vaccination. No association was observed for Arepanrix-AS03 or Focetria-MF59 adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the case-control study nor for children born between 2004 and 2009 in the Netherlands case-coverage study for Pandemrix-AS03.ConclusionsOther than elevated narcolepsy IRs in the period after vaccination campaigns in Sweden, we did not find an association between AS03- or MF59-adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the sites studied, although power to evaluate the AS03-adjuvanted Pandemrix brand vaccine was limited in our study.     

Pandemic Influenza A (H1N1) in Non-vaccinated,Pregnant Women in Spain (2009–2010)

The aim of this study was to investigate the main characteristics of non-vaccinated pregnant women who were hospitalised for influenza A (H1N1) pdm09 pandemic versus pregnant women hospitalised for non-influenza-related reasons in Spain, and to characterise the clinical presentation of the disease in this population to facilitate early diagnosis and future action programmes. Understanding influenza infection during pregnancy is important as pregnant women are a high-risk population for increased morbidity from influenza infection. We investigated the socio-demographic and clinical features of 51 non-vaccinated, pregnant women infected with the pandemic influenza A (H1N1) virus in Spain (cases) and compared them to 114 controls (non-vaccinated and non-infected pregnant women) aged 15–44 years. Substantial and significant odd ratios (ORs) for pandemic influenza A (H1N1) were found for the pregnant women who were obese compared with controls (body mass index > 30) (OR 3.03; 95 % confidence intervals 1.13–8.11). The more prevalent symptoms observed in pandemic influenza-infected pregnant women were high temperature, cough (82.4 %), malaise (80.5 %), myalgia (56.1 %), and headaches (54.9 %). Our results suggest that the initial symptoms and risk factors for infection of pregnant women with the influenza A (H1N1) pdm09 virus are similar to the symptoms and risk factors for seasonal influenza, which make early diagnosis difficult, and reinforces the need to identify and protect high-risk groups.     

WHO报告全球人类禽流感(H5N1)确诊病例全球人类禽流感(H5N1)确诊病例

国家2003年病例数死亡数2003年病例数死亡数2003年病例数死亡数2003年病例数死亡数2003年病例数死亡数阿塞拜疆0 0 0 0 0 0 8 5 8 5柬埔寨0 0 0 0 4 4 2 2 6 6中国0 0 0 0 8 5 10 7 18 12埃及0 0 0 00 0 0 13 5 13 5印度尼西亚0 0 0 0 17 11 16 14 33 25伊拉克0 0 0 0 0 0 2 2     

2010-2013年中山市流感病毒(H3N2)血凝素基因特征分析

目的研究中山市2010-2013年流行的H3N2亚型流感病毒的血凝素基因特征,分析其基因变异情况。方法选取2010-2013年中山市流行的H3N2亚型流感病毒6株,用MDCK细胞分离病毒,提取病毒RNA,RT-PCR扩增HA基因并测定序列,利用BLASTn对序列进行相似性检索,分析其与疫苗株,不同年份、区域流行株的进化变异情况。结果共分离鉴定到6株H3N2亚型流感病毒,其中2株为2010年流行株,2株为2012年流行株,2株为2013年流行株。各年流行株与其他国家或地区当年大部分流行株在一个分支上,其进化距离随着进化时间变长而变远。2012年流行株相对2010年流行株在HA1区发生12个氨基酸位点变异,有3个位于B、C区。2013年流行株相对2012年流行株发生4个氨基酸位点变异,有2个位于A区。2012年、2013年流行株相对于疫苗株分别发生6、8个氨基酸位点变异,分别有2、4个位于A、B、C区。受体结合位点未发生变异。结论中山市H3N2亚型流感病毒流行株在年度之间存在一定变异程度,进化距离随着进化时间变长而变远,相对于疫苗株也存在一定程度上的变异。     

AdimFlu-S(®) influenza A (H1N1) vaccine during pregnancy: the Taiwanese Pharmacovigilance Survey

Background

This study evaluated the incidence, nature, and seriousness of adverse drug reactions (ADRs) occurring after AdimFlu-S^® influenza A (H1N1) vaccination in pregnant women was administered.

Methods

This is a retrospective cohort study. Between October 2009 and February 2010, 198 pregnant women who had received the AdimFlu-S^® influenza A (H1N1) vaccine during pregnancy and 198 age-matched pregnant women who had not received influenza vaccine were included and recorded. The pregnancy outcome and maternal adverse effects were extracted from chart reviews. Infant health status data were followed up until 8 weeks post-partum.

Results

During the observation period of each cohort, four subjects (2.0%) in the exposed group experienced vaccine-related adverse events that were mild in severity. A total of 17 women (8.6%) in the vaccine exposed group and 40 women (20.2%) in the unexposed group underwent at least one adverse effect during their pregnancy. A total of 72 infants (35.6%) in the exposed group and 101 infants (49%) in the unexposed group had at least one adverse event within 8 weeks after they were born (p < 0.05). The adverse events experienced by the women and their infants were not increased when the vaccine was administered during the first trimester. There were no significant differences between these two groups with regard to preterm delivery rate and stillbirth rate.

Conclusion

AdimFlu-S ^® influenza A (H1N1) vaccine is safe for pregnant women and their infants.     

Influenza A(H1N1)pdm09 Virus in Pigs, R��union Island

During 2009, pandemic influenza A(H1N1)pdm09 virus affected humans on Réunion Island. Since then, the virus has sustained circulation among local swine herds, raising concerns about the potential for genetic evolution of the virus and possible retransmission back to humans of variants with increased virulence. Continuous surveillance of A(H1N1)pdm09 infection in pigs is recommended.     

荧光素酶标记的重组A/WSN/33(H1N1)流感病毒的构建

目的构建表达荧光素酶的A型流感病毒反向遗传操作系统,对研究流感病毒的致病机制、抗病毒药物筛选、中和抗体检测以及病毒在动物体内的实时监测都具有重要意义。方法本文利用融合PCR方法,在A/WSN/33(H1N1)毒株NA基因的N端插入Gaussia荧光素酶(GLUC)或Renllia荧光酶(RLUC)报告基因编码序列,分别构建能表达GLUC或RLUC的重组NA质粒。将构建好的重组NA质粒替换A/WSN/33(H1N1)8质粒反向遗传操作系统中的NA基因,进行表达荧光素酶报告基因病毒的拯救。结果经过Western blot和荧光素酶活性检测等方法验证,分别成功获得了表达GLUC或RLUC的2株重组病毒;P0代上清感染MDCK后,仍能通过免疫荧光技术检测到NP蛋白的表达。结论这种表达LUC的流感病毒系统将会成为流感的基础性研究和应用性研究的有利工具,尤其是GLUC作为一种分泌型的荧光素酶,可以通过体外监测重组病毒GLUC的表达来实时监测流感病毒在体内的感染过程。     

郴州市2009年流感病原学监测及A(H1N1)NA基因特征研究

[目的]了解2009年郴州市流感病毒流行株的病原学特征,为流感防控提供科学依据。[方法]采集哨点医院ILI咽拭子标本,用MDCK细胞进行病毒分离,采用HA和HI试验对流感病毒进行分型鉴定;采集暴发疫情ILI咽拭子用PCR法检测流感病毒核酸;随机抽取4、10月份的季节性A(H1N1)流感毒株进行NA基因测序,测序结果与国内各省市流行株及WHO推荐的北半球疫苗株作同源性比对,绘制种系进化树。[结果]分离哨点医院监测标本2284份,阳性254份:其中季节性A(H1N1)109株、A(H3N2)97株、甲型H1N130株、B型18株;PCR检测3024份标本,甲型H1N1核酸阳性1002份,阳性率33.13%;BLAST比对结果显示,4、10月份的季节性A(H1N1)毒株与2009年WHO推荐的北半球疫苗毒株A/Brisbane/59/2007的核酸同源性分别为99%和98%;种系进化分析结果表明4月份分离株与疫苗株亲缘关系最近,而10月份分离株较4月份分离株已明显发生变异。[结论]2009年郴州市甲型流感病毒异常活跃,其中1～6月季节性A(H1N1)为优势毒株,7～9月A(H3N2)为优势毒株,10～12月甲型H1N1为优势毒株,且出现甲型H1N1流感大流行。季节性A(H1N1)病毒在流行过程中NA基因已经发生了一定的变异,有必要持续跟踪和监测其变异情况。     

科学防控甲型(H1N1)流感的探讨报告

面临着严峻的甲型H1N1流感形势,我院身为民营医院能以高度的政治责任感,敏锐的医疗市场嗅觉,在全市率先启动甲型H1N1流感防控工作。目的排查、救治甲型H1N1流感病例,防控疫情扩散和死亡病例,最大程度地减少对公众健康和生命安全造成危害,维护社会和谐稳定。方法落实部门管理,明确职责,分工合作。初期借鉴非典防控经验,制定木院甲型H1N1流感防控方案,实行每日0报告制,预检分诊,力争“早发现、早隔离,早诊断、早救治”。尔后,按照国家、省、市、区卫生部门的防控部署,根据对甲流发展不同阶段的认识,先后2次制定、修订本院甲型H1N1流感防控工作方案、预案;7次开展专题培训,组织实战演练,提高医护人员防控技能;开展社区义诊,实施健康促进,有条不紊地推进各项防控工作,科学、规范、有效地排查发热病人．隔离留观,稳步防治甲流“二代”,早期识别危重症、及时转诊。与此同时,做好职业保护,在全市第1批次2个时间段完成342支甲流疫苗的预防接种,建立医护人员免疫屏障。结果截止12月07日,我院预检分诊发热病人2549人,院内医学隔离留观率0．16％,二代甲型H1N1流感检测确诊率0．08％（其中包括早期识别重症甲流1例）,分别实行居家隔离和转诊定点医院集中救治。防控工作6次通过卫生主管部门的督查,先后2次被定为市、区甲型H1N1流感防治定点后备医院。结论民营医院主动积极参与甲型H1N1流感重大疫情的排查救治,严防疫情扩散,成效显著,为维护利：会人群的健康做出了积极的贡献。     

甲型H1N1流感医院感染控制技术指南(试行)

甲型H1N1流感是一种新的甲型H1N1病毒引起的急性呼吸道传染病,具有较强的传染性,可通过近距离飞沫和接触传播.目前,甲型H1N1流感疫情已在全球较大范围内传播,世界卫生组织已将流感大流行预警级别提至5级.     

2007年南宁市A(H3N2)亚型流感病毒抗原性及血凝素重链区基因特性分析

目的:了解南宁市A(H3N2)亚型流感病毒血凝素的抗原性和基因变异情况。方法:对分离到的A(H3N2)亚型流感病毒进行单向HI试验分析抗原性,并按不同时间、不同人群选取35株进行血凝素核苷酸全长序列测定,推导出其氨基酸序列,重点对血凝素重链区进行基因特性分析。结果:单向HI试验表明,2007年度南宁市分离到的A(H3N2)亚型流感病毒抗原性与2004年WHO推荐株A/福建/411/2002(H3)相比,后者HI效价比前者高4倍以上;与2007年国内代表株A/江西东湖/312/2006(H3)相比,HI效价无≥4倍差异。核苷酸和氨基酸序列分析结果表明,与A/福建/411/2002(H3)相比核苷酸和氨基酸同源性分别为97.99%和97.81%,平均替换数分别为19.8个和7.2个,涉及2个抗原决定簇和受体结合位点左侧壁;与A/江西东湖/312/2006(H3)相比核苷酸和氨基酸同源性均为98.40%,平均替换数分别为15.8个和5.2个,涉及2个抗原决定簇。结论:2007年南宁市分离的A(H3N2)亚型流感病毒已发生抗原漂移。