Keywords
Influenza A and B viruses
Severe Acute Respiratory Infections
Epidemiological and virological surveillance
Severe Acute Respiratory Infections
Epidemiological and virological surveillance
Abstract
Background: Influenza is a major public health issue. Indeed, in Italy there were 7.6 million symptomatic cases of influenza in the 2019/2020 influenza season (from October 2019 to April 2020). We analysed influenza A and B viruses in hospitalized adult and elderly patients with Severe Acute Respiratory Infections (SARI) at Le Scotte University Hospital in Siena.
Methods: Oropharyngeal swabs were taken from 68 SARI patients, who also completed a questionnaire recording their underlying diseases and vaccination status. Total RNA was extracted from each respiratory swab by means of the QIAamp Viral RNA Mini kit, and RT-PCR was carried out. All statistical analyses were performed by means of GraphPad Prism 6 software and STATA.
Results: The average age of subjects was 79.4 years (C.I.: 76.6-82.3) and 52.9% were female. The subjects had fever (89.7%), fatigue (77%), headache (47%), cough (75%), sore throat (70.5%), and breathlessness (63.2%). We found that 20% of the 68 subjects were positive (13% for A H3N2 and 7% for A H1N1). Of the 68 subjects, 25% had received a seasonal influenza vaccine (91.6% trivalent and 8.4% quadrivalent).
Conclusions: The virological surveillance of influenza is important in order to determine the timing and spread of influenza viruses and track changes in circulating influenza viruses, so as to inform seasonal influenza vaccine composition. SARI surveillance has been implemented in the European Region since 2009. Seasonal vaccination is considered the most effective way to prevent influenza and its complications.
References
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[2] Park J-E, Ryu Y. Transmissibility and severity of influenza virus by subtype. Infect Genet Evol 2018;65:288–92. https://doi.org/10.1016/j.meegid.2018.08.007.
[3] Influenza Type A Viruses | Avian Influenza (Flu) 2020. Available at: https://www.cdc.gov/flu/avianflu/influenza-a-virus-subtypes.htm. Accessed on: 09/07/2021).
[4] Trombetta CM, Marchi S, Manini I, Kistner O, Li F, Piu P, et al. Influenza D Virus: Serological Evidence in the Italian Population from 2005 to 2017. Viruses 2019;12. https://doi.org/10.3390/v12010030.
[5] CDC. Selecting Viruses for the Seasonal Flu Vaccine. Cent Dis Control Prev 2020. Available at: https://www.cdc.gov/flu/prevent/vaccine-selection.htm Accessed on: 04/05/2021.
[6] Pozzi T, Zanda M., Quartesan E., Rossolini G.M., Cvallucci F., Biagioli C.,Bagnoli A., D’Errico A., Nante N. Influenza epidemiology in Sienna from 1 October 1986 to 31 May 1987. In: Giornale Di Igiene e Medicina Preventiva, vol.29: 1988.
[7] Nante N., Baldaccini P.,, Tiezzi G., Pieretti V.M. Diffusion and effects of influenza vaccination in a aged population group in Tuscany (Italy). In: Giornale Di Igiene e Medicina Preventiva, vol. 31, 1990:43–6.
[8] Fitzner J, Qasmieh S, Mounts AW, Alexander B, Besselaar T, Briand S, et al. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection. Bull World Health Organ 2018;96:122–8. https://doi.org/10.2471/BLT.17.194514.
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[15] van Asten L, Luna Pinzon A, van de Kassteele J, Donker G, de Lange DW, Dongelmans DA, et al. The association between influenza infections in primary care and intensive care admissions for severe acute respiratory infection (SARI): A modelling approach. Influenza Other Respir Viruses 2020;14:575–86. https://doi.org/10.1111/irv.12759.
[16] Antonino B. Protocollo Operativo InfluNet: stagione 2019-20. Available at: https://www.salute.gov.it/imgs/C_17_pubblicazioni_2889_allegato.pdf. Accessed on: 04/05/2021
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[18] Macias AE, McElhaney JE, Chaves SS, Nealon J, Nunes MC, Samson SI, et al. The disease burden of influenza beyond respiratory illness. Vaccine 2021;39 Suppl 1:A6–14. https://doi.org/10.1016/j.vaccine.2020.09.048.
[19] Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, et al. Influenza-associated hospitalizations in the United States. JAMA 2004;292:1333–40. https://doi.org/10.1001/jama.292.11.1333.
[20] Chow EJ, Doyle JD, Uyeki TM. Influenza virus-related critical illness: prevention, diagnosis, treatment. Crit Care Lond Engl 2019;23:214. https://doi.org/10.1186/s13054-019-2491-9.
[21] Caini S, Kroneman M, Wiegers T, El Guerche-Séblain C, Paget J. Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: A systematic literature review. Influenza Other Respir Viruses 2018;12:780–92. https://doi.org/10.1111/irv.12575.
[22] Ministero della Salute. P r e v e n zi o n e e c o n t r o l l o d e l l ’ i n f l u e n z a : r a c c o m a n d a zi o n i p e r l a s t a g i o n e 2 0 2 1 - 2 0 2 2. Available at: https://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2021&codLeg=79647&parte=1%20&serie=null. Accessed on: 04/05/2021
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[34] Coronavirus disease (COVID-19): How is it transmitted? Available at: https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted. Accessed on: 04/05/2021.
[35] Strategies for the surveillance of COVID-19. Eur Cent Dis Prev Control 2020. Available at: https://www.ecdc.europa.eu/en/publications-data/strategies-surveillance-covid-19. Accessed on: 04/05/2021
[36] Grosso F, Castrofino A, Del Castillo G, Galli C, Binda S, Pellegrinelli L, et al. A comparative study between the incidence and epidemiological features of Influenza-Like Illness and laboratory-confirmed COVID-19 cases in the Italian epicenter (Lombardy). J Infect Public Health 2021;14:674–80. https://doi.org/10.1016/j.jiph.2021.02.003.
[37] Adlhoch C, Mook P, Lamb F, Ferland L, Melidou A, Amato-Gauci AJ, et al. Very little influenza in the WHO European Region during the 2020/21 season, weeks 40 2020 to 8 2021. Eurosurveillance 2021;26:2100221. https://doi.org/10.2807/1560-7917.ES.2021.26.11.2100221.
[38] Amato M, Werba JP, Frigerio B, Coggi D, Sansaro D, Ravani A, et al. Relationship between Influenza Vaccination Coverage Rate and COVID-19 Outbreak: An Italian Ecological Study. Vaccines 2020;8. https://doi.org/10.3390/vaccines8030535.
[39] WHO | Protecting lifesaving immunization services during COVID-19: New guidance from WHO. Available at: http://www.who.int/immunization/news_guidance_immunization_services_during_COVID-19/en/. Accessed on: 04/05/2021.