Tropical Medicine and Infectious Disease

Research

8 pages, 894 KiB

Open AccessArticle

Future Pandemic Influenza Virus Detection Relies on the Existing Influenza Surveillance Systems: A Perspective from Australia and New Zealand

by Lance C. Jennings and Ian G. Barr

Trop. Med. Infect. Dis. 2019, 4(4), 121; https://doi.org/10.3390/tropicalmed4040121 - 23 Sep 2019

Viewed by 4901

Abstract

The anniversary of the 1918–1919 influenza pandemic has allowed a refocusing on the global burden of influenza and the importance of co-ordinated international surveillance for both seasonal influenza and the identification of control strategies for future pandemics. Since the introduction of the International [...] Read more.

The anniversary of the 1918–1919 influenza pandemic has allowed a refocusing on the global burden of influenza and the importance of co-ordinated international surveillance for both seasonal influenza and the identification of control strategies for future pandemics. Since the introduction of the International Health Regulations (IHR), progress had been slow, until the emergence of the novel influenza A(H1N1)2009 virus and its global spread, which has led to the World Health Organization (WHO) developing a series of guidance documents on global influenza surveillance procedures, severity and risk assessments, and essential measurements for the determination of national pandemic responses. However, the greatest burden of disease from influenza occurs between pandemics during seasonal influenza outbreaks and epidemics. Both Australia and New Zealand utilise seasonal influenza surveillance to support national influenza awareness programs focused on seasonal influenza vaccination education and promotion. These programs also serve to promote the importance of pandemic preparedness. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

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14 pages, 1861 KiB

Open AccessArticle

Impact of the 1918 Influenza Pandemic in Coastal Kenya

by Fred Andayi, Sandra S. Chaves and Marc-Alain Widdowson

Trop. Med. Infect. Dis. 2019, 4(2), 91; https://doi.org/10.3390/tropicalmed4020091 - 8 Jun 2019

Cited by 9 | Viewed by 13398

Abstract

The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been [...] Read more.

The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been poorly documented in many countries especially those in Africa. We used colonial-era records to describe the impact of 1918 influenza pandemic in the Coast Province of Kenya. We gathered quantitative data on facility use and all-cause mortality from 1912 to 1925, and pandemic-specific data from active reporting from September 1918 to March 1919. We also extracted quotes from correspondence to complement the quantitative data and describe the societal impact of the pandemic. We found that crude mortality rates and healthcare utilization increased six- and three-fold, respectively, in 1918, and estimated a pandemic mortality rate of 25.3 deaths/1000 people/year. Impact to society and the health care system was dramatic as evidenced by correspondence. In conclusion, the 1918 pandemic profoundly affected Coastal Kenya. Preparation for the next pandemic requires continued improvement in surveillance, education about influenza vaccines, and efforts to prevent, detect and respond to novel influenza outbreaks. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

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14 pages, 227 KiB

Open AccessArticle

Tuberculosis as a Risk Factor for 1918 Influenza Pandemic Outcomes

by Svenn-Erik Mamelund and Jessica Dimka

Trop. Med. Infect. Dis. 2019, 4(2), 74; https://doi.org/10.3390/tropicalmed4020074 - 29 Apr 2019

Cited by 16 | Viewed by 5717

Abstract

Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts [...] Read more.

Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts of TB on influenza-like illness (% of population sick) and case fatality (% of cases dying) by age and sex through case-control comparisons of patients (N = 201) and employees (N = 97) from two Norwegian sanatoriums. Female patients, patients at Landeskogen sanatorium, and patients aged 10–39 years had significantly lower morbidity than the controls. None of the 62 sick employees died, while 15 of 84 sick patients did. The case-control difference in case fatality by sex was only significant for females at Lyster sanatorium and females at both sanatoriums combined. Non-significant case-control differences in case fatality for males were likely due to small samples. Patients 20–29 years for both sexes combined at Lyster sanatorium and at both sanatoriums combined, as well as females 20–29 years for both sanatoriums combined, had significantly higher case fatality. We conclude that TB was associated with higher case fatality, but morbidity was lower for patients than for employees. The results add to the study of interactions between bacterial and viral diseases and are relevant in preparing for pandemics in TB endemic areas. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

19 pages, 568 KiB

Open AccessArticle

Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza Forecasts

by Robert Moss, Alexander E. Zarebski, Sandra J. Carlson and James M. McCaw

Trop. Med. Infect. Dis. 2019, 4(1), 12; https://doi.org/10.3390/tropicalmed4010012 - 11 Jan 2019

Cited by 19 | Viewed by 4369

Abstract

For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide [...] Read more.

For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to: (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for reverse transcription polymerase chain reaction (RT-PCR) influenza tests. In this study, we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data. These methods are also applicable beyond the Australian context, as similar community-level surveillance systems operate in other countries. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

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6 pages, 1585 KiB

Open AccessArticle

The ‘Influenza’ Vaccine Used during the Samoan Pandemic of 1918

by G. Dennis Shanks

Trop. Med. Infect. Dis. 2018, 3(1), 17; https://doi.org/10.3390/tropicalmed3010017 - 2 Feb 2018

Cited by 4 | Viewed by 5219

Abstract

In 1918, a crude influenza vaccine made from chemically inactivated, mixed cultures of respiratory bacteria was widely used prior to the understanding that influenza was caused by a virus. Such vaccines contained no viral material and probably consisted largely of bacterial endotoxin. The [...] Read more.

In 1918, a crude influenza vaccine made from chemically inactivated, mixed cultures of respiratory bacteria was widely used prior to the understanding that influenza was caused by a virus. Such vaccines contained no viral material and probably consisted largely of bacterial endotoxin. The Australian military used such a vaccine on Samoa in December 1918 and thought it was valuable. Post hoc analyses suggest that the mixed respiratory bacteria vaccine may have actually been of some benefit, but the mechanism of such protection is unknown. Although such a crude vaccine would not be considered in a modern setting, the rapid use of problematic vaccines still remains a risk when new influenza types suddenly appear, as in 1976 and 2009. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

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Review

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10 pages, 1290 KiB

Open AccessReview

New York State Emergency Preparedness and Response to Influenza Pandemics 1918–2018

by Kay L. Escuyer, Meghan E. Fuschino and Kirsten St. George

Trop. Med. Infect. Dis. 2019, 4(4), 132; https://doi.org/10.3390/tropicalmed4040132 - 30 Oct 2019

Cited by 5 | Viewed by 4183

Abstract

Emergency health preparedness and response efforts are a necessity in order to safeguard the public against major events, such as influenza pandemics. Since posting warnings of the epidemic influenza in 1918, to the mass media communications available a century later, state, national and [...] Read more.

Emergency health preparedness and response efforts are a necessity in order to safeguard the public against major events, such as influenza pandemics. Since posting warnings of the epidemic influenza in 1918, to the mass media communications available a century later, state, national and global public health agencies have developed sophisticated networks, tools, detection methods, and preparedness plans. These progressive measures guide health departments and clinical providers, track patient specimens and test reports, monitor the spread of disease, and evaluate the most threatening influenza strains by means of risk assessment, to be able to respond readily to a pandemic. Surge drills and staff training were key aspects for New York State preparedness and response to the 2009 influenza pandemic, and the re-evaluation of preparedness plans is recommended to ensure readiness to address the emergence and spread of a future novel virulent influenza strain. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

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7 pages, 219 KiB

Open AccessReview

The Critical Interspecies Transmission Barrier at the Animal–Human Interface

by Kanta Subbarao

Trop. Med. Infect. Dis. 2019, 4(2), 72; https://doi.org/10.3390/tropicalmed4020072 - 25 Apr 2019

Cited by 14 | Viewed by 3970

Abstract

Influenza A viruses (IAVs) infect humans and a wide range of animal species in nature, and waterfowl and shorebirds are their reservoir hosts. Of the 18 haemagglutinin (HA) and 11 neuraminidase (NA) subtypes of IAV, 16 HA and 9 NA subtypes infect aquatic [...] Read more.

Influenza A viruses (IAVs) infect humans and a wide range of animal species in nature, and waterfowl and shorebirds are their reservoir hosts. Of the 18 haemagglutinin (HA) and 11 neuraminidase (NA) subtypes of IAV, 16 HA and 9 NA subtypes infect aquatic birds. However, among the diverse pool of IAVs in nature, only a limited number of animal IAVs cross the species barrier to infect humans and a small subset of those have spread efficiently from person to person to cause an influenza pandemic. The ability to infect a different species, replicate in the new host and transmit are three distinct steps in this process. Viral and host factors that are critical determinants of the ability of an avian IAV to infect and spread in humans are discussed. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

21 pages, 466 KiB

Open AccessReview

Sowing the Seeds of a Pandemic? Mammalian Pathogenicity and Transmissibility of H1 Variant Influenza Viruses from the Swine Reservoir

by Joanna A. Pulit-Penaloza, Jessica A. Belser, Terrence M. Tumpey and Taronna R. Maines

Trop. Med. Infect. Dis. 2019, 4(1), 41; https://doi.org/10.3390/tropicalmed4010041 - 27 Feb 2019

Cited by 16 | Viewed by 4629

Abstract

Emergence of genetically and antigenically diverse strains of influenza to which the human population has no or limited immunity necessitates continuous risk assessments to determine the likelihood of these viruses acquiring adaptations that facilitate sustained human-to-human transmission. As the North American swine H1 [...] Read more.

Emergence of genetically and antigenically diverse strains of influenza to which the human population has no or limited immunity necessitates continuous risk assessments to determine the likelihood of these viruses acquiring adaptations that facilitate sustained human-to-human transmission. As the North American swine H1 virus population has diversified over the last century by means of both antigenic drift and shift, in vivo assessments to study multifactorial traits like mammalian pathogenicity and transmissibility of these emerging influenza viruses are critical. In this review, we examine genetic, molecular, and pathogenicity and transmissibility data from a panel of contemporary North American H1 subtype swine-origin viruses isolated from humans, as compared to H1N1 seasonal and pandemic viruses, including the reconstructed 1918 virus. We present side-by-side analyses of experiments performed in the mouse and ferret models using consistent experimental protocols to facilitate enhanced interpretation of in vivo data. Contextualizing these analyses in a broader context permits a greater appreciation of the role that in vivo risk assessment experiments play in pandemic preparedness. Collectively, we find that despite strain-specific heterogeneity among swine-origin H1 viruses, contemporary swine viruses isolated from humans possess many attributes shared by prior pandemic strains, warranting heightened surveillance and evaluation of these zoonotic viruses. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

Other

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7 pages, 186 KiB

Open AccessCommentary

Antiviral Therapy for the Next Influenza Pandemic

by Aeron C. Hurt

Trop. Med. Infect. Dis. 2019, 4(2), 67; https://doi.org/10.3390/tropicalmed4020067 - 18 Apr 2019

Cited by 23 | Viewed by 4172

Abstract

Influenza antivirals will play a critical role in the treatment of outpatients and hospitalised patients in the next pandemic. In the past decade, a number of new influenza antivirals have been licensed for seasonal influenza, which can now be considered for inclusion into [...] Read more.

Influenza antivirals will play a critical role in the treatment of outpatients and hospitalised patients in the next pandemic. In the past decade, a number of new influenza antivirals have been licensed for seasonal influenza, which can now be considered for inclusion into antiviral stockpiles held by the World Health Organization (WHO) and individual countries. However, data gaps remain regarding the effectiveness of new and existing antivirals in severely ill patients, and regarding which monotherapy or combinations of antivirals may yield the greatest improvement in outcomes. Regardless of the drug being used, influenza antivirals are most effective when treatment is initiated early in the course of infection, and therefore in a pandemic, effective strategies which enable rapid diagnosis and prompt delivery will yield the greatest benefits. Full article

(This article belongs to the Special Issue Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic)

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