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The database of the Global Influenza B Study was created by collecting surveillance datasets from each of the participating countries. These national datasets are owned by the participating countries, and thus cannot be shared publicly. Researchers interested in obtaining the country-specific datasets may contact the individuals listed below for further details regarding data access.Argentina (Santa Fe Province): Gabriela Kusznierz (labconi@yahoo.com.ar)Australia: Kate Pennington (kate.pennington@health.gov.au)Bhutan: Sonam Wangchuk (swangchuk@health.gov.bt)Brazil: Cláudio Maierovitch Pessanha Henriques (claudio.henriques@saude.gov.br)Cameroon: Guy Vernet (vernet@pasteur-yaounde.org)Chile: Rodrigo Fasce (rfasce@ispch.cl)China: Feng Luzhao (fenglz@chinacdc.cn)Costa Rica: Alexey W. Clara (wclara@cdc.gov)Ecuador: Alfredo Bruno (alfredobruno@yahoo.es)El Salvador: Alexey W. Clara (wclara@cdc.gov)England: Maria Zambon (maria.zambon@phe.gov.uk)Guatemala: Alexey W. Clara (wclara@cdc.gov)Honduras: Alexey W. Clara (wclara@cdc.gov)Indonesia: Herman Kosasih (hermaninarespond@gmail.com)Italy: Caterina Rizzo (caterina.rizzo@iss.it)Ivory Coast: Herve A. Kadjo (hervekadjo@pasteur.ci)Kazakhstan: Gulzhan Muratbayeva (hnv2@cdc.gov)Kenya: Joshua Mott (zud9@cdc.gov)Madagascar: Jean-Michel Heraud (jmheraud@pasteur.mg)Morocco: Amal Barakat (amal.barakat@yahoo.fr)New Zealand: Sue Huang (sue.huang@esr.cri.nz)Nicaragua: Alexey W. Clara (wclara@cdc.gov)Panama: Alexey W. Clara (wclara@cdc.gov)Portugal: Ana Paula Rodrigues (ana.rodrigues@insa.min-saude.pt)Singapore: Vernon Lee (vernonljm@hotmail.com)South Africa: Cheryl Cohen (cherylc@nicd.ac.za)Turkey: Meral Akcay Ciblak (ciblakm@yahoo.com)Ukraine: Alla Mironenko (miralla@ukr.net)Viet Nam: Le Thi Quinh Mai (lom9@hotmail.com); International audience; BACKGROUND:Influenza disease burden varies by age and this has important public health implications. We compared the proportional distribution of different influenza virus types within age strata using surveillance data from twenty-nine countries during 1999-2014 (N=358,796 influenza cases).METHODS:For each virus, we calculated a Relative Illness Ratio (defined as the ratio of the percentage of cases in an age group to the percentage of the country population in the same age group) for young children (0-4 years), older children (5-17 years), young adults (18-39 years), older adults (40-64 years), and the elderly (65+ years). We used random-effects meta-analysis models to obtain summary relative illness ratios (sRIRs), and conducted meta-regression and sub-group analyses to explore causes of between-estimates heterogeneity.RESULTS:The influenza virus with highest sRIR was A(H1N1) for young children, B for older children, A(H1N1)pdm2009 for adults, and (A(H3N2) for the elderly. As expected, considering the diverse nature of the national surveillance datasets included in our analysis, between-estimates heterogeneity was high (I2>90%) for most sRIRs. The variations of countries' geographic, demographic and economic characteristics and the proportion of outpatients among reported influenza cases explained only part of the heterogeneity, suggesting that multiple factors were at play.CONCLUSIONS:These results highlight the importance of presenting burden of disease estimates by age group and virus (sub)type.

Introduction: The aim of this study was to asses the surveillance of influenza A/other respiratory viruses and risk factors in hospitalized children with the symptoms of influenza-like illness during two consecutive influenza seasons. Methodology: All children hospitalized with adiagnosis of influenza-like illness had been investigated for Influenza A and other respiratory antigens in pharengeal/nasopharyngeal secretions. Results: A total of 132 hospitalized children between December 2013-May 2014 and December 2014-May 2015 were enrolled in this study. At least one respiratory virus was found to be positive by RT-PCR in 78 (59%) patients, influenza A (H3N2) was detected in only 8 (6%) patients. In 54 (41%) patients samples no respiratory viral pathogen was detected and in 70 (53%) patients, one non- influenza A virus was detected. The respiratory viral pathogens detected in decreasing rates were:RSV (n = 46, 35%), HCoV (n = 10, 7.5%), adenovirüs (n = 7, 5%), rhinovirüs (n = 6, 4.5%), HMPV (n = 5, 4%), Influenza B (n = 4, 3%) ve human Bocavirus (n = 2, 1.5%). In 10 patients, coinfection was detected, however none was with H3N2. In the H3N2 (+) group, the following risk factors were identified: age older than three years (p < 0.05), asthma history (p < 0.05) and chronic lung diseases (p < 0.05). Conclusion: Influenza A virus was detected in 6% of hospitalized patients with influenza-like illness. Viruses other then Influenza, especially RSV, can cause similar symptoms compatible with Influenza-like-illness.

Objective: With a wide range of clinical presentations, respiratory tractinfections remain a significant cause of morbidity and mortality worldwide,particularly in infants. The aim of this cross-sectional descriptive study was to determine the frequency of respiratory virusesresponsible for upper respiratory tract infections during the 2013-2014influenza season in infants less than 6 months of age. Method: Nasal swabswere obtained from patients with symptoms suggestive of an influenza-likeillness (ILI) between January and April 2014. Specimens were evaluated byRT-PCR to help identify the causative viral pathogens. Results: A total of150 patients with ILI were enrolled in the study. A respiratory virus wassuccessfully detected in 126 (86%) infants; RSV in 41 (32.5%),rhinovirus in 17 (13.4%), metapneumovirus in 15 (11.9%), coronavirus in 11(8.7%), adenovirus in 5 (3.9%), parainfluenza virus in 2 (1.5%) and bocavirusin 2 (1.5%) infants. Thirty-three (26.1%) patients were found to be co-infectedwith both two viruses. Rhinorrhea and developing complications weresignificantly more frequently seen in RT-PCR positive patients (p=0.023 andp=0.019, respectively). All complications were seen in RT-PCR positive group,especially in metapneumovirus, RSV and multiple viruses positive patients.Conclusions: With an overall viral pathogen detection rate of 86%, findings ofour study present that influenza viruses were not seen in infants less than 6months of age in our study population, whether RSV and multiple viralinfections were the most common causes in this age group., Amaç: Solunum yolu enfeksiyonlarıtüm dünyada özellikle süt çocuklarında mortalite ve morbiditenin önemli birnedenidir. Bu kesitsel- tanımlayıcıçalışmanın amacı, 6 ay altındaki süt çocuklarında 2013-2014 influenza sezonuboyunca üst solunum yolu enfeksiyonlarından sorumlu olan solunum yoluviruslarının saptanmasıdır.Yöntem:Ocak - Nisan 2014 tarihleri arasında akut üst solunum yoluenfeksiyonu (ÜSYE) semptomları ile başvuran hastalardan nazofaringeal sürüntü(swab) alındı. Örneklerden solunum yoluvirusları için RT-PCR çalışıldı.Bulgular:150 hasta çalışmaya alındı. 126 (% 86) hastada solunumyolu virusları pozitif bulundu. Virus pozitif hastaların 41'inde (% 32.5) RSV,17'sinde (% 13.4) rinovirus, 15’inde (%11.9) metapnömovirus, 11’inde (% 8.7) koronavirus, beşinde (% 3.9) adenovirus,ikisinde (% 1.5) parainfluenza ve ikisinde (% 1.5) bokavirus saptandı. Otuz üç(% 26.1) hastanın iki virusle ko-enfeksiyonu olduğu tespit edildi. Burunakıntısı ve komplikasyon gelişimi RT-PCR pozitif hastalarda daha fazla idi(sırasıyla p = 0.023 ve p = 0.019). Tüm komplikasyonlar RT-PCR pozitif gruptaözellikle metapnömovirus, RSV ve çoklu virus pozitif hastalarda görüldü.Sonuç: Viralpatojen pozitifliği %86 saptanan çalışmamızda, 6 ay altındaki sütçocuklarında influenza virusugörülmediği, RSV ve çoklu viral enfeksiyonların bu yaş grubunda en sık neden olduğu ortaya konmuştur.

Background There is a limited knowledge regarding the epidemiology of influenza in Middle East and North Africa. Objectives We described the patterns of influenza circulation and the timing of seasonal epidemics in countries of Middle East and North Africa. Methods We used virological surveillance data for 2010-2016 from the WHO FluNet database. In each country, we calculated the median proportion of cases that were caused by each virus type and subtype; determined the timing and amplitude of the primary and secondary peaks; and used linear regression models to test for spatial trends in the timing of epidemics. Results We included 70 532 influenza cases from seventeen countries. Influenza A and B accounted for a median 76.5% and 23.5% of cases in a season and were the dominant type in 86.8% and 13.2% of seasons. The proportion of influenza A cases that were subtyped was 85.9%, while only 4.4% of influenza B cases were characterized. For most countries, influenza seasonality was similar to the Northern Hemisphere, with a single large peak between January and March; exceptions were the countries in the Arabian Peninsula and Jordan, all of which showed clear secondary peaks, and some countries had an earlier primary peak (in November-December in Bahrain and Qatar). The direction of the timing of influenza activity was east to west and south to north in 2012-2013 and 2015-2016, and west to east in 2014-2015. Conclusions The epidemiology of influenza is generally uniform in countries of Middle East and North Africa, with influenza B playing an important role in the seasonal disease burden.

The aim of this study was to determine the frequency of respiratory viruses responsible for respiratory tract infections in Turkish children during the 2011-2012 influenza season. Nasal swabs were obtained from patients with symptoms suggestive of an influenza-like illness between December 2011 and April 2012. Samples were analyzed with multiplex real-time polymerase chain reaction (RT-PCR) to help identify the causative viral pathogen. A total of 200 patients were enrolled in the study. A respiratory virus was detected successfully in 102 (51%) children; influenza A (H3N2) in 39.2%, influenza B in 23.5%, RSV in 15.6%, rhinovirus in 13.7%, bocavirus in 2.9%, coronavirus in 2.9%, and metapneumovirus in 0.9% of patients. Only one patient was co-infected with bocavirus and influenza A virus. A statistically significant difference in the mean age of presentation was observed between the various viral pathogens (P

Erratum in - Correction: Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination? PLoS One. 2016 May 2;11(5):e0155089. doi: 10.1371/journal.pone.0155089. Introduction: Determining the optimal time to vaccinate is important for influenza vaccination programmes. Here, we assessed the temporal characteristics of influenza epidemics in the Northern and Southern hemispheres and in the tropics, and discuss their implications for vaccination programmes. Methods: This was a retrospective analysis of surveillance data between 2000 and 2014 from the Global Influenza B Study database. The seasonal peak of influenza was defined as the week with the most reported cases (overall, A, and B) in the season. The duration of seasonal activity was assessed using the maximum proportion of influenza cases during three consecutive months and the minimum number of months with 80% of cases in the season. We also assessed whether co-circulation of A and B virus types affected the duration of influenza epidemics. Results: 212 influenza seasons and 571,907 cases were included from 30 countries. In tropical countries, the seasonal influenza activity lasted longer and the peaks of influenza A and B coincided less frequently than in temperate countries. Temporal characteristics of influenza epidemics were heterogeneous in the tropics, with distinct seasonal epidemics observed only in some countries. Seasons with co-circulation of influenza A and B were longer than influenza A seasons, especially in the tropics. Discussion: Our findings show that influenza seasonality is less well defined in the tropics than in temperate regions. This has important implications for vaccination programmes in these countries. High-quality influenza surveillance systems are needed in the tropics to enable decisions about when to vaccinate. The Global Influenza B Study is supported by an unrestricted research grant from Sanofi Pasteur. info:eu-repo/semantics/publishedVersion

Background: The aim of this study was to describe the clinical and epidemiological characteristics of pandemic influenza in hospitalized children. Methods: A total of 114 patients with suspected H1N1 virus infection were hospitalized, and nasal swabs were sent to National Influenza Reference Laboratory for confirmation of pandemic influenza A (H1N1) virus infection by rRT–PCR assay. Results: Forty-six female and 68 male patients were included in the study. Age of the patients ranged from 40 days to 16 years. Clinical and/or radiological pneumonia were detected in 96% of all. Sixteen patients required mechanical ventilation due to hypoxemia. Previously healthy children required mechanical ventilation and oxygen therapy more than patients with chronic diseases. Elevated levels of CRP and LDH in patients with respiratory distress and patients who required mechanical ventilation were statistically significant. Conclusion: Our study showed that progress of pandemic influenza infection in previously healthy children is as severe as their counterparts with chronic underlying diseases.

Contains fulltext : 152751.PDF (Publisher’s version ) (Open Access) Influenza B represents a high proportion of influenza cases in some seasons (even over 50%). The Influenza B study in General Practice (IBGP) is a multicenter study providing information about the clinical, demographic and socio-economic characteristics of patients affected by lab-confirmed influenza A or B. Influenza B patients and age-matched influenza A patients were recruited within the sentinel surveillance networks of France and Turkey in 2010-11 and 2011-12 seasons. Data were collected for each patient at the swab test day, after 9+/-2 days and, if not recovered, after 28+/-5 days. It was related to patient's characteristics, symptoms at presentation, vaccination status, prescriptions of antibiotics and antivirals, duration of illness, follow-up consultations in general practice or emergency room. We performed descriptive analyses and developed a multiple regression model to investigate the effect of patients and disease characteristics on the duration of illness. Overall, 774 influenza cases were included in the study: 419 influenza B cases (209 in France and 210 in Turkey) and 355 influenza A cases (205 in France and 150 in Turkey). There were no differences between influenza A and B patients in terms of clinical presentation and number of consultations with a practitioner; however, the use of antivirals was higher among influenza B patients in both countries. The average (median) reported duration of illness in the age groups 0-14 years, 15-64 years and 65+ years was 7.4 (6), 8.7 (8) and 10.5 (9) days in France, and 6.3 (6), 8.2 (7) and 9.2 (6) days in Turkey; it increased with age but did not differ by virus type; increased duration of illness was associated with antibiotics prescription. In conclusion, our findings show that influenza B infection appears not to be milder disease than influenza A infection.

The objective of this study was to determine the phenotypic profile of blood mononuclear cells, specifically CD8+/CD28+ cells, in patients with generalized aggressive periodontitis (GAgP) and chronic periodontitis (CP) in peripheral blood and in blood obtained from periodontal defect site which might contribute to tissue damage. 13 GAgP, 11 chronic periodontitis (CP) and 5 healthy controls (H) were included in the study. Plaque index (PI), bleeding on probing (BoP), periodontal probing depth (PPD) and clinical attachment level (CAL) were recorded. Blood from the base of periodontal defect site and peripheral blood from the antecubital vein were obtained. Relative counts of CD45+, CD3+, CD4+, CD8+/CD28+, CD8+/CD28−, CD19+, CD16+/CD56+/CD3, CD3+/CD16+/CD56+ receptors were determined with two color flow cytometry using monoclonal antibodies. BoP, PPD and CAL were significantly higher in both periodontitis groups than healthy controls (p +/CD28+ cells, were significantly elevated in GAgP and CP groups compared to HC both in blood obtained from defect site and blood obtained from systemic circulation (p

Background: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods: This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1) pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results: In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1) pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions: Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

The aim of this study was to determine the frequency of respiratory viruses responsible for respiratory tract infections in Turkish children during the 2011–2012 influenza season. Nasal swabs were obtained from patients with symptoms suggestive of an influenza‐like illness between December 2011 and April 2012. Samples were analyzed with multiplex real‐time polymerase chain reaction (RT‐PCR) to help identify the causative viral pathogen. A total of 200 patients were enrolled in the study. A respiratory virus was detected successfully in 102 (51%) children; influenza A (H3N2) in 39.2%, influenza B in 23.5%, RSV in 15.6%, rhinovirus in 13.7%, bocavirus in 2.9%, coronavirus in 2.9%, and metapneumovirus in 0.9% of patients. Only one patient was co‐infected with bocavirus and influenza A virus. A statistically significant difference in the mean age of presentation was observed between the various viral pathogens (P

2010-2011 kış sezonunda influenza benzeri semptomlarla başvuran hastalarda influenza virüs tiplerinin (influenza A, influenza B ve H1N1) dağılımı, klinik özellikleri ve tedavide oseltamivirin etkinliğinin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya Ocak-Mart 2011 tarihlerinde üç farklı merkeze influenza benzeri semptomlarla başvuran 18 yaş altındaki 300 hasta dahil edildi. İnfluenza sorgulama formu oluşturulan hastaların yaşı, influenza aşı durumu, başvuru semptomlarının başlangıç ve bitiş tarihleri, komplikasyonların varlığı, antiviral tedavi ve antiviral tedavi dışındaki kullanılan ilaçlar (antipiretik, antibiyotik vb.), hospitalizasyon durumu, altta yatan kronik bir hastalık olup olmadığı kaydedildi. Tüm hastalardan influenza virüsleri için nazal sürüntü (swab) örnekleri alındı. Örneklerden influenza virüs tipleri için "reverse-transcription" polimeraz zincir reaksiyonu (RT-PCR) çalışıldı. Hastaların bir kısmına RT-PCR sonuçları beklenmeden rastgele oseltamivir tedavisi başlandı ve takibe alındı. Bulgular: Hastalarda başvuru sırasında en sık görülen semptomlar ateş (%87.3), öksürük (%84.7), burun tıkanıklığı (%86.3), burun akıntısı (%83.7), boğaz ağrısı (%32), baş ağrısı (%21.3), kas ağrısı (%16.3) idi. Hastaların 45’ine (%15) mevsimsel influenza aşısı yapılmışken, 255’inin (%85) aşısı yoktu. Hastaların 129’unda (%43) influenza RT-PCR pozitif bulundu ve bunların 71’ine oseltamivir başlanmıştı. İnfluenza pozitif grupta yer alan ve oseltamivir başlanan hastalarda ateş, öksürük, burun tıkanıklığı ve burun akıntısı süresinin istatistiksel olarak daha kısa olduğu saptandı (p

We report mutations in influenza A virus (H5N1) strains associated with 2 outbreaks in Turkey. Four novel amino acid changes (Q447L, N556K, and R46K in RNA polymerase and S133A in hemagglutinin) were detected in virus isolates from 2 siblings who died.

WOS: 000301663800010, PubMed ID: 22310296, Objective: The aim of this multicenter prospective study was to evaluate the efficacy of a new bioequivalent formulation of oseltamivir for the treatment of influenza A, influenza B, and H1N1 during the 2010-2011 influenza season. Methods: We compared the symptoms and signs of 300 pediatric patients presenting to three university hospitals with an influenza-like illness between January and March 2011. Nasal swab specimens were collected from all children and tested by reverse-transcription polymerase chain reaction (RT-PCR) for influenza viruses. After randomization, half of the participants were prescribed oseltamivir, while the other half were observed conservatively. Forty patients who were followed-up for influenza prior to the study were also included in the evaluation. Results: Influenza was confirmed by RT-PCR in 129 children, 71 of whom were prescribed oseltamivir. The durations of the symptoms fever, cough, nasal congestion, and rhinorrhea were significantly shorter for patients who were treated with oseltamivir compared with untreated patients (p < 0.002 for all symptoms). Early initiation of oseltamivir therapy (within 48 h of the onset of symptoms) was associated with more favorable outcomes and an earlier recovery than in patients for whom treatment was delayed (beyond 48 h). Thirty-seven patients (28.7%) had H1N1, 44 (34.1%) had influenza A, 46 (35.7%) had influenza B, one (0.8%) had H1N1 plus influenza A, and one (0.8%) had influenza A plus influenza B viruses. In the comparison of the duration of symptoms according to the different virus types, a statistically significant difference was only observed in patients with influenza B who had a longer duration of cough (p < 0.001), nasal congestion (p < 0.001), and rhinorrhea (p < 0.001). Conclusions: Oseltamivir is an effective treatment for the management of seasonal influenza and H1N1, and should be initiated immediately without waiting for laboratory confirmation of diagnosis. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Background The Global Influenza Hospital Surveillance Network (GIHSN) was developed to improve understanding of severe influenza infection, as represented by hospitalized cases. The GIHSN is composed of coordinating sites, mainly affiliated with health authorities, each of which supervises and compiles data from one to seven hospitals. This report describes the distribution of influenza viruses A(H1N1), A(H3N2), B/Victoria, and B/Yamagata resulting in hospitalization during 2012–2013, the network’s first year. Methods In 2012–2013, the GIHSN included 21 hospitals (five in Spain, five in France, four in the Russian Federation, and seven in Turkey). All hospitals used a reference protocol and core questionnaire to collect data, and data were consolidated at five coordinating sites. Influenza infection was confirmed by reverse-transcription polymerase chain reaction. Hospitalized patients admitted within 7 days of onset of influenza-like illness were included in the analysis. Results Of 5034 patients included with polymerase chain reaction results, 1545 (30.7%) were positive for influenza. Influenza A(H1N1), A(H3N2), and both B lineages co-circulated, although distributions varied greatly between coordinating sites and over time. All age groups were affected. A(H1N1) was the most common influenza strain isolated among hospitalized adults 18–64 years of age at four of five coordinating sites, whereas A(H3N2) and B viruses were isolated more often than A(H1N1) in adults ≥65 years of age at all five coordinating sites. A total of 16 deaths and 20 intensive care unit admissions were recorded among patients with influenza. Conclusions Influenza strains resulting in hospitalization varied greatly between coordinating sites and over time. These first-year results of the GIHSN are relevant, useful, and timely. Due to its broad regional representativeness and sustainable framework, this growing network should contribute substantially to understanding the epidemiology of influenza, particularly for more severe disease.

Influenza associated myositis has generally a clearly defined clinical picture. However, it may cause diagnostic confusion and unnecessary work up due to unfamiliarity with this condition by the medical staff. In this report, retrospective clinical and laboratory data about 10 children with influenza associated myositis diagnosed among all admissions to emergency room of a tertiary referral centre during the cold season of 2013-2014 was presented to increase awareness of this clinical issue. (Hong Kong j.emerg.med. 2016;23:186-191)

Following the declaration by the World Health Organization (WHO) of human cases of infection with a new influenza A(H1N1)v virus of swine origin, the Turkish Ministry of Health launched a case-based reporting of influenza A(H1N1)v throughout the country on 27 April 2009. The index case was detected on 15 May 2009. As of 17 July 2009 the number of laboratory-confirmed cases of influenza A(H1N1)v totaled 128 of whom 38 were indigenous cases.