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Gripe aviar en Egipto, Actualización Influenza A (H1N1)

AVIAN INFLUENZA, HUMAN (05): EGYPT, WHO

Date: Wed 10 Feb 2010 Source: WHO Global Alert and Response (GAR) Disease Outbreak News [edited] <http://www.who.int/csr/don/2010_02_10/en/index.html>

Avian influenza situation in Egypt - WHO update 29 --- The Ministry of Health of Egypt has announced a new case of human H5N1 avian influenza infection.

The case is a 37-year-old male from Helwan District, Helwan Governorate. He developed symptoms on 31 Jan [2010] and was hospitalized on 6 Feb [2010], where he received oseltamivir treatment. He is in a critical condition.

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

Of the 97 laboratory confirmed cases of avian influenza A(H5N1) reported in Egypt, 27 have been fatal.

INFLUENZA A (H1N1) 2009: EUROPA

Data: Quarta-feira / Miercoles, 10 de fevereiro / Febrero de 2010 De: ProMED-PORT <Promed-Port@promedmail.org> Fonte: O Globo [04.10.2010] http://oglobo.globo.com/mundo/mat/2010/02/04/gripe-h1n1-aumentou-morte-de-criancas-na-europa-diz-estudo-915789709.asp

Gripe H1N1 aumentou morte de crianças na Europa, diz estudo

WASHINGTON (Reuters) - A pandemia do vírus H1N1, da chamada gripe suína, elevou a taxa de mortalidade entre crianças na Europa no fim do ano passado, mas não teve o mesmo efeito em adultos, segundo um estudo publicado nesta quinta-feira.

Os primeiros relatos mostraram um aumento de cerca de 28 por cento nas mortes de crianças de 5 a 14 anos em oito países, segundo Anne Mazick, do Statens Serum Institut, da Dinamarca, e seus colegas.

Isso equivale a cerca de 77 mortes acima do que seria normal nesses meses e nessa faixa etária, de acordo com o artigo publicado na revista eletrônica Eurosurveillance.

Estimar as mortes resultantes da gripe é complicado, já que a maioria das pessoas nunca fez exames, as mortes nem sempre podem ser relacionadas à gripe, e os casos de morte nem sempre são claramente notificados. "Essa estimativa é provavelmente conservadora devido à demora na notificação", acrescentaram os pesquisadores europeus.

Mazick e seus colegas reuniram dados de Bélgica, Dinamarca, Grécia, Malta, Holanda, Suécia e Suíça, e também do Estado alemão de Hesse. Ao todo, trata-se de uma população de 66,8 milhões de pessoas.

"Nossos dados preliminares mostram que a mortalidade relatada durante a pandemia de influenza de 2009 não alcançou os níveis normalmente vistos durante epidemias sazonais de influenza", escreveram os pesquisadores.

Mas eles descobriram 77 mortes entre crianças de 5 a 14 anos, acima do que seria normal nessa época. "A forte ascensão nas mortes após a 41a semana (do ano) corresponde a grosso modo a um aumento de 28 por cento na mortalidade entre crianças de 5-14 anos, coincidindo com a pandemia."

Para efeito de comparação, os Estados Unidos, com 300 milhões de habitantes, confirmaram mais de 300 mortes de crianças por causa do vírus H1N1, e dizem que provavelmente o número real foi muito maior. Isso equivale a mais do que o dobro dos números registrados durante a epidemia sazonal de gripe de todos os anos.

AVIAN INFLUENZA, HUMAN (12): WORLD HEALTH ORGANISATION 2009 UPDATE

Date: Fri 12 Feb 2010 Source: World Health Organisation (WHO), Weekly epidemiological Record Bulletin, vol. 85, 7 (pp 49-56) [edited] <http://www.who.int/wer/2010/wer8507.pdf>

Update on human cases of highly pathogenic avian influenza A (H5N1) infection in 2009 ------------------------------------------------------------------------------------- During 2009, 73 laboratory-confirmed cases of human infection with highly pathogenic avian influenza A (H5N1) virus were reported to the WHO from 5 countries. This report summarizes these cases.

Temporal and geographical distribution: --------------------------------------- The 73 laboratory-confirmed cases of H5N1 virus infection were reported from Cambodia (1 case), China (7), Egypt (39), Indonesia (21) and Viet Nam (5); all of these countries had reported human cases of H5N1 previously. Circulation of highly pathogenic H5N1 virus in poultry is considered to be endemic in these countries, with the exception of Cambodia, where poultry outbreaks occur sporadically. As in previous years, an increase in cases was reported during the northern hemisphere's winter and spring seasons [These data are illustrated graphically in the original text]. Reports of outbreaks among animals also tended to increase during the same period.

Distribution by sex and age: ---------------------------- In 2009, the overall ratio of male cases (n=35) to female cases (n=38) was almost even (ratio of males to females, 0.92). However, Indonesia reported twice as many cases in females as in males (ratio, 0.5). Cases ranged in age from 6 months to 57 years, with a median age of 5 years. The low median age was due primarily to the high proportion of cases occurring among children in Egypt; Egypt accounted for 53 percent of all cases worldwide. The age of cases in Egypt was notably younger than elsewhere, with a median age of 3 years; 80 percent of cases occurred in children aged less than 10 years.

Outcome: -------- The overall case-fatality ratio (CFR) for 2009 was 44 percent, lower than the previous 2 years but similar to the CFR in 2005 [These data are tabulated in the original text]. CFRs varied widely among countries. Egypt reported its lowest CFR (10 percent) since 2003. In all countries, the CFR was lower for cases aged less thjan 10 years than for cases aged greater than or equal to 10 years (24 percent versus 71 percent; odds ratio [OR], 7.8; 95 percent confidence interval [CI], 2.7­22.4). In contrast to previous years, the CFR for females in all countries was higher than for males, but the difference was not significant (50 percent versus 37 percent; OR, 1.7; 95 percent CI, 0.7­4.3); this pattern was not consistent among countries.

Discussion: ----------- With almost double the number of human cases of H5N1 reported in 2009 compared with 2008, and with continuing circulation of the virus among certain poultry populations, it is clear that H5N1 remains a concern for both animal health and public health. Although the CFR remains high, there are differences among affected countries. These data do not allow a determination of the causes of this difference to be made. Possible explanations for the disparities among countries might include differences in the type or intensity of exposure, in health-seeking behaviour, in testing or treatment practices, or even in the virulence of virus strains. The marked difference in the age distribution of cases among countries makes a direct comparison of risk factors difficult, given the relatively small total number of cases available for analysis. At present, this remains an avian virus that has not demonstrated a facility for human-to-human transmission, and human infections remain rare and sporadic.

Fulminant Myocarditis Associated With Pandemic H1N1 Influenza A Virus in Children ------------------------------------------------------------------------------------------- By: Andras Bratincsak, MD, PhD*, Howaida G. El-Said, MD, PhD,John S. Bradley, MD,Katayoon Shayan, MD,Paul D. Grossfeld, MD and Christopher R. Cannavino, MD. At: Rady Children's Hospital­San Diego, University of California San Diego, School of Medicine, 3020 Children's Way, MC5004, San Diego, California 92123

Acute myocarditis is a well-recognized, albeit rare, manifestation of numerous viral infections (1) with a broad spectrum of symptoms and clinical features (2). Fulminant myocarditis may present with fatal arrhythmias, atrioventricular block, and/or varying degrees of cardiogenic shock (3). The prevalence of myocardial involvement in influenza infection ranges from 0 to 11 percent depending on the diagnostic criteria used to define myocarditis (4). Fulminant myocarditis is an uncommon complication, typically diagnosed in association with circulatory collapse or at autopsy in patients with influenza- associated fatal outcomes (5). A few case reports and series (6­8) represent the incidental diagnoses of influenza-associated acute fulminant myocarditis, but the true prevalence remains unknown. Here we present the first known report of acute myocarditis in pediatric population associated with the present pandemicH1N1 influenza A virus infection. Four cases occurred within a 30-day period, and 3 of them were diagnosed as fulminant myocarditis with fatal or near-fatal outcomes.

A retrospective chart review was conducted on all patients admitted to Rady Children's Hospital­San Diego with the diagnosis of H1N1 influenza A infection during October 2009. Criteria for fulminant myocarditis included echocardiographic and clinical evidence of severely decreased left ventricular systolic function and/or lymphocytic infiltration of the myocardium documented at autopsy.

Within a 30-day period, 80 children were admitted with H1N1 influenza A infection to Rady Children's Hospital­SanDiego. Serum troponin I and creatine phosphokinase myocardial band levels were obtained in 11 children, and echocardiography was performed in 8 children. We included 4 H1N1 influenza­associated myocarditis cases based on elevated cardiac enzymes (n = 2), significant acute decrease in left ventricular systolic function demonstrated by the echocardiogram (n = 3), or histologic evidence of severe myocarditis . Three children presented with fulminant myocarditis, 1 with a fatal outcome and 2 requiring extracorporeal membrane oxygenation support. None of the children with fulminant myocarditis had evidence of sepsis or bacterial infection (negative blood, urine, and tracheal aspirate cultures). Two of the 3 children with decreased systolic function experienced recovery in 5 to 7 days. All 4 children had a positive rapid influenza enzyme immunoassay test result from a nasopharyngeal swab sample that was subsequently confirmed as H1N1 by reverse- transcriptase polymerase chain reaction performed at the San Diego County Department of Health.

Fulminant myocarditis due to viral infection is an uncommon form of acute myocarditis. Influenza A virus­associated fulminant myocarditis is exceedingly rare, with only a few cases reported in the literature. We report the 1st 4 cases of acute myocarditis in children associated with the pandemic H1N1 influenza A virus, all occurring within a 30- day period. Our tertiary care hospital serves a geographic region that includes approximately 800 000 children. During the past 3 years, there was an annual average of 2 cases of acute myocarditis due to suspected viral etiology, none of which had evidence of influenza infection. Within a 30-day period in October 2009, there were 3 cases of acute fulminant myocarditis and 1 case of acute perimyocarditis at Rady Children's Hospital­San Diego, all associated with confirmed H1N1 influenza A infection. There was serologic, echocardiographic, and/or histologic evidence of myocardial involvement in all cases . Three children had echocardiographic evidence of an acutely decreased myocardial function. One child died likely due to acute atrioventricular block, as suggested by severe lymphocytic infiltration of the conduction system. Two children required extracorporeal membrane oxygenation support with gradual improvement of the ventricular systolic function over a 1-week period, which is typically observed in patients with fulminant myocarditis (2).

The prevalence of influenza-associated fulminant myocarditis is not known because of the lack of comprehensive screening, with only a handful of clinical cases and autopsy findings reported in the literature (5­8). Our documented 4 cases within a 30-day period, compared with our previous experience, raise the possibility that the novel [pandemic] H1N1 influenza A virus is more commonly associated with a severe form of myocarditis than previously encountered influenza strains.

Our observations warrant a high index of suspicion for myocarditis in children with H1N1 influenza A infection. Early detection and aggressive management are paramount. Timely intervention with circulatory support may decrease morbidity and mortality, with the potential for a favorable cardiac prognosis.

 

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