This document analyzes mortality associated with influenza in the state of São Paulo, Brazil from 2002 to 2011. It finds that the pre-pandemic years showed a seasonal pattern of increased mortality during the winter linked to increased activity of influenza A(H3N2) viruses, especially in those over 60. The 2009 H1N1 pandemic was associated with higher than average mortality in those aged 5-19 and 20-59. Mortality in those over 60 was lower during the pandemic than previous influenza seasons. The pandemic wave occurred from July to November 2009. Overall mortality during the pandemic was higher than average but similar to severe H3N2 seasons.
The document discusses the threat of pandemic influenza and the need for healthcare systems to prepare for disease outbreaks. It notes that recent outbreaks of avian influenza A(H5N1) are a reminder that a human pandemic could occur at any time, causing major suffering and economic losses. Past pandemics like the 1918 Spanish flu prompted authorities to plan for preparedness, but structured planning is still lacking in many healthcare systems. The ability of influenza viruses to mutate and reassort means a new pandemic strain could emerge.
This document summarizes a study on influenza-like illness (ILI) sentinel surveillance in Peru between 2006-2008. Over 6,800 patients with ILI were enrolled from clinics across Peru. Respiratory samples were tested and at least one virus was detected in 42.6% of samples. The most common viruses were influenza A (25.1%), influenza B (9.7%), and parainfluenza (3.2%). Genetic analysis found multiple lineages of influenza A and B circulating. This study characterized the viral causes of ILI in Peru and has implications for vaccine design and clinical treatment in South America.
The Importance of Asymptomatic Coronavirus Disease-19 Patients: Never Trust a...asclepiuspdfs
The asymptomatic infectious case is a “silent client,” one of the most complex and damaging types of client: It is someone who does not provide information; of which we have no information. The silent client, as in the asymptomatic infection, can undermine the business by apparently not being able to address the problem. So how do you manage silent clients, asymptomatic cases? Identifying the points where asymptomatic (silent) cases occur and addressing the situation from a comprehensive perspective. This includes: (1) Preventing contagion and interrupting the transmission process immediately after contact with the virus: Test system, trace, and public health measures: Polymerase chain reaction testing on as many people as possible who have been in contact with infected people which allows the isolation of infected and the tracking and quarantine of their contacts; (2) universal public health measures: Wear a mask in public, wash your hands regularly, stay home when sick, keep a physical distance, and avoid meeting people outside of your home; (3) being so strict with negative cases as with positive ones: The consequences of high rates of false negatives are serious because they allow asymptomatic – and symptomatic – people to transmit diseases; follow-up is recommended, from a clinical point of view – epidemiological, as strict to negative cases as to positive ones; (4) trace back the contacts of the positive cases: search the source of a new case, together with the contacts of that person; and (5) massive and opportunistic tests for the detection of general and specific populations: Rapid response tests for coronavirus disease-19 available to everyone, especially those without symptoms, carried out as mass population screening, to certain groups such as health workers and students, as detection opportunistic in the general practitioner’s consultation, and even self-administered by anyone.
The role of influenza in the epidemiology of pneumoniaJoshua Berus
1. The document examines the role of influenza in pneumonia epidemiology using longitudinal influenza and pneumonia incidence data from different time periods and locations in the US.
2. Using a transmission model and likelihood-based inference framework, the analysis found that influenza infection increases an individual's risk of developing pneumonia by around 100-fold, supporting the hypothesis that influenza enhances susceptibility to pneumonia.
3. However, the analysis found no evidence that influenza infection affects the transmission or severity of pneumonia. The consistency of these findings across different datasets and the model's ability to predict pneumonia incidence increases confidence in the conclusion that influenza substantially increases risk of pneumonia for a short period.
Forecasting the peak and fading out of novel coronavirus of 2019Islam Saeed
The document summarizes a statistical model that was developed to forecast the size, peak, and fading out of the 2019 novel coronavirus outbreak using confirmed case and death data. The model predicts that:
1) The outbreak will peak on February 20, 2020 with over 91,000 confirmed cases and 1,655 deaths worldwide.
2) The number of cases and deaths will then decline through the end of March 2020 as the outbreak fades out.
3) The outbreak will likely be completely died out by the first week of April 2020, according to the model.
This document provides a summary of mathematical modeling of HIV/AIDS treatment. It discusses the background and history of the HIV epidemic, noting that the number of people living with HIV has increased to 32-38 million globally since 1981. Prevention programs like antiretroviral treatment (ART) have helped reduce prevalence since 1999. The document examines the natural history and transmission of HIV, antiretroviral therapy, socioeconomic risks, and the genetic structure and replication cycle of HIV. It states the problem is determining the optimal timing for ART initiation to increase immunity and decrease mortality and mobility from the disease.
Pneumonia and respiratory failure from swine origin influenza h1 n1pharmaindexing
This document summarizes information about pneumonia and respiratory failure caused by swine influenza H1N1. It discusses how the World Health Organization declared swine flu a public health emergency in 2009. Symptoms are similar to seasonal flu but can cause respiratory failure, the most common cause of death. Patients are usually treated with antivirals and antibiotics. As of 2009, over 177 countries reported over 182,000 cases of H1N1 infection, with nearly 1,800 deaths. H1N1 can cause severe illness in young and middle-aged people and lead to acute respiratory distress syndrome.
This study summarizes the first outbreak of Chikungunya virus in Suriname in 2014-2015. It followed patients clinically suspected of Chikungunya infection and tested their blood to confirm cases. It found that 68% of symptomatic patients tested positive for Chikungunya virus. It described the symptoms in both adults and children over time. It also conducted household surveys to estimate a cumulative incidence of 249 Chikungunya cases per 1000 people in Paramaribo. A government campaign against mosquitos coincided with a sharp decline in reported cases.
The document discusses the threat of pandemic influenza and the need for healthcare systems to prepare for disease outbreaks. It notes that recent outbreaks of avian influenza A(H5N1) are a reminder that a human pandemic could occur at any time, causing major suffering and economic losses. Past pandemics like the 1918 Spanish flu prompted authorities to plan for preparedness, but structured planning is still lacking in many healthcare systems. The ability of influenza viruses to mutate and reassort means a new pandemic strain could emerge.
This document summarizes a study on influenza-like illness (ILI) sentinel surveillance in Peru between 2006-2008. Over 6,800 patients with ILI were enrolled from clinics across Peru. Respiratory samples were tested and at least one virus was detected in 42.6% of samples. The most common viruses were influenza A (25.1%), influenza B (9.7%), and parainfluenza (3.2%). Genetic analysis found multiple lineages of influenza A and B circulating. This study characterized the viral causes of ILI in Peru and has implications for vaccine design and clinical treatment in South America.
The Importance of Asymptomatic Coronavirus Disease-19 Patients: Never Trust a...asclepiuspdfs
The asymptomatic infectious case is a “silent client,” one of the most complex and damaging types of client: It is someone who does not provide information; of which we have no information. The silent client, as in the asymptomatic infection, can undermine the business by apparently not being able to address the problem. So how do you manage silent clients, asymptomatic cases? Identifying the points where asymptomatic (silent) cases occur and addressing the situation from a comprehensive perspective. This includes: (1) Preventing contagion and interrupting the transmission process immediately after contact with the virus: Test system, trace, and public health measures: Polymerase chain reaction testing on as many people as possible who have been in contact with infected people which allows the isolation of infected and the tracking and quarantine of their contacts; (2) universal public health measures: Wear a mask in public, wash your hands regularly, stay home when sick, keep a physical distance, and avoid meeting people outside of your home; (3) being so strict with negative cases as with positive ones: The consequences of high rates of false negatives are serious because they allow asymptomatic – and symptomatic – people to transmit diseases; follow-up is recommended, from a clinical point of view – epidemiological, as strict to negative cases as to positive ones; (4) trace back the contacts of the positive cases: search the source of a new case, together with the contacts of that person; and (5) massive and opportunistic tests for the detection of general and specific populations: Rapid response tests for coronavirus disease-19 available to everyone, especially those without symptoms, carried out as mass population screening, to certain groups such as health workers and students, as detection opportunistic in the general practitioner’s consultation, and even self-administered by anyone.
The role of influenza in the epidemiology of pneumoniaJoshua Berus
1. The document examines the role of influenza in pneumonia epidemiology using longitudinal influenza and pneumonia incidence data from different time periods and locations in the US.
2. Using a transmission model and likelihood-based inference framework, the analysis found that influenza infection increases an individual's risk of developing pneumonia by around 100-fold, supporting the hypothesis that influenza enhances susceptibility to pneumonia.
3. However, the analysis found no evidence that influenza infection affects the transmission or severity of pneumonia. The consistency of these findings across different datasets and the model's ability to predict pneumonia incidence increases confidence in the conclusion that influenza substantially increases risk of pneumonia for a short period.
Forecasting the peak and fading out of novel coronavirus of 2019Islam Saeed
The document summarizes a statistical model that was developed to forecast the size, peak, and fading out of the 2019 novel coronavirus outbreak using confirmed case and death data. The model predicts that:
1) The outbreak will peak on February 20, 2020 with over 91,000 confirmed cases and 1,655 deaths worldwide.
2) The number of cases and deaths will then decline through the end of March 2020 as the outbreak fades out.
3) The outbreak will likely be completely died out by the first week of April 2020, according to the model.
This document provides a summary of mathematical modeling of HIV/AIDS treatment. It discusses the background and history of the HIV epidemic, noting that the number of people living with HIV has increased to 32-38 million globally since 1981. Prevention programs like antiretroviral treatment (ART) have helped reduce prevalence since 1999. The document examines the natural history and transmission of HIV, antiretroviral therapy, socioeconomic risks, and the genetic structure and replication cycle of HIV. It states the problem is determining the optimal timing for ART initiation to increase immunity and decrease mortality and mobility from the disease.
Pneumonia and respiratory failure from swine origin influenza h1 n1pharmaindexing
This document summarizes information about pneumonia and respiratory failure caused by swine influenza H1N1. It discusses how the World Health Organization declared swine flu a public health emergency in 2009. Symptoms are similar to seasonal flu but can cause respiratory failure, the most common cause of death. Patients are usually treated with antivirals and antibiotics. As of 2009, over 177 countries reported over 182,000 cases of H1N1 infection, with nearly 1,800 deaths. H1N1 can cause severe illness in young and middle-aged people and lead to acute respiratory distress syndrome.
This study summarizes the first outbreak of Chikungunya virus in Suriname in 2014-2015. It followed patients clinically suspected of Chikungunya infection and tested their blood to confirm cases. It found that 68% of symptomatic patients tested positive for Chikungunya virus. It described the symptoms in both adults and children over time. It also conducted household surveys to estimate a cumulative incidence of 249 Chikungunya cases per 1000 people in Paramaribo. A government campaign against mosquitos coincided with a sharp decline in reported cases.
This document discusses lessons that can be learned from past influenza pandemics and applied to understanding the future course of the COVID-19 pandemic. It outlines three possible scenarios for the future trajectory of COVID-19 based on patterns seen in influenza. Scenario 1 involves repetitive smaller waves over 1-2 years as immunity gradually increases. Scenario 2 consists of a large second peak in cases around 6 months after the first. Scenario 3 follows a seasonal pattern with peaks in winter. The pandemic may last 18-24 months until 60-70% of the population is immune through natural infection or vaccination.
There are several key reasons why infectious disease outbreaks have been increasing globally in recent decades. Increased travel, trade, and urbanization have made it easier for pathogens to spread to new areas. Climate change is also enabling some disease-carrying mosquitoes and other animals to thrive in new environments. However, public health organizations have gotten better at detecting and responding to outbreaks early, meaning fewer cases per outbreak overall. Still, underfunding of disease surveillance programs in some areas has allowed certain illnesses to resurge. Continued challenges include poverty, conflict, and environmental degradation. Proper isolation of infectious patients also remains important for control.
- 84 of the 201 patients with COVID-19 pneumonia (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84 patients, 44 (52.4%) died.
- Risk factors for developing ARDS included older age, pre-existing comorbidities like hypertension and diabetes, and signs of disease severity like dyspnea.
- Risk factors for progression from ARDS to death included older age, signs of immune system overactivation and organ dysfunction like neutrophilia and elevated lactate dehydrogenase and D-dimer levels.
- Treatment with the corticosteroid methylprednisolone was associated with decreased risk of death among patients with ARDS.
Pneumonia is a common respiratory infection that affects the lungs. It is broadly divided into community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). The causative microorganisms differ between CAP and HAP depending on whether the pneumonia was acquired in the community or healthcare setting. Mortality from pneumonia is highest in young children and older adults, and is influenced by treatment setting, age, comorbidities, and the specific type of pneumonia such as CAP or HAP.
AI transmission risks: Analysis of biosecurity measures and contact structureHarm Kiezebrink
Contacts between people, equipment and vehicles prior and during outbreak situations are critical to determine the possible source of infection of a farm. Hired laborers are known to play a big role in interconnecting farms. Once a farm is infected, culling entire flock is the only option to prevent further spreading with devastating consequences for the industry.
In this paper, based on the HPAI outbreak in Holland 2003, the researchers found that 32 farms hired external labor of which seven accessed other poultry on the same day.
However, they were not the only ‘connectors’ as some (twelve) farmers also reported themselves helping on other poultry farms.
Furthermore, 27 farms had family members visiting poultry or poultry-related businesses of which nine entered poultry houses during those visits. The other enhancing factor of farm interconnections was the reported ownership of multiple locations for ten of the interviewed farms and the reported on-premises sale of farm products on one pullet and eight layer farms.
Also worth mentioning is the practice of a multiple age system reported on eight of the interviewed farms as this may increase the risk of infecting remaining birds when off-premises poultry movements occur.
AI viruses may be introduced into poultry from reservoirs such as aquatic wild birds but the mechanisms of their subsequent spread are partially unclear. Transmission of the virus through movements of humans (visitors, servicemen and farm personnel), vectors (wild birds, rodents, insects), air- (and dust-) related routes and other fomites (e.g., delivery trucks, visitors’ clothes and farm equipment) have all been hypothesized.
It is therefore hypothesized that the risk of introducing the virus to a farm is determined by the farm’s neighborhood characteristics, contact structure and its biosecurity practices.
On the one hand, neighborhood characteristics include factors such as the presence of water bodies (accessed by wild birds), the density of poultry farms (together with the number and type of birds on these farms) and poultry-related businesses and the road network. The use of manure in the farm’s vicinity is also deemed to be risky.
On the other hand, contact structure risk factors include the nature and frequency of farm visits. Therefore, a detailed analysis of the contact structure, including neighborhood risks, and biosecurity practices across different types of poultry farms and poultry-related businesses helps the improvement of intervention strategies, biosecurity protocols and adherence to these, as well as contact tracing protocols.
Farmers’ perception of visitor- and neighborhood-associated risks of virus spread is also important due to its relevance to adherence with biosecurity protocols, to contact tracing and to communicating advice to them.
Clinical Epidemiological Study of Secondary Syphilis - Current Scenarioiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the risks of COVID-19 infection in pregnant women based on a study of nine cases in China. It finds that the clinical characteristics and outcomes for pregnant women with COVID-19 were less severe than those seen in pregnant women with SARS. However, more research is still needed given the small number of cases. It recommends pregnant women and newborns be considered at-risk populations and that prevention and management strategies be strengthened.
Imperial college covid19 europe estimates and npi impactValentina Corona
The document summarizes estimates from a model analyzing COVID-19 mortality data from 11 European countries. Key findings include:
- Millions of infections have likely occurred, far more than the number detected. Italy may have had 5.9 million infections (9.8% of population) as of March 28th.
- Non-pharmaceutical interventions have likely reduced the reproduction number (Rt) substantially, though estimates vary by country. On average, interventions represent a 64% reduction from initial Rt of around 3.87.
- Interventions may have averted 59,000 deaths by March 31st across the 11 countries. More data is needed to determine if Rt has been driven below 1 in
This document summarizes risk factors and response actions related to influenza A H1N1. It outlines background information on influenza strains and pandemics. The 2009 H1N1 strain was a combination of genes from swine, avian, and human influenza viruses. Studies identified higher risk groups as American Indians, younger/older individuals, and those with pre-existing medical conditions. Vaccination timing and strategies were modeled in Canada, showing reduced infection risk with vaccination. Key response actions included isolation, hand washing, and informing healthcare providers.
This document discusses key concepts in infectious disease epidemiology including definitions of prevalence, incidence, epidemics, and quality improvement strategies. It covers:
- Definitions of epidemiology, prevalence, incidence, and incidence proportion and how they are used to measure disease occurrence.
- Types of infectious disease transmission including endemic, epidemic, pandemic, and nosocomial.
- The importance of understanding infectious diseases and their epidemiology to implement control and prevention measures.
- Strategies for quality improvement in infectious disease care including antibiotic stewardship programs and infection control committees.
Human-to-Human transmission of H7H7 in Holland 2003Harm Kiezebrink
The outbreak of highly pathogenic avian influenza A virus subtype H7N7 started at the end of February, 2003, in commercial poultry farms in the Netherlands. In this study, published in The Lancet in 2004, it is noted that an unexpectedly high number of transmissions of avian influenza A virus subtype H7N7 to people directly involved in handling infected poultry, providing evidence for person-to-person transmission.
Although the risk of transmission of these viruses to humans was initially thought to be low, an outbreak investigation was launched to assess the extent of transmission of influenza A virus subtype H7N7 from chickens to humans.
453 people had health complaints—349 reported conjunctivitis, 90 had influenza-like illness, and 67 had other complaints. We detected A/H7 in conjunctival samples from 78 (26·4%) people with conjunctivitis only, in five (9·4%) with influenza-like illness and conjunctivitis, in two (5·4%) with influenza-like illness only, and in four (6%) who reported other symptoms. Most positive samples had been collected within 5 days of symptom onset. A/H7 infection was confirmed in three contacts (of 83 tested), one of whom developed influenza-like illness. Six people had influenza A/H3N2 infection. After 19 people had been diagnosed with the infection, all workers received mandatory influenza virus vaccination and prophylactic treatment with oseltamivir. More than half (56%) of A/H7 infections reported here arose before the vaccination and treatment programme.
A study of health comprehension about the cholera among a slicesin74
A study was conducted among 98 University of Baghdad employees and 30 randomly selected individuals to assess their knowledge of cholera. Most participants correctly identified that cholera is transmitted through contaminated water and food and causes watery diarrhea. While over half of the study group identified bacteria as the causative agent, answers varied more among the control group. The results indicate relatively good understanding of cholera transmission and symptoms but lack of complete knowledge about the bacterial cause.
This paper reviews the evolution of the definition of sepsis and the controversy surrounding the sepsis-3 definition and the sepsis screening tool, qSOFA.
Respiratory virus shedding in exhaled breath and efficacy of face masksValentina Corona
1) The study identified seasonal human coronaviruses, influenza viruses, and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness.
2) Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols. There was also a trend toward reduced detection of coronavirus RNA in respiratory droplets.
3) The results indicate that surgical face masks could help prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
Abstract—The frequent occurrence of epidemics even after the launching of the Integrated Diseases Surveillance Programme (IDSP) was an indication toward inadequacy of the control system. These epidemics/outbreaks may be identified if disease status analysis is done properly. The aim of the this study was to find out status of some of major diseases included in the IDSP in a tertiary level hospital of western Rajasthan. It was a record-based analysis carried out in hospitals attached to SMS medical College, Jaipur (Rajasthan) India. Weekly report of IDSP in 'L' Form was collected of year 2015 from SMS Medical College, Hospitals. Data related to major diseases of IDSP were gathered from these reports. These reports were analysed in percentage and proportion. It was observed among major six diseases studied in this present study, majority of cases were of Swine flue followed by Dengue, Scrub Typhus and Malaria. There was no case of Chikungunia and Enteric Fever. When deaths due to these major six diseases were observed it was found that majority of deaths occurred due to Swine flue followed by Dengue, Scrub Typhus and Malaria. Malaria death was due to Plasmodiun Falcifarrum. Maximum PCR was of Swine flue (42.32%) followed by Dengue (29.16 %), Scrub Typhus (21.87%) and Malaria (6.65%). Maximum PDR was of Swine flue (93.08%) followed by Dengue (3.08%), Scrub Typhus (3.08%) and Malaria (0.77%). Overall Case Fatality (CFR) of these diseases was found 9.2%. Regarding variation CFR of these diseases it was found that maximum CFR was of Swine flue (20.23%) followed by Scrub Typhus (1.29%), Dengue (1.06%) and Malaria (0.97%). This variation of CFR as per the type of diseases was found with significant variation (p<0.001).So more emphasis should be given to more fatal disease like swine flue.
Baseline characteristics and outcomes of 1591 patients infected with sars co ...Valentina Corona
This case series describes 1591 critically ill patients with COVID-19 admitted to ICUs in Lombardy, Italy between February 20th and March 18th. The median age was 63 years and 82% were male. Of those with available data, 68% had at least one comorbidity and 49% had hypertension. Among those with respiratory support data, 99% required support including 88% who received mechanical ventilation. ICU mortality was 26% as of March 25th and older patients had higher mortality than younger patients.
Avian influenza virus-infected poultry can release a large amount of virus-contaminated droppings that serve as sources of infection for susceptible birds. Much research so far has focused on virus spread within flocks. However, as fecal material or manure is a major constituent of airborne poultry dust, virus-contaminated particulate matter from infected flocks may be dispersed into the environment.
This study, demonstrates the presence of airborne influenza virus RNA downwind from buildings holding LPAI-infected birds, and the observed correlation between field data on airborne poultry and livestock associated microbial exposure and the OPS-ST model. These findings suggest that geographical estimates of areas at high risk for human and animal exposure to airborne influenza virus can be modeled during an outbreak, although additional field measurements are needed to validate this proposition. In addition, the outdoor detection of influenza virus contaminated airborne dust during outbreaks in poultry suggests that practical measures can assist in the control of future influenza outbreaks.
In general, exposure to airborne influenza virus on commercial poultry farms could be reduced both by minimizing the initial generation of airborne particles and implementing methods for abatement of particles once generated. As an example, emergency mass culling of poultry using a foam blanket over the birds instead of labor-intensive whole-house gassing followed by ventilation reduces both exposure of cullers and dispersion of contaminated dust into the environment, contributing to the control of influenza outbreaks.
Fair Allocation of Scarce Medical Resources in the Time of Covid-19Valentina Corona
This document discusses the challenges of rationing scarce medical resources during the Covid-19 pandemic. It notes that rationing has already begun with shortages of masks, ICU beds, and hospital beds in some areas. The pandemic will likely overwhelm healthcare systems and resources. Estimates suggest that 5-20% of the US population could be infected, requiring millions of hospitalizations and ICU beds beyond current capacity. Principles are needed for how to allocate limited resources fairly during the crisis.
Ruan2020 likelihood of survival of coronavirus disease 2019Nilda Vllacres
This document discusses estimates of the case fatality ratio (CFR) for COVID-19. The CFR is an important indicator of disease severity and public health impact. Early estimates of the CFR for COVID-19 have varied from 1.4-3.8% depending on datasets and time periods. A recent study estimated an overall CFR of 1.38% in China, increasing with age. Comparisons show COVID-19's CFR is much higher than seasonal flu across all age groups, highlighting it is more severe. Early detection and treatment can help control outbreaks and lower the CFR.
The dynmics of covid 19 in africa compare to the rest of the worldoyepata
1. The document analyzes data from 187 countries to compare the impact of COVID-19 on African countries versus other parts of the world.
2. It finds that with the exception of South Africa, African countries appear to be least affected by the virus in terms of total cases and mortality rates.
3. The lower impact in Africa may be due to factors like a more robust immune response, though more research is needed to understand the reasons.
Seasonal influenza is a highly contagious airborne disease that occurs annually, causing mild to severe illness and sometimes death. It is caused by influenza A and B viruses. Common symptoms include fever, cough, and fatigue. While most people recover within a week, those at high risk like the elderly and very young are more likely to develop severe complications. Vaccination is the most effective prevention strategy and is recommended annually for high risk groups.
This document discusses lessons that can be learned from past influenza pandemics and applied to understanding the future course of the COVID-19 pandemic. It outlines three possible scenarios for the future trajectory of COVID-19 based on patterns seen in influenza. Scenario 1 involves repetitive smaller waves over 1-2 years as immunity gradually increases. Scenario 2 consists of a large second peak in cases around 6 months after the first. Scenario 3 follows a seasonal pattern with peaks in winter. The pandemic may last 18-24 months until 60-70% of the population is immune through natural infection or vaccination.
There are several key reasons why infectious disease outbreaks have been increasing globally in recent decades. Increased travel, trade, and urbanization have made it easier for pathogens to spread to new areas. Climate change is also enabling some disease-carrying mosquitoes and other animals to thrive in new environments. However, public health organizations have gotten better at detecting and responding to outbreaks early, meaning fewer cases per outbreak overall. Still, underfunding of disease surveillance programs in some areas has allowed certain illnesses to resurge. Continued challenges include poverty, conflict, and environmental degradation. Proper isolation of infectious patients also remains important for control.
- 84 of the 201 patients with COVID-19 pneumonia (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84 patients, 44 (52.4%) died.
- Risk factors for developing ARDS included older age, pre-existing comorbidities like hypertension and diabetes, and signs of disease severity like dyspnea.
- Risk factors for progression from ARDS to death included older age, signs of immune system overactivation and organ dysfunction like neutrophilia and elevated lactate dehydrogenase and D-dimer levels.
- Treatment with the corticosteroid methylprednisolone was associated with decreased risk of death among patients with ARDS.
Pneumonia is a common respiratory infection that affects the lungs. It is broadly divided into community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). The causative microorganisms differ between CAP and HAP depending on whether the pneumonia was acquired in the community or healthcare setting. Mortality from pneumonia is highest in young children and older adults, and is influenced by treatment setting, age, comorbidities, and the specific type of pneumonia such as CAP or HAP.
AI transmission risks: Analysis of biosecurity measures and contact structureHarm Kiezebrink
Contacts between people, equipment and vehicles prior and during outbreak situations are critical to determine the possible source of infection of a farm. Hired laborers are known to play a big role in interconnecting farms. Once a farm is infected, culling entire flock is the only option to prevent further spreading with devastating consequences for the industry.
In this paper, based on the HPAI outbreak in Holland 2003, the researchers found that 32 farms hired external labor of which seven accessed other poultry on the same day.
However, they were not the only ‘connectors’ as some (twelve) farmers also reported themselves helping on other poultry farms.
Furthermore, 27 farms had family members visiting poultry or poultry-related businesses of which nine entered poultry houses during those visits. The other enhancing factor of farm interconnections was the reported ownership of multiple locations for ten of the interviewed farms and the reported on-premises sale of farm products on one pullet and eight layer farms.
Also worth mentioning is the practice of a multiple age system reported on eight of the interviewed farms as this may increase the risk of infecting remaining birds when off-premises poultry movements occur.
AI viruses may be introduced into poultry from reservoirs such as aquatic wild birds but the mechanisms of their subsequent spread are partially unclear. Transmission of the virus through movements of humans (visitors, servicemen and farm personnel), vectors (wild birds, rodents, insects), air- (and dust-) related routes and other fomites (e.g., delivery trucks, visitors’ clothes and farm equipment) have all been hypothesized.
It is therefore hypothesized that the risk of introducing the virus to a farm is determined by the farm’s neighborhood characteristics, contact structure and its biosecurity practices.
On the one hand, neighborhood characteristics include factors such as the presence of water bodies (accessed by wild birds), the density of poultry farms (together with the number and type of birds on these farms) and poultry-related businesses and the road network. The use of manure in the farm’s vicinity is also deemed to be risky.
On the other hand, contact structure risk factors include the nature and frequency of farm visits. Therefore, a detailed analysis of the contact structure, including neighborhood risks, and biosecurity practices across different types of poultry farms and poultry-related businesses helps the improvement of intervention strategies, biosecurity protocols and adherence to these, as well as contact tracing protocols.
Farmers’ perception of visitor- and neighborhood-associated risks of virus spread is also important due to its relevance to adherence with biosecurity protocols, to contact tracing and to communicating advice to them.
Clinical Epidemiological Study of Secondary Syphilis - Current Scenarioiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the risks of COVID-19 infection in pregnant women based on a study of nine cases in China. It finds that the clinical characteristics and outcomes for pregnant women with COVID-19 were less severe than those seen in pregnant women with SARS. However, more research is still needed given the small number of cases. It recommends pregnant women and newborns be considered at-risk populations and that prevention and management strategies be strengthened.
Imperial college covid19 europe estimates and npi impactValentina Corona
The document summarizes estimates from a model analyzing COVID-19 mortality data from 11 European countries. Key findings include:
- Millions of infections have likely occurred, far more than the number detected. Italy may have had 5.9 million infections (9.8% of population) as of March 28th.
- Non-pharmaceutical interventions have likely reduced the reproduction number (Rt) substantially, though estimates vary by country. On average, interventions represent a 64% reduction from initial Rt of around 3.87.
- Interventions may have averted 59,000 deaths by March 31st across the 11 countries. More data is needed to determine if Rt has been driven below 1 in
This document summarizes risk factors and response actions related to influenza A H1N1. It outlines background information on influenza strains and pandemics. The 2009 H1N1 strain was a combination of genes from swine, avian, and human influenza viruses. Studies identified higher risk groups as American Indians, younger/older individuals, and those with pre-existing medical conditions. Vaccination timing and strategies were modeled in Canada, showing reduced infection risk with vaccination. Key response actions included isolation, hand washing, and informing healthcare providers.
This document discusses key concepts in infectious disease epidemiology including definitions of prevalence, incidence, epidemics, and quality improvement strategies. It covers:
- Definitions of epidemiology, prevalence, incidence, and incidence proportion and how they are used to measure disease occurrence.
- Types of infectious disease transmission including endemic, epidemic, pandemic, and nosocomial.
- The importance of understanding infectious diseases and their epidemiology to implement control and prevention measures.
- Strategies for quality improvement in infectious disease care including antibiotic stewardship programs and infection control committees.
Human-to-Human transmission of H7H7 in Holland 2003Harm Kiezebrink
The outbreak of highly pathogenic avian influenza A virus subtype H7N7 started at the end of February, 2003, in commercial poultry farms in the Netherlands. In this study, published in The Lancet in 2004, it is noted that an unexpectedly high number of transmissions of avian influenza A virus subtype H7N7 to people directly involved in handling infected poultry, providing evidence for person-to-person transmission.
Although the risk of transmission of these viruses to humans was initially thought to be low, an outbreak investigation was launched to assess the extent of transmission of influenza A virus subtype H7N7 from chickens to humans.
453 people had health complaints—349 reported conjunctivitis, 90 had influenza-like illness, and 67 had other complaints. We detected A/H7 in conjunctival samples from 78 (26·4%) people with conjunctivitis only, in five (9·4%) with influenza-like illness and conjunctivitis, in two (5·4%) with influenza-like illness only, and in four (6%) who reported other symptoms. Most positive samples had been collected within 5 days of symptom onset. A/H7 infection was confirmed in three contacts (of 83 tested), one of whom developed influenza-like illness. Six people had influenza A/H3N2 infection. After 19 people had been diagnosed with the infection, all workers received mandatory influenza virus vaccination and prophylactic treatment with oseltamivir. More than half (56%) of A/H7 infections reported here arose before the vaccination and treatment programme.
A study of health comprehension about the cholera among a slicesin74
A study was conducted among 98 University of Baghdad employees and 30 randomly selected individuals to assess their knowledge of cholera. Most participants correctly identified that cholera is transmitted through contaminated water and food and causes watery diarrhea. While over half of the study group identified bacteria as the causative agent, answers varied more among the control group. The results indicate relatively good understanding of cholera transmission and symptoms but lack of complete knowledge about the bacterial cause.
This paper reviews the evolution of the definition of sepsis and the controversy surrounding the sepsis-3 definition and the sepsis screening tool, qSOFA.
Respiratory virus shedding in exhaled breath and efficacy of face masksValentina Corona
1) The study identified seasonal human coronaviruses, influenza viruses, and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness.
2) Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols. There was also a trend toward reduced detection of coronavirus RNA in respiratory droplets.
3) The results indicate that surgical face masks could help prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
Abstract—The frequent occurrence of epidemics even after the launching of the Integrated Diseases Surveillance Programme (IDSP) was an indication toward inadequacy of the control system. These epidemics/outbreaks may be identified if disease status analysis is done properly. The aim of the this study was to find out status of some of major diseases included in the IDSP in a tertiary level hospital of western Rajasthan. It was a record-based analysis carried out in hospitals attached to SMS medical College, Jaipur (Rajasthan) India. Weekly report of IDSP in 'L' Form was collected of year 2015 from SMS Medical College, Hospitals. Data related to major diseases of IDSP were gathered from these reports. These reports were analysed in percentage and proportion. It was observed among major six diseases studied in this present study, majority of cases were of Swine flue followed by Dengue, Scrub Typhus and Malaria. There was no case of Chikungunia and Enteric Fever. When deaths due to these major six diseases were observed it was found that majority of deaths occurred due to Swine flue followed by Dengue, Scrub Typhus and Malaria. Malaria death was due to Plasmodiun Falcifarrum. Maximum PCR was of Swine flue (42.32%) followed by Dengue (29.16 %), Scrub Typhus (21.87%) and Malaria (6.65%). Maximum PDR was of Swine flue (93.08%) followed by Dengue (3.08%), Scrub Typhus (3.08%) and Malaria (0.77%). Overall Case Fatality (CFR) of these diseases was found 9.2%. Regarding variation CFR of these diseases it was found that maximum CFR was of Swine flue (20.23%) followed by Scrub Typhus (1.29%), Dengue (1.06%) and Malaria (0.97%). This variation of CFR as per the type of diseases was found with significant variation (p<0.001).So more emphasis should be given to more fatal disease like swine flue.
Baseline characteristics and outcomes of 1591 patients infected with sars co ...Valentina Corona
This case series describes 1591 critically ill patients with COVID-19 admitted to ICUs in Lombardy, Italy between February 20th and March 18th. The median age was 63 years and 82% were male. Of those with available data, 68% had at least one comorbidity and 49% had hypertension. Among those with respiratory support data, 99% required support including 88% who received mechanical ventilation. ICU mortality was 26% as of March 25th and older patients had higher mortality than younger patients.
Avian influenza virus-infected poultry can release a large amount of virus-contaminated droppings that serve as sources of infection for susceptible birds. Much research so far has focused on virus spread within flocks. However, as fecal material or manure is a major constituent of airborne poultry dust, virus-contaminated particulate matter from infected flocks may be dispersed into the environment.
This study, demonstrates the presence of airborne influenza virus RNA downwind from buildings holding LPAI-infected birds, and the observed correlation between field data on airborne poultry and livestock associated microbial exposure and the OPS-ST model. These findings suggest that geographical estimates of areas at high risk for human and animal exposure to airborne influenza virus can be modeled during an outbreak, although additional field measurements are needed to validate this proposition. In addition, the outdoor detection of influenza virus contaminated airborne dust during outbreaks in poultry suggests that practical measures can assist in the control of future influenza outbreaks.
In general, exposure to airborne influenza virus on commercial poultry farms could be reduced both by minimizing the initial generation of airborne particles and implementing methods for abatement of particles once generated. As an example, emergency mass culling of poultry using a foam blanket over the birds instead of labor-intensive whole-house gassing followed by ventilation reduces both exposure of cullers and dispersion of contaminated dust into the environment, contributing to the control of influenza outbreaks.
Fair Allocation of Scarce Medical Resources in the Time of Covid-19Valentina Corona
This document discusses the challenges of rationing scarce medical resources during the Covid-19 pandemic. It notes that rationing has already begun with shortages of masks, ICU beds, and hospital beds in some areas. The pandemic will likely overwhelm healthcare systems and resources. Estimates suggest that 5-20% of the US population could be infected, requiring millions of hospitalizations and ICU beds beyond current capacity. Principles are needed for how to allocate limited resources fairly during the crisis.
Fair Allocation of Scarce Medical Resources in the Time of Covid-19
Similar to Mortality Associated with Influenza in Tropics, State of São Paulo, Brazil, from 2002 to 2011: The Pre-Pandemic, Pandemic, and Post-Pandemic Periods
Ruan2020 likelihood of survival of coronavirus disease 2019Nilda Vllacres
This document discusses estimates of the case fatality ratio (CFR) for COVID-19. The CFR is an important indicator of disease severity and public health impact. Early estimates of the CFR for COVID-19 have varied from 1.4-3.8% depending on datasets and time periods. A recent study estimated an overall CFR of 1.38% in China, increasing with age. Comparisons show COVID-19's CFR is much higher than seasonal flu across all age groups, highlighting it is more severe. Early detection and treatment can help control outbreaks and lower the CFR.
The dynmics of covid 19 in africa compare to the rest of the worldoyepata
1. The document analyzes data from 187 countries to compare the impact of COVID-19 on African countries versus other parts of the world.
2. It finds that with the exception of South Africa, African countries appear to be least affected by the virus in terms of total cases and mortality rates.
3. The lower impact in Africa may be due to factors like a more robust immune response, though more research is needed to understand the reasons.
Seasonal influenza is a highly contagious airborne disease that occurs annually, causing mild to severe illness and sometimes death. It is caused by influenza A and B viruses. Common symptoms include fever, cough, and fatigue. While most people recover within a week, those at high risk like the elderly and very young are more likely to develop severe complications. Vaccination is the most effective prevention strategy and is recommended annually for high risk groups.
Assessing Differential Impacts of COVID-19 on African Countries: A Comparativ...oyepata
The document compares the impact of COVID-19 across different African countries and to the United States. Data from 55 randomly selected countries based on cases was analyzed against US data. Results show that with the exception of South Africa, African countries have been less affected by the virus overall with fewer total cases, higher recovery rates, and fewer deaths compared to indexes from the US and other continents. This difference may be due to factors like a more robust immune response in Africa.
1. The document summarizes the current state of knowledge about COVID-19, including its origin, pathophysiology, epidemiology, clinical presentation, diagnosis, and management.
2. Key points include that SARS-CoV-2 likely evolved through natural selection in an animal host before transferring to humans, its optimal binding to the human ACE2 receptor, and viral shedding occurring for up to 37 days including in asymptomatic cases.
3. Clinical presentation varies from mild to critical illness, with risk factors for severe disease including older age and comorbidities. Lymphopenia and elevated inflammatory markers are common lab findings.
Similarities and Differences between the New Coronavirus Infectious 2019 COVI...ijtsrd
This document compares the similarities and differences between COVID-19 and seasonal influenza. Both viruses cause respiratory illness with symptoms like fever and cough. However, COVID-19 has a longer incubation period and causes virus shedding for a longer duration than influenza. Additionally, COVID-19 spreads more easily between adults and leads to more secondary infections. In contrast, influenza has a higher transmission rate and often spreads more through children. The mortality rate of COVID-19 is also significantly higher than seasonal influenza. Currently, there are treatments and vaccines available for influenza but not yet for COVID-19.
Covid-19: Summary Recommendations - Brazilian Medical Association (AMB)
Authors: S. E. TANNI, H.A. BACHA, C. E. FERNANDES, J. E. L. DOLCI, A.N. BARBOSA, W. BERNARDO
Publication date: 2021
Journal: World Medical Journal
ISSN: 2256-0580
Volume: 2
Pages: 37-52
Publisher
World Medical Association
The editorial discusses the Covid-19 outbreak caused by a novel coronavirus. It summarizes a study describing the first 425 cases in Wuhan, China, noting the median age was 59 and higher mortality in the elderly and those with preexisting conditions. While the current fatality rate is around 2%, it may ultimately be closer to seasonal flu if asymptomatic cases are accounted for. The virus has an estimated reproduction number of 2.2, indicating rapid spread. Countries have implemented travel restrictions and should prepare for broader community spread, potentially using social distancing and isolation measures. Research efforts are underway to develop treatments and a vaccine.
Forecasts for the end of the new coronavirus pandemic in brazil and the worldFernando Alcoforado
The document summarizes predictions from universities in Singapore and Minnesota regarding the end of the COVID-19 pandemic in Brazil and worldwide. Researchers in Singapore predict that 97% of the crisis will end by May 30th, 2020 and 100% by December 2nd, 2020. They predict the pandemic will slow in Brazil by June 6th and health will be recovered by September 6th, 2020. Researchers at the University of Minnesota believe the pandemic may involve repetitive waves over 1-2 years or a severe second wave in late 2020, and that 60-70% of the population needs immunity for it to end. Overall predictions vary in optimism, with Singapore's estimates being more optimistic and Minnesota's acknowledging the pandemic may not end soon.
The document discusses 5 signature features of past influenza pandemics that can inform pandemic preparedness planning: 1) a shift in the virus subtype, 2) a shift in the highest death rates to younger populations, 3) successive pandemic waves over multiple years, 4) higher transmissibility than seasonal influenza, and 5) differences in impact across geographic regions. Understanding these features is important for optimizing control strategies, prioritizing vaccine distribution, and emphasizing the need for international collaboration on surveillance, data sharing, and response.
Pulmonary Tuberculosis in Coronavirus Disease-19 Patients: Report of Casesasclepiuspdfs
The coronavirus disease 2019 (COVID-19) is known to cause severe respiratory illness manifesting in a spectrum of related disorders. Amidst the continuous evolution of this pandemic which has caused vast devastation globally, it is crucial to note that tuberculosis (TB), which also causes respiratory diseases, has and still affects over a quarter of the world’s population. Coinfection of both diseases have severe health implications. Therefore, it is vital to understand the effects of this novel virus on the immune system and coinfection with a bacterial infection, like TB. Based on peer-reviewed cases, there seems to be an associational relationship between COVID-19 and TB; research suggests both weaken the immune system and further complicate clinical outcomes, which was further explored in this paper.
COVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously known as 2019 novel coronavirus (2019-nCoV), a strain of coronavirus. The first cases were seen in Wuhan, China in December 2019 before spreading globally. The current outbreak was recognized as a pandemic on 11 March 2020.
The non-specific imaging findings are most commonly of atypical or organizing pneumonia, often with a bilateral, peripheral, and basal predominant distribution. No effective treatment or vaccine exists currently (March 2020).
The document discusses the COVID-19 pandemic, including the origins and spread of SARS-CoV-2. It describes key events like the virus being first identified in Wuhan, China in late 2019, the WHO declaring a public health emergency in January 2020, and the virus spreading widely in the United States between late January and February 2020. It also discusses recommendations from the CDC on preventive measures like social distancing and mask-wearing during surges. Finally, it lists common comorbidities and risk factors like older age, obesity, and heart or lung conditions that are associated with more severe COVID-19 outcomes.
H1 n1 influenza a disease information for health professionals lindsey_nejm 2009Ruth Vargas Gonzales
1. A novel H1N1 influenza virus emerged in Mexico and the US in April 2009 that was a triple reassortment of human, avian, and swine influenza viruses.
2. Researchers developed PCR tests to identify confirmed cases of the virus and help track the outbreak. Health authorities worldwide are monitoring and trying to control the outbreak.
3. As of early May 2009, the virus was causing mild to moderate illness in most patients. However, some hospitalized patients developed pneumonia or other complications, and two deaths occurred in high-risk patients. The age distribution and symptoms resembled typical seasonal influenza.
The document discusses the Ebola virus epidemic. It was first identified in 1976 in the Democratic Republic of Congo and Sudan. Ebola virus is transmitted from animals to humans and then spreads through person-to-person transmission, causing outbreaks and epidemics. While its origin is unknown, between 1972 and 2007 there were several outbreaks with high fatality rates of 50-90%. The 2014-2016 West Africa epidemic was the largest and most complex Ebola outbreak to date.
About the national experience in the last pandemic flu in 2009. A descriptive analysis of the first national laboratory-confirmed cases of the diseases.
Estimates of the severity of coronavirus disease 2019 - a model-based analysisGuy Boulianne
This study used individual-level case data and aggregate case/death counts from China, Hong Kong, Macau, and other countries to estimate key severity metrics for COVID-19, accounting for biases. The researchers estimated that the mean duration from symptom onset to death is 17.8 days, and to hospital discharge is 24.7 days. They estimated the case fatality ratio in China to be 1.38% overall but higher in older age groups, and the infection fatality ratio in China to be 0.66% with increasing risk with age. They also estimated the proportion of infections likely to require hospitalization increases with age up to 18.4% for those aged 80+.
Similar to Mortality Associated with Influenza in Tropics, State of São Paulo, Brazil, from 2002 to 2011: The Pre-Pandemic, Pandemic, and Post-Pandemic Periods (20)
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Fexofenadine is sold under the brand name Allegra.
It is a selective peripheral H1 blocker. It is classified as a second-generation antihistamine because it is less able to pass the blood–brain barrier and causes lesser sedation, as compared to first-generation antihistamines.
It is on the World Health Organization's List of Essential Medicines. Fexofenadine has been manufactured in generic form since 2011.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
2. 2 Influenza Research and Treatment
pneumonia and influenza mortality by age is key to analyze
the total burden of disease and to compare with other
influenza seasons and with other regions. Understanding the
behavior of past pandemics and epidemics of influenza is
critical for setting public health priorities for the coming sea-
sonal and pandemic influenza.
The aim of this study is to evaluate the influenza-
associated mortality in the State of S˜ao Paulo, Brazil, from
2002 to 2011. The choice of this period was due to the avail-
ability of systematic virological surveillance data, allowing
validate data on mortality associated with influenza with
information about the antigenic characteristics and levels of
viral activity.
2. Material and Methods
2.1. Locality. S˜ao Paulo is the most populate state in Brazil
(over 41 million inhabitants in 2010 Census) with a GDP
of U.S. $15,000.00 per capita and a Human Development
Index of 0.833 (United Nations Development Programme),
also with good health care services and epidemiological sur-
veillance [15]. It is located between latitudes 19∘
46
45
S and
25∘
18
43
S. Despite being in the region of predominantly tro-
pical and subtropical climate, the study region has clearly
defined seasons of increased circulation of influenza viruses
[16].
2.2. Mortality and Population. Mortality data were obtained
from Health Statistics System (DATASUS), Mortality Infor-
mation System which covers 100% of the State of S˜ao Paulo
since 1979 [17]. Causes of death are classified using the
International Cause of Death, ICD-10 codes for pneumonia
and influenza (ICD J 10 to J18.9), respiratory causes (ICD J00
to J99), and all-cause mortality (excluding external causes of
mortality). The mortality rates were calculated in three age
groups, 0 to 4, 5 to 19, 20 to 59, and more than 60 years.
Population data were obtained from the Brazilian Insti-
tute of Geography and Statistics (IBGE) using data from the
2010 Census [17]. The weekly estimates were obtained by
interpolation.
2.3. Virological Data. Data on influenza virus activity in
Southeastern Brazil were obtained from the Ministry of
Health through the Information System of Epidemiological
Surveillance of Influenza Department of Health Surveillance,
(SIVEP-Gripe) [18]. This system monitors the occurrence
of influenza through sentinel units, which investigate the
etiology of respiratory viruses causing flu-like syndromes.
National Reference Laboratories test the samples by indi-
rect immunofluorescence for a panel of respiratory viruses
(including influenza A and B, parainfluenza 1, 2, and 3,
respiratory syncytial virus, and adenovirus) and forward
samples for culture of virus and real-time RT-PCR. As the
viral subtypes are not provided by SIVEP, data are obtained
from various official sources [18–22].
2.4. Deaths due to Laboratory-Confirmed Pandemic Influenza.
In the beginning of the pandemic, the criterion to confirm the
influenza cases was as follows: any patient who had flu-like
illness (defined as fever, cough, or sore throat) and history
of traveling to countries with occurrence of cases or con-
tacting with infected person. After the initial phase, diffuse
transmission was confirmed in epidemiological week 28. At
this time the registration of cases was as follows: patients
with severe acute respiratory infections (SARI); that is, the
definition of SARI included fever, cough and dyspnea, or
death. All patients reported by the National System of Surveil-
lance Reportable Disease (SINAN) had respiratory secretion
samples collected for performing real-time RT-PCR in the
National Reference Laboratories. Data on deaths confirming
influenza pandemic were extracted from SINAN by age.
2.5. Statistical Analysis. The estimation of influenza-asso-
ciated mortality was obtained through the classic method
Serfling with adaptation to weekly data [23]. To fit regression,
we used the total period of 10 years excluding the weeks of
greater viral circulation by laboratory criteria.
We defined the onset of periods of increased activity of
the influenza virus by virological criteria in the Brazilian
southeast (where State of S˜ao Paulo is located) when there
was the occurrence of two consecutive weeks in which was
confirmed by indirect immunofluorescence more than twice
of the annual average of cases. We defined that this period
ends with the occurrence of two consecutive weeks with viral
diagnostic below the annual average. The period of highest
viral activity in 2009 began at the time the Brazilian Ministry
of Health [15] officially declared epidemiological situation as
“widespread viral transmission” until the official end of the
pandemic was reported by WHO [24].
A cyclical linear regression was constructed as follow:
𝑌 = 𝛽0 + 𝛽1 ∗ 𝑡 + 𝛽2 ∗ 𝑡2
+ 𝛽3 ∗ 𝑡3
+ 𝛽4 ∗ sin (
2 ∗ 𝜋 ∗ 𝑡
52.17
)
+ 𝛽5 ∗ cos (
2 ∗ 𝜋 ∗ 𝑡
52.17
) + 𝑒1,
(1)
where 𝑌 is the mortality rate, 𝛽 is the coefficients of regres-
sion, 𝑡 is time in weeks and 𝑡2
and 𝑡3
are variables for adjusting
the secular trend of the disease.
After adjusting stepwise linear regression, the baseline of
expected mortality in the absence of influenza was defined.
Using this reference, influenza epidemic periods were demar-
cated as the periods in which mortality from pneumonia and
influenza was above 95% confidence interval predicted by
the model for two consecutive weeks; these periods ended
when mortality was less than the upper confidence interval
for two consecutive weeks. Weekly excess mortality rate was
estimated by the difference between the observed and pre-
dicted mortality rates by the model during influenza epi-
demic periods. Season mortality rate was calculated as the
sum of weekly excess mortality rate during the year.
The data were analyzed using the statistical program
SPSS for Windows, version 13.0, graphics, and data compi-
lation were made using the Microsoft Office Excel 2007. All
databases analyzed were not able to do any kind of patient
identification to preserve patients’ privacy.
3. Influenza Research and Treatment 3
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Mortalityrateper100.000
0 to 4 years
0
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Mortalityrateper100.000
5 to 19 years
0.1
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Mortalityrateper100.000
20 to 59 years
3
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Mortalityrateper100.000
More than 60 years
Figure 1: Mortality due to pneumonia and influenza (rate per 100.000). Weekly pneumonia and influenza mortality rate per 100.000
inhabitants by age group, S˜ao Paulo, Brazil, January, 2002 to December, 2011. (Dark blue line: observed rate; light blue line: baseline mortality
rate predict by model; red line: upper limit of confidence interval).
3. Results
3.1. Viral Activity and Excess Mortality due Pneumonia and
Influenza. The weekly mortality due pneumonia and influ-
enza, respiratory causes, and all causes showed a seasonal
pattern, with increased mortality during winter in the South-
ern hemisphere (Figures 1, 2, and 3). There was concurrency
between periods of viral activity increased and excess mortal-
ity peaks in 8 of the 10 years under study.
In the pre-pandemic period, the years of highest mortality
among individuals over 60 years (2006 and 2007) showed
high proportion of specimens positive for influenza with
predominance of the AH3N2 virus (Tables 1 and 2).
Still considering the pre-pandemic period, the years of
lower mortality from pneumonia and influenza in all age
groups presented low viral activity (2005) and prevalence of
AH1N1 virus (2008), known to be less lethal.
The first laboratory-confirmed imported cases of influ-
enza AH1N1 pdm 2009 were detected in Brazil in early May.
On July 16th, epidemiological week (EW) 28th, Brazilian
Health Ministry [15] officially recognized the occurrence of
cases due to autochthonous widespread transmission. From
early July, EW 26th, there seems to be evidence of excess
mortality due to pneumonia and influenza among individuals
of 20 to 59 years of age. During weeks EW 28th to 47th in 2009
(late November) we found the vast majority of deaths related
to the pandemic first wave, mainly in age groups 5 to 19 and
20 to 59 years.
Along the first half of 2010, there was a predominance of
2009 AH1N1 pdm, while the second AH3N2 variant was more
4. 4 Influenza Research and Treatment
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Jan-10
Jul-10
Jan-11
Jul-11
Jan-02
Jul-02Jul-02Jul-02Jul-02
Jan-03
Jul-03
Jan-04
Jul-04
Jan-05
Jul-05
Jan-06
Jul-06
Jan-07
Jul-07
Jan-08
Jul-08
Jan-09
Jul-09
Jan-10
Jul-10
Jan-11
Jul-11
Mortalityrateper100.000
0 to 4 years
0
0.1
0.2
Mortalityrateper100.000
5 to 19 years
0.25
0.45
0.85
0.65
Mortalityrateper100.000
20 to 59 years
5
10
15
20
Mortalityrateper100.000
More than 60 years
Figure 2: Mortality due respiratory causes (rate per 100.000). Weekly respiratory mortality rate per 100.000 inhabitants by age group, S˜ao
Paulo, Brazil, January, 2002 to December, 2011. (Dark blue line: observed rate; light blue line: baseline mortality rate predict by model; red
line: upper limit of confidence interval).
prevalent [19]. In 2010, the excess mortality from pneumonia
and influenza in the age group 0 to 4 and 5 to 19 years was,
respectively, 0.6 and 0.2 per 100,000, in both cases below the
average of previous years. In the age group 20 to 59 years it
was 1.1 per 100,000, slightly above the average for seasonal
influenza epidemics (0.9 per 100.000), but well below mor-
tality observed in 2009 (2.8 per 100.000). Mortality in over
60 years was 17.0 per 100,000, a level slightly below the aver-
age of influenza epidemic years.
That is, in 2010 the overall excess mortality from pneu-
monia and influenza presented a pattern more like a year of
seasonal influenza epidemics, with higher mortality among
the elderly and sparing ages between 5 and 59 years, some-
thing very different from the pandemic period. This situation
may have been influenced by the wide dissemination of
the virus in 2009 with naturally induced immunization,
extensive vaccination campaign conducted in early 2010
against pandemic influenza and atypical intense circulation
of the virus AH3N2 in the second half of 2010. This atypical
movement of AH3N2 remained throughout spring of 2010
and early summer of 2011 and may have been a consequence
of disturbances in herd immunity caused by the pandemic.
In early 2011, there was a wave of excess mortality due to
pneumonia and influenza in EW 4th and 6th (January and
February), probably related to atypical activity of AH3N2.
The alternative hypothesis to explain this peak which is the
activity of respiratory syncytial virus activity seems unlikely,
because the higher prevalence of this virus was in EW
13th that year (SIVEP GRIPE). The pattern of mortality
from pneumonia and influenza in 2011 was similar to years
of seasonal H3N2 influenza epidemics with high mortality
among the elderly, above normal.
5. Influenza Research and Treatment 5
Table 1: Annual excess mortality rate per 100.000 inhabitants by age group in prepandemic, pandemic, and postpandemic periods, State of
S˜ao Paulo, Brazil, 2002 to 2011.
1–4 years
(95% C.I.)
5–19 years
(95% C.I.)
20–59 years
(95% C.I.)
60 and more years
(95% C.I.)
All ages
(95% C.I.)
2002
Pneumonia and influenza 2,0 (1,5–2,5) 0,3 (1,2–0,4) 0,7 (0,6–0,9) 16,8 (12,6–21,0) 2,2 (1,9–2,7)
Respiratory causes 2,7 (2,0–3,4) 0,4 (0,3–0,5) 1,3 (9,9–1,6) 27,0 (21,0–33,0) 3,5 (7,6–4,3)
All causes 5,5 (3,8–7,2) 1,2 (0,8–1,6) 6,3 (4,8–7,7) 89,1 (61,1–117,0) 12,2 (8,7–15,7)
2003
Pneumonia and influenza 2,5 (2,0–3,0) 0,2 (1,3–0,2) 0,9 (0,7–1,1) 14,6 (11,3–17,9) 2,1 (1,9–2,5)
Respiratory causes 2,3 (1,9–2,7) 0,3 (0,2–0,3) 1,3 (10,0–1,7) 26,1 (20,7–31,5) 3,3 (7,5–4,0)
All causes 8,3 (6,0–10,5) 0,9 (0,7–1,1) 5,1 (4,1–6,2) 80,5 (60,2–100,8) 11,0 (8,3–13,6)
2004
Pneumonia and influenza 2,3 (1,8–2,9) 0,2 (1,2–0,3) 0,6 (0,5–0,8) 20,6 (15,6–25,6) 2,4 (2,1–3,0)
Respiratory causes 2,4 (1,9–3,0) 0,2 (0,2–0,3) 1,2 (10,1–1,7) 47,7 (38,3–57,1) 5,2 (9,2–6,4)
All causes 9,1 (7,1–11,1) 0,7 (0,6–0,9) 5,5 (4,4–6,6) 98,3 (65,8–130,9) 12,8 (9,0–16,5)
2005
Pneumonia and influenza 0,7 (0,5–1,0) 0,2 (1,2–0,2) 0,1 (0,1–0,2) 2,3 (1,6–3,0) 0,4 (0,6–0,5)
Respiratory causes 0,4 (0,2–0,6) 0,2 (0,1–0,2) 0,1 (10,3–0,1) 4,8 (3,6–5,9) 0,6 (6,0–0,7)
All causes 2,8 (1,8–3,9) 0,4 (0,3–0,4) 1,2 (0,7–1,8) 19,8 (15,6–24,1) 2,8 (2,0–3,6)
2006
Pneumonia and influenza 1,6 (1,2–2,0) 0,3 (1,1–0,4) 0,8 (0,6–1,0) 26,3 (22,4–30,2) 3,0 (2,8–3,5)
Respiratory causes 2,5 (1,8–3,1) 0,4 (0,4–0,5) 1,3 (10,5–1,5) 35,8 (30,8–40,7) 4,2 (8,8–4,9)
All causes 9,7 (7,4–12,0) 1,8 (1,4–2,2) 5,8 (4,8–6,9) 110,9 (89,2–132,6) 14,4 (11,6–17,2)
2007
Pneumonia and influenza 1,5 (1,1–1,9) 0,1 (1,1–0,2) 1,0 (0,8–1,2) 18,2 (15,0–21,4) 2,6 (2,3–3,0)
Respiratory causes 2,1 (1,6–2,6) 0,3 (0,2–0,3) 1,6 (10,8–1,9) 25,6 (21,5–29,6) 3,8 (8,6–4,5)
All causes 5,8 (4,9–6,8) 1,4 (1,1–1,7) 5,1 (4,2–6,0) 87,9 (68,4–107,5) 12,8 (10,1–15,4)
2008
Pneumonia and influenza 1,7 (1,3–2,1) 0,2 (1,1–0,3) 0,4 (0,3–0,5) 7,1 (5,3–9,0) 1,2 (1,1–1,5)
Respiratory causes 2,1 (1,5–2,8) 0,2 (0,1–0,3) 0,5 (11,2–0,7) 17,0 (12,4–21,6) 2,3 (7,9–3,0)
All causes 9,2 (6,9–11,6) 0,8 (0,6–1,1) 3,3 (2,3–4,2) 38,8 (26,8–50,9) 6,9 (4,8–9,0)
2009
Pneumonia and influenza 0,9 (0,5–1,2) 0,6 (1,1–0,7) 2,8 (2,4–3,1) 13,1 (9,6–16,6) 3,3 (2,8–3,9)
Respiratory causes 2,0 (1,3–2,6) 0,8 (0,7–1,0) 3,9 (11,6–4,3) 22,2 (15,4–28,9) 5,0 (8,7–6,1)
All causes 9,8 (6,7–12,9) 1,3 (0,9–1,7) 8,3 (6,5–10,0) 62,7 (47,8–77,5) 12,7 (9,7–15,6)
2010
Pneumonia and influenza 0,6 (0,4–0,8) 0,2 (1,1–0,3) 1,1 (0,8–1,4) 17,0 (12,5–21,5) 2,7 (2,2–3,4)
Respiratory causes 1,4 (0,9–1,9) 0,4 (0,3–0,5) 1,4 (12,0–2,0) 34,5 (26,2–42,8) 5,0 (10,2–6,3)
All causes 5,0 (3,5–6,5) 0,7 (0,5–0,9) 5,7 (4,1–7,2) 106,8 (76,0–137,6) 16,2 (11,5–20,8)
2011
Pneumonia and influenza 1,0 (0,6–1,3) 0,2 (1,2–0,3) 0,8 (0,6–1,0) 20,1 (16,9–23,3) 2,9 (2,6–3,5)
Respiratory causes 2,3 (1,6–3,0) 0,2 (0,1–0,2) 1,2 (12,4–1,5) 37,6 (30,9–44,3) 5,2 (11,0–6,3)
All causes 5,5 (3,6–7,4) 1,2 (0,7–1,7) 4,1 (2,9–5,2) 96,2 (76,6–115,9) 14,1 (11,0–17,3)
Average of epidemics
H3N2 (2006-2007) years
(a)
Pneumonia and influenza 1,5 0,2 0,9 22,2 2,8
Respiratory causes 2,3 0,4 1,5 30,7 4,0
All causes 7,8 1,6 5,5 99,4 13,6
Average 2002 to 2008
years (b)
Pneumonia and influenza 1,8 0,2 0,6 15,1 2,0
Respiratory causes 2,1 0,3 1,1 26,3 3,3
All causes 7,2 1,0 4,6 75,1 10,4
Rate ratio (2009/a)
Pneumonia and influenza 0,6 2,6 3,2 0,6 1,2
Respiratory causes 0,9 2,3 2,6 0,7 1,2
All causes 1,3 0,8 1,5 0,6 0,9
Rate ratio (2009/b)
Pneumonia and influenza 0,5 2,6 4,4 0,9 1,7
Respiratory causes 0,9 2,9 3,7 0,8 1,5
All causes 1,4 1,2 1,8 0,8 1,2
6. 6 Influenza Research and Treatment
4
5
6
7
8
Jan-02
Jan-03
Jul-03
Jan-04
Jul-04
Jan-05
Jul-05
Jan-06
Jul-06
Jan-07
Jul-07
Jan-08
Jul-08
Jan-09
Jul-09
Jan-10
Jul-10
Jan-11
Jul-11
Jan-02
Jan-03
Jul-03
Jan-04
Jul-04
Jan-05
Jul-05
Jan-06
Jul-06
Jan-07
Jul-07
Jan-08
Jul-08
Jan-09
Jul-09
Jan-10
Jul-10
Jan-11
Jul-11
Jan-02
Jan-03
Jul-03
Jan-04
Jul-04
Jan-05
Jul-05
Jan-06
Jul-06
Jan-07
Jul-07
Jan-08
Jul-08
Jan-09
Jul-09
Jan-10
Jul-10
Jan-11
Jul-11
Jan-02
Jul-02Jul-02Jul-02Jul-02
Jan-03
Jul-03
Jan-04
Jul-04
Jan-05
Jul-05
Jan-06
Jul-06
Jan-07
Jul-07
Jan-08
Jul-08
Jan-09
Jul-09
Jan-10
Jul-10
Jan-11
Jul-11
Mortalityrateper100.000 0 to 4 years
0.3
0.2
0.7
0.6
0.5
0.4
Mortalityrateper100.000
5 to 19 years
4.2
6.2
5.2
Mortalityrateper100.000
20 to 59 years
50
70
90
110
Mortalityrateper100.000
More than 60 years
Figure 3: Mortality due to all causes (rate per 100.000). Weekly all causes mortality rate per 100.000 inhabitants by age group, S˜ao Paulo,
Brazil, January, 2002 to December, 2011. (Dark blue line: observed rate; light blue line: baseline mortality rate predict by model; red line:
upper limit of confidence interval).
In 2011, the seasonality seems to have returned to normal,
since 86% of positive samples for influenza were obtained in
EW 20th to 32th in the Southeast, similar to the standard
pattern before the pandemic.
Data from official surveillance for SARI confirmed an
excess of mortality like more than half of the estimated cases
of deaths in 2009 (54%). The sensitivity for diagnosis appears
to have been greater in younger age groups (Table 3). On the
other hand, the age group with the highest underreporting
was the over 60 years (3%). This may be due to the higher
incidence of severe pneumonia in the elderly as a complica-
tion of chronic diseases confusing the diagnosis. Moreover,
in young patients, viral pneumonia were more severe and
clinically distinct from bacterial pneumonia, which is often
the cause of complications in patients older than 60 years.
4. Discussion
In the study period, we identified pneumonia and influenza
excess mortality simultaneously with the increase in viral cir-
culation. There was a clear relationship between the intensity
of the circulation of influenza virus known to be pathogenic
(AH3N2) and occurrence of mortality from pneumonia and
influenza, particularly in over 60 years group.
The excess mortality due to pneumonia and influenza and
other outcomes in 2009 was below the average of previous
influenza seasons (2002 to 2008) in the age groups 0 to 4
and over 60 years. In the groups 5 to 19 and 20 to 59 years,
during 2009, the pneumonia and influenza excess mortality
was, respectively, 2.6 and 4.4 times the average of the previous
periods. In all age groups, mortality was higher than those
the average of the previous period (2002 to 2008) and equal
7. Influenza Research and Treatment 7
Table 2: Influenza virus identified by year, positivity of specimens by season State of S˜ao Paulo, 2002–2011.
Year Virus probably predominant Positive specimens, average in season6
Total number of specimens
20021
B (58%), AH3N2 e AH1N1 (20% each) 9.9% 892
20031
AH3N2 (60,6%), H1N1 (27%) 11.8% 1365
20042
AH3N2 (67%), influenza B (20%) 9.0% 2159
20051
H3N2 (65,6%), B (24%) e H1N1 (11,4%) 4.9% 1612
20063
AH3N2 10.4% 2135
20073
AH3N2 8.5% 4840
20084
AH1N1 e B 6.6% 6303
20094
AH1N1 e AH1N1 pdm 2009 7.8% 1703∗
20105
AH1N1 pdm2009 = 1st mid, AH3N2 = 2nd mid 4.8% 2205∗
20115
AH3N2 e AH1N1 pdm2009 3.5% 2795
1
FluNet (WHO, data referring to South America) [22].
2
Guia de vigilˆancia epidemiol´ogica. Minist´erio da Sa´ude, Secretaria de Vigilˆancia em Sa´ude. 6. ed. Bras´ılia 2005 [28].
3
Boletim da Sa´ude, 2009 (State Board of Health, Rio Grande do Sul) [29].
4
Boletim Epidemiol´ogico, 2011 (State Board of Health, Rio Grande do Sul) [30].
5
Site: http://ais.paho.org/phip/viz/ed flu.asp [19].
6
SIVEP GRIPE-(Brazilian Ministry of Health) [31].
∗
During the pandemic there was a commitment in the collection of samples for surveillance of flu-like syndromes.
Table 3: Deaths by laboratory–confirmed 2009 pandemics and estimates from statics models State of S˜ao Paulo, 2002–2011.
Laboratory-confirmed Laboratory-
confirmed/estimate
deaths due to
respiratory causes (%)
2009 Pandemics excess mortality
rate/100.000 (95% C.I.)
H3N2 epidemics excess mortality
rate/100.000 (2006-2007), (95% C.I.)
Mortality
(rate/100.000)
Deaths Deaths (P & I) Respiratory causes Deaths (P & I) Respiratory causes
0–4 years 1.4 40 73% 25 (15–35) 55 (36–75) 44 (33–55) 65 (48–82)
5–19 years 0.6 57 70% 58 (49–67) 81 (66–96) 22 (18–27) 35 (28–42)
20–59 years 1.8 418 46% 659 (577–741) 907 (792–1,023) 207 (165–249) 343 (280–407)
60+ 0.7 33 3% 425 (318–532) 976 (678–1,274) 962 (814–1,111) 1,351 (1,151–1,550)
All ages 1.4 1098 54% 1,172 (962–1,382) 2,032 (1,581–2,483) 1,117 (927–1,307) 1,627 (1,362–1,892)
Proportion of
excess death
among >60
years
6% 36% 48% 86% 83%
mortality in epidemics of AH3N2 (2006 to 2007), although
the age groups most affected were different (Table 3). The total
number of influenza-related deaths in 2009 was higher than
the average of previous years, but was lower than in years
of seasonal H3N2 influenza epidemics. During epidemics
of AH3N2, 86% of deaths from pneumonia and influenza
occurred among those over 60 years, while in 2009 pandemic
only 36% of the deaths occurred in this age group, confirming
the expected shift in age, characteristic of pandemics. These
results are consistent with others from study performed in
Brazil [25].
Research conducted in other countries shows slightly
different results. In The Netherlands increased mortality con-
centrated in the age group 0 to 4 [26]. The most affected in
France were children under 4 and 35 to 44 years (considering
the outcome pneumonia, and influenza) [8]. In Austria of all
age groups below 44 years had higher mortality than the aver-
age of previous years, but the most affected group was child-
ren under 14 years [27]. In Mexico, the age groups most
affected were 5 to 19 and 20 to 59 years, with increases of
9 and 14.5 times from the average of the previous periods,
respectively. The same groups were the most affected in Brazil,
although with higher incidence and mortality rates in Mexico
[7]. In that country, children under 5 years and elderly older
than 60 years were less affected than in previous years, but
the influenza pneumonia excess mortality in all ages was
2.6 times higher than that observed in previous years. Study
carried out in Hong Kong [9] showed a different tendency, as
the most affected by influenza A H1N1 was the elderly. These
results should be viewed with caution because it is a unique
city.
Unlike what happened in England, where the second
wave seems to have been more intense than the first, in Brazil
there was not a second wave of the 2009 pandemic [11].
In Mexico, Charu and colleagues [7] observed increased
mortality among people over 60 already in the year 2010,
as noted in S˜ao Paulo in 2011. In that country, this phe-
nomenon occurred in a period slightly different from the
normal influenza seasonal, probably due to an increase in
the circulation of the virus AH3N2 which could not be
identified by sentinel surveillance due to be concentrated in
some region or in certain age groups [7].
8. 8 Influenza Research and Treatment
This study has some limitations mentioned below. As it
is an ecological study of mortality rates, certainly there are
variables not controlled, as vaccination, climatic changing,
and circulation of others virus. Other limitation is the small
number of specimens collected weekly (average of 50.0 per
week) which may have hampered the identification of small
peaks of viral activity, contributing to the lack of perfect
synchronization between the excess mortality and increased
viral activity. Analysis of subtypes circulating in influenza
seasons was compromised by having used aggregate data
obtained from the entire South America 2002, 2003, 2005,
2010, and 2011 and may not accurately reflect the local reality
of the state of S˜ao Paulo (PAHO, WHO).
This study concludes that the method Serfling adapted
to weekly information, with validation through viral activity
data using the influenza and pneumonia excess mortality,
may be appropriate in this geographic, climatic, and epidem-
iological context. In the state of S˜ao Paulo, mortality from
2009 pandemic influenza affected most age groups 5–50
years, and spared those younger than 5 and older than 60
years. The 2009 influenza H1N1 pandemic had almost all its
effect in 2009, without a second significant wave. Others stud-
ies are needed with standardized methodology for evaluating
the appropriate charge of the 2009 pandemic in different
regions considering climatic and social context, health sys-
tems, and measures taken. This can be useful to health auth-
orities in developing appropriate contingency plans for new
pandemics.
Conflict of Interests
All authors declare that they have no conflict of interests in
the research.
Acknowledgments
The authors are grateful to Roberto Men Fernandes and
Walquiria Aparecida Ferreira de Almeida, from Brazilian
Ministry of Health, for providing the mortality and virologi-
cal surveillance data, respectively, and Luana Hughes Freitas,
Bruno, Marcela and Nicole Montenegro de Medeiros, for
helpful comments on the manuscript and general discussions
many aspects of influenza.
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