Monitoring mortality as an indicator of influenza in Catalonia, Spain.

This study aimed to investigate the behaviour of two indicators of influenza activity in the area of Barcelona and to evaluate the usefulness of modelling them to improve the detection of influenza epidemics. DESIGN: Descriptive time series study using the number of deaths due to all causes registered by funeral services and reported cases of influenza-like illness. The study concentrated on five influenza seasons, from week 45 of 1988 to week 44 of 1993. The weekly number of deaths and cases of influenza-like illness registered were processed using identification of a time series ARIMA model. SETTING: Six large towns in the Barcelona province which have more than 60,000 inhabitants and funeral services in all of them. MAIN RESULTS: For mortality, the proposed model was an autoregressive one of order 2 (ARIMA (2,0,0)) and for morbidity it was one of order 3 (ARIMA (3,0,0)). Finally, the two time series were analysed together to facilitate the detection of possible implications between them. The joint study of the two series shows that the mortality series can be modelled separately from the reported morbidity series, but the morbidity series is influenced as much by the number of previous cases of influenza reported as by the previous mortality registered. CONCLUSIONS: The model based on general mortality is useful for detecting epidemic activity of influenza. However, because there is not an absolute gold standard that allows definition of the beginning of the epidemic, the final decision of when it is considered an epidemic and control measures recommended should be taken after evaluating all the indicators included in the influenza surveillance programme.

How critical is timing for the diagnosis of influenza in general practice?

QUESTIONS UNDER STUDY: The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. PRINCIPLES: A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. RESULTS: 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associated with a diagnosis of influenza. In a multivariable logistic analysis, the best model predicting influenza was the association of a duration of symptom <48 hours, medical attendance at the beginning of the epidemic (weeks 49-50), fever >37.8 and cough, with a sensitivity of 79%, specificity of 69%, positive predictive value of 67%, negative predictive value of 73% and an area under the ROC curve of 0.74. CONCLUSIONS: Besides relevant symptoms and signs, the physician should also consider the duration of symptoms and the epidemiological context (start, peak or end of the epidemic) in his appraisal, since both parameters considerably modify the value of the clinical predictors when assessing the probability of a patient having influenza.

Influenza vaccination in immunocompromised patients: efficacy and safety.

Yearly administration of the influenza vaccine is the main strategy to prevent influenza in immunocompromised patients. Here, we reviewed the recent literature regarding the clinical significance of the influenza virus infection, as well as the immunogenicity and safety of the influenza vaccine in HIV‑infected individuals, solid-organ and stem-cell transplant recipients and patients receiving biological agents. Epidemiological data produced during the 2009 influenza pandemic have confirmed that immunocompromised patients remain at high risk of influenza-associated complications, namely viral and bacterial pneumonia, hospitalization and even death. The immunogenicity of the influenza vaccine is overall reduced in immunocompromised patients, although a significant clinical protection from influenza is expected to be obtained with vaccination. Influenza vaccination is safe in immunocompromised patients. The efficacy of novel strategies to improve the immunogenicity to the vaccine, such as the use of adjuvanted vaccines, boosting doses and intradermal vaccination, needs to be validated in appropriately powered clinical trials.

Prevalence rate and reasons for refusals of influenza vaccine in the elderly

RESUME Peu d'informations sont disponibles concernant la prévalence et les motifs de refus de la vaccination contre la grippe dans la population âgée. Le but de notre recherche était d'investiguer les vrais motifs de refus de la vaccination (c'est-à-dire pas uniquement les raisons de non-vaccination parfois indépendantes du patient lui- même) chez les personnes âgées. Tous les patients ambulatoires de plus de 65 ans consultant la Policlinique Médicale Universitaire (PMU) de Lausanne ou leur médecin traitant durant les périodes de vaccination contre la grippe 1999-2000 et 2000-2001 ont été inclus. Chaque patient recevait une information sur la grippe et ses complications, de même que sur la nécessité de la vaccination, son efficacité et ses effets seconda ires éventuels. En l'absence de contre-indication, la vaccination était proposée. En cas de refus, les motifs étaient investigués par une question ouverte. Sur 1398 sujets inclus, 148 (12%) ont refusé la vaccination. Les raisons principales de refus étaient la perception d'être en bonne santé (16%), de ne pas être susceptible à la grippe (15%) ou le fait de ne jamais avoir été vacciné contre la grippe dans le passé (15%). On retrouvait également la mauvaise expérience personnelle ou d'un proche lors d'une vaccination (15%) et l'impression d'inutilité du vaccin (10%). 17% des personnes interrogées ont donné des motifs autres et 12% n'ont pas explicité leur non-acceptation. Les refus de vaccination contre la grippe dans la population âgée sont essentiellement liés aux convictions intimes du patient quant à son état de santé et à sa susceptibilité à la grippe, de même qu'à l'efficacité supposée de la vaccination. La résistance au changement semble être un obstacle majeur à l'introduction de la vaccination chez les personnes de plus de 65 ans. SUMMARY More knowledge on the reasons for refusal of the influenza vaccine in elderly patients is essential to target groups for additional information, and hence improve coverage rate. The objective of the present study was to describe precisely the true motives for refusal. All patients aged over 64 who attended the Medical Outpatient Clinic, University of Lausanne, or their private practitioner's office during the 1999 and 2000 vaccination periods were included. Each patient was informed on influenza and its complications, as well as on the need for vaccination, its efficacy and adverse events. The vaccination was then proposed. In case of refusal, the reasons were investigated with an open question. Out of 1398 patients, 148 (12%) refused the vaccination. The main reasons for refusal were the perception of being in good health (16%), of not being susceptible to influenza (15%), of not having had the influenza vaccine in the past (15%), of having had a bad experience either personally or a relative (15%), and the uselessness of the vaccine (10%). Seventeen percent gave miscellaneous reasons and 12% no reason at all for refusal. Little epidemiological knowledge and resistance to change appear to be the major obstacles for wide acceptance of the vaccine by the elderly.

Efeitos da premunização da abóbora 'Menina Brasileira' com estirpes fracas do vírus-do-mosaico-do-mamoeiro - estirpe melancia

Neste trabalho avaliou-se o efeito da premunização com duas estirpes fracas do vírus-do-mosaico-do-mamoeiro - estirpe melancia ("papaya ringspot virus - type W", PRSV-W), combinada com a tolerância das plantas, no controle do mosaico e na produtividade da abóbora 'Menina Brasileira'. Testes realizados em casa de vegetação mostraram que as plantas dessa cultivar premunizadas com as estirpes fracas PRSV-W-1 e 2 ficaram totalmente protegidas contra a infecção por uma estirpe severa de Campinas. Em condições de campo avaliou-se comparativamente a produção de plantas premunizadas, infectadas com a estirpe severa de Campinas, e sadias e expostas à infecção natural (controle). A proteção foi medida com base na produção individual das plantas, cujos frutos foram classificados em comerciais e não-comerciais. As plantas premunizadas tiveram uma produção média de frutos comerciais (peso) 33% superior à daquelas naturalmente infectadas em campo. Quanto ao número de frutos comerciais, o aumento foi da ordem de 50%. A premunização combinada com a tolerância da abóbora 'Menina Brasileira' permitiu um melhor controle do mosaico, com ganhos na produção de frutos comerciais.

Suscetibilidade de Spodoptera Frugiperda a isolados geográficos de um vírus de poliedrose nuclear

O presente trabalho objetivou verificar a suscetibilidade de larvas de segundo ínstar de Spodoptera frugiperda (Smith, 1797) a sete isolados geográficos de um vírus de poliedrose nuclear (VPN), conduzindo-se sete bioensaios no Laboratório de Patologia de Insetos da Embrapa-Centro Nacional de Pesquisa de Soja, Londrina. Para cada isolado preparou-se dieta artificial contendo 0, 2x10³, 4x10³, 8x10³, 16x10³, 32x10³ e 64x10³ corpos poliédricos de inclusão (CPI)/mL. Cada dose foi oferecida às larvas em copos de plástico de 50 mL, sob condições controladas (temperatura: 26±2ºC; umidade relativa: 60±10%; fotófase:14 horas). A análise (Probits) realizada sobre o somatório de larvas mortas (contadas, diariamente, do quinto ao décimo quarto dia após a inoculação) mostrou, com base na ausência de sobreposição das amplitudes dos intervalos de confiança das concentrações letais médias (CL50), que: o isolado de Sertaneja, PR (5.631 CPI/mL), foi o mais virulento; o da Guatemala (11.520 CPI/mL) equivaleu aos de Ponta Grossa, PR (14.184 CPI/mL), Argentina (15.891 CPI/mL) e Alabama, EUA (17.558 CPI/mL), mas foi superior aos isolados de Louisiana, EUA (19.325 CPI/mL) e Sete Lagoas, MG (25.310 CPI/mL). A variação do tempo letal médio, de 8,3 a 10 dias, não foi significativa em relação aos isolados.

Controle da lagarta-da-soja com aplicações de seu vírus de poliedrose nuclear por vias aérea e terrestre

De 1983 a 1988 foram conduzidos, na região de Dourados, MS, seis experimentos e três campos-piloto, objetivando controlar a lagarta Anticarsia gemmatalis Hübner, 1818, com aplicações aérea e terrestre de seu vírus de poliedrose nuclear (VPN Ag). Cem lagartas equivalentes (LE) de VPN Ag associadas a óleo de soja, melaço de cana-de-açúcar e água, foram aplicadas com avião agrícola equipado com Micronair. Os preparados oleosos (5,5 e 5 L ha-1) e com melaço (10 L ha-1) controlaram 75-89% e 79-96% das lagartas, respectivamente. A suspensão aquosa de 3 L ha-1 foi ineficaz, porém as de 15, 20 e 25 L ha-1 controlaram de 81% a 90% das lagartas. Cinqüenta LE, aplicadas com avião agrícola (3 L ha-1) ou atomizador (15 L ha-1), foram ineficientes. Aplicações da mesma dose com pulverizador de barra (134 e 150 L ha-1) proporcionaram controle de 87% e 90%, respectivamente, e com avião (15, 20 e 25 L ha-1), entre 93% e 98%. Aplicações aéreas de 50 LE com óleo de soja (5 L ha-1) ou melaço (10 L ha-1) foram eficientes (86-88% e 99%, respectivamente). Aplicações aéreas de suspensões aquosas e formulado oleoso, em campos-piloto, confirmaram os resultados experimentais.

Análise dialélica para tolerância ao vírus-do-nanismo-amarelo-da-cevada em cultivares brasileiras de trigo

Seis cultivares brasileiras de trigo com diferentes níveis de tolerância ao vírus-do-nanismo-amarelo-da-cevada (VNAC) foram cruzadas de modo dialélico para avaliar as capacidades geral e específica de combinação quanto à herança da tolerância. Um isolado do vírus transmitido por Rhopalosiphum padi (L.) foi inoculado nas cultivares e nos híbridos F1 no estádio de plântula com duas folhas. Foram atribuídas notas individuais a cada planta de acordo com a severidade de sintomas apresentados. Os dados obtidos foram analisados segundo os três métodos: o de Griffing, o modelo fixo, e método 2. Ficou evidenciada a presença de heterose, provavelmente decorrente do efeito aditivo de genes complementares. As cultivares BR 34 e BR 35 se destacaram com melhores valores de capacidade geral de combinação (CGC), e é recomendado seu uso como genitores em programas de melhoramento de trigo que visem à obtenção de combinações genéticas com tolerância ao VNAC.

Bilateral anterior ischemic optic neuropathy following influenza vaccination.

Optic neuritis is an occasional complication of vaccination. Visual loss can be unilateral or bilateral, and most patients recover substantially without treatment. The presumptive mechanism is an immune-mediated demyelinating injury of the optic nerve. We report two patients who had permanent visual loss following influenza vaccination. Their pattern of visual loss, segmental optic disc changes, and failure of visual recovery were atypical for demyelinating optic neuritis and reminiscent of a primary ischemic injury to the optic nerve. We speculate that an immune complex-mediated vasculopathy following vaccination can cause anterior ischemic optic neuropathy. Clinicians should be aware of this entity because of the less favorable prognosis for visual recovery in these cases.

Efeito do controle químico da mosca-branca na incidência do vírus-do-mosaico-dourado e na produtividade do feijoeiro

O objetivo deste trabalho foi avaliar o efeito de inseticidas no controle da mosca-branca (Bemisia argentifolii Bellows & Perring, 1994) na incidência do vírus-do-mosaico-dourado e na produtividade do feijoeiro. Utilizou-se de tratamento de sementes com imidacloprid ou thiamethoxam, e de pulverizações de inseticidas, em intervalos semanais. O experimento foi realizado no campo, em área irrigada, em Petrolina, PE, em blocos ao acaso, com cinco tratamentos e quatro repetições. Houve redução significativa no número médio de ovos, de ninfas e de adultos da mosca-branca e na porcentagem de infecção pelo vírus-do-mosaico-dourado do feijoeiro. A produtividade nas parcelas tratadas variou de 1.930 a 2.405 kg/ha, enquanto na testemunha foi de 1.490 kg/ha. Não foi observada diferença significativa entre os tratamentos, no número de vagens/planta e peso de 100 sementes.

Report of The Iowa Pandemic Influenza Ethics Committee, September 2007

This ethical framework document, compiled by the Iowa Pandemic Influenza Ethics Committee, provides ethical guidance to the Iowa Department of Public Health (IDPH) for a pandemic influenza situation. The ethics committee proposes the document as a foundation for decision making in preparing for and responding to pandemic influenza. The document addresses four ethical or moral focal points that public health and health care workers may need to address during a public health disaster.

Suscetibilidade de genótipos de feijão ao vírus-do-mosaico-dourado

O objetivo deste trabalho foi avaliar a suscetibilidade de diversos genótipos de feijão ao vírus-do-mosaico-dourado (VMDF), transmitido pela mosca branca (Bemisia tabaci). A semeadura foi realizada na época da seca e das águas, com e sem aplicação do inseticida granulado Aldicarb (3,0 kg ha-1 do i.a.) no sulco de semeadura. O delineamento experimental utilizado foi o de blocos casualizados disposto em esquema fatorial 14x2, representado por genótipos e inseticida, respectivamente, com quatro repetições. A maior infestação de mosca-branca e incidência do vírus ocorreu na época da seca, causando prejuízos à produção do feijoeiro. Os genótipos apresentaram diferentes graus de suscetibilidade ao vírus e ao inseto vetor. Os genótipos mais tolerantes foram IAPAR 57, IAPAR 65, IAPAR 72, Ônix, Aporé e 606 (5)(214-17). A aplicação do inseticida sistêmico controla o vetor em ambas as épocas de cultivo, proporcionando aumentos da produtividade.

Does Influenza Vaccination Induce De Novo HLA Alloantibody Formation in Transplant Recipients?

Introduction: Infl uenza vaccination is recommended for all solid organ transplant recipients. However, some centers are reluctant to give annual vaccination due to concerns about precipitating rejection. A proposed mechanism of this is vaccineinduced development of cellular and humoral responses to donor HLA antigens. We studied the induction of HLA Ab in a cohort of lung transplant recipients receiving infl uenza vaccination. Methods: Adult lung transplant recipients were immunized with 0.5 mL intramuscular seasonal infl uenza vaccine followed by 0.1 mL intradermal booster at 4 weeks as part of a previous study. Sera were collected pre-vaccination and at 4, 8 weeks post-vaccination. Post-vaccination sera were analyzed for HLA Ab using fl owPRA specifi c beads (One Lambda Inc). A positive result was defi ned as 5%. Positive samples were further analyzed for antibody specifi city by single antigen bead testing. Pre-vaccination sera were tested only only if post-vaccination sample screen was positive for HLA Ab. The presence of HLA Ab was correlated to vaccine seroresponse and rejection episodes. Results: Sixty patients were included with equal numbers of men and women. Mean age of patients was 47.3 years (range 20.7-72.4). Median time post-transplant was 1.3 years (range 85 days - 17 years). One patient was excluded due to an uninterpretable baseline screen result. 16/59 (27.1%) patients were positive for HLA Ab both in both pre- and post-vaccination samples. Of these, 12/16 (75%) had antibody against HLA Class I (majority A30,A31,B27,B44), 2/16 (12.5%) had antibody against HLA class II (majority DQ4, DQ7), and 2/16 (12.5%) had antibody against both Class I & II. There was no signifi cant increase in existing HLA Ab post-vaccination. Of the 16 patients, only one (6.3%) patient had de novo HLA Ab and this was determined to be non donor specifi c. Factors such as gender, time from transplant, immunosuppression, and acute rejection episodes did not correlate with presence of HLA Ab. HLA Ab was not associated with seroconversion to to vaccine antigens. Conclusions: Our data support that receiving the annual infl uenza vaccine does not lead to the generation of de novo donor specifi c antibodies in lung transplant recipients or upregulation of existing HLA Ab.