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      Influenza in Refugees on the Thailand–Myanmar Border, May–October 2009


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          TOC Summary: Influenza viruses can be identified in up to 22% of patients who have acute respiratory infections.


          We describe the epidemiology of influenza virus infections in refugees in a camp in rural Southeast Asia during May–October 2009, the first 6 months after identification of pandemic (H1N1) 2009 in Thailand. Influenza A viruses were detected in 20% of patients who had influenza-like illness and in 23% of those who had clinical pneumonia. Seasonal influenza A (H1N1) was the predominant virus circulating during weeks 26–33 (June 25–August 29) and was subsequently replaced by the pandemic strain. A review of passive surveillance for acute respiratory infection did not show an increase in acute respiratory tract infection incidence associated with the arrival of pandemic (H1N1) 2009 in the camp.

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          Real-Time Reverse Transcription–Polymerase Chain Reaction Assay for SARS-associated Coronavirus

          A real-time reverse transcription–polymerase chain reaction (RT-PCR) assay was developed to rapidly detect the severe acute respiratory syndrome–associated coronavirus (SARS-CoV). The assay, based on multiple primer and probe sets located in different regions of the SARS-CoV genome, could discriminate SARS-CoV from other human and animal coronaviruses with a potential detection limit of <10 genomic copies per reaction. The real-time RT-PCR assay was more sensitive than a conventional RT-PCR assay or culture isolation and proved suitable to detect SARS-CoV in clinical specimens. Application of this assay will aid in diagnosing SARS-CoV infection.
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            Predicting influenza infections during epidemics with use of a clinical case definition.

            Combined pharyngeal and nasal swab specimens were collected from 100 subjects who presented with a flu-like illness (fever >37.8 degrees C plus 2 of 4 symptoms: cough, myalgia, sore throat, and headache) of or =38.2 degrees C as well as 3 or 4 of the symptoms in the clinical case definition. Stepwise logistic regression showed that cough (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.4-34.1; P=.02) and fever (OR, 3.1; 95% CI, 1.4-8.0; P=.01) were the only factors significantly associated with a positive PCR test for influenza. The positive predictive value, negative predictive value, sensitivity, and the specificity of a case definition including fever (temperature of >38 degrees C) and cough for the diagnosis of influenza infection during this flu season were 86.8%, 39.3%, 77.6%, and 55.0%, respectively.
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              Incidence, Seasonality and Mortality Associated with Influenza Pneumonia in Thailand: 2005–2008

              Background Data on the incidence, seasonality and mortality associated with influenza in subtropical low and middle income countries are limited. Prospective data from multiple years are needed to develop vaccine policy and treatment guidelines, and improve pandemic preparedness. Methods During January 2005 through December 2008, we used an active, population-based surveillance system to prospectively identify hospitalized pneumonia cases with influenza confirmed by reverse transcriptase–polymerase chain reaction or cell culture in 20 hospitals in two provinces in Thailand. Age-specific incidence was calculated and extrapolated to estimate national annual influenza pneumonia hospital admissions and in-hospital deaths. Results Influenza was identified in 1,346 (10.4%) of pneumonia patients of all ages, and 10 influenza pneumonia patients died while in the hospital. 702 (52%) influenza pneumonia patients were less than 15 years of age. The average annual incidence of influenza pneumonia was greatest in children less than 5 years of age (236 per 100,000) and in those age 75 or older (375 per 100,000). During 2005, 2006 and 2008 influenza A virus detection among pneumonia cases peaked during June through October. In 2007 a sharp increase was observed during the months of January through April. Influenza B virus infections did not demonstrate a consistent seasonal pattern. Influenza pneumonia incidence was high in 2005, a year when influenza A(H3N2) subtype virus strains predominated, low in 2006 when A(H1N1) viruses were more common, moderate in 2007 when H3N2 and influenza B co-predominated, and high again in 2008 when influenza B viruses were most common. During 2005–2008, influenza pneumonia resulted in an estimated annual average 36,413 hospital admissions and 322 in-hospital pneumonia deaths in Thailand. Conclusion Influenza virus infection is an important cause of hospitalized pneumonia in Thailand. Young children and the elderly are most affected and in-hospital deaths are more common than previously appreciated. Influenza occurs year-round and tends to follow a bimodal seasonal pattern with substantial variability. The disease burden varies significantly from year to year. Our findings support a recent Thailand Ministry of Public Health (MOPH) decision to extend annual influenza vaccination to older adults and suggest that children should also be targeted for routine vaccination.

                Author and article information

                Emerg Infect Dis
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                September 2010
                : 16
                : 9
                : 1366-1372
                [1]Author affiliations: Shoklo Malaria Research Unit, Mae Sot, Thailand (P. Turner, C.L. Turner, W. Watthanaworawit, V.I. Carrara, F.H. Nosten);
                [2]Mahidol–Oxford Tropical Medicine Research Unit, Bangkok, Thailand (P. Turner, C.L. Turner, W. Watthanaworawit, V.I. Carrara, F.H. Nosten);
                [3]University of Oxford, Oxford, UK (P. Turner, C.L. Turner, F.H. Nosten);
                [4]Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B.K. Kapella, J. Painter)
                Author notes
                Address for correspondence: Paul Turner, Shoklo Malaria Research Unit, PO Box 46, 68/30 Ban Toong Rd, Mae Sot, Thailand 63110; email: pault@ 123456tropmedres.ac

                Infectious disease & Microbiology
                carrara vi,viruses,kapella bk,watthanaworawit,human,research,painter j,turner cl,pandemic (h1n1) 2009,thailand,et al. influenza in refugees on the thailand–myanmar border,refugees,may–october 2009. emerg infect dis [serial on the internet]. 2010 sep [date cited]. http://dx.doi.org/10.3201/eid1609.100220,bacteria,influenza,disease outbreaks,suggested citation for this article: turner p,pneumonia


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