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INVESTIGATION OF AN OUTBREAK OF ACUTE RESPIRATORY DISEASE IN AN INDIGENOUS VILLAGE IN BRAZIL: CONTRIBUTION OF INFLUENZA A(H1N1)PDM09 AND HUMAN RESPIRATORY SYNCYTIAL VIRUSES
Surto
Doença respiratória aguda
Vírus sincicial respiratório humano
Aldeia Indígena
Brasil
Outbreak
Acute respiratory disease
Human respiratory syncytial viruses
indigenous village
Brazil
Author
Cardoso, Andrey Moreira
Resende, Paola Cristina
Paixao, Enny S.
Tavares, Felipe G.
Farias, Yasmin N.
Barreto, Carla Tatiana G.
Pantoja, Lídia N.
Ferreira, Fernanda L.
Martins, André Luiz
Lima, Ângela Barbosa
Fernandes, Daniella A.
Sanches, Patrícia Machado
Almeida, Walquiria A. F.
Rodrigues, Laura C.
Siqueira, Marilda Agudo Mendonça Teixeira de
Resende, Paola Cristina
Paixao, Enny S.
Tavares, Felipe G.
Farias, Yasmin N.
Barreto, Carla Tatiana G.
Pantoja, Lídia N.
Ferreira, Fernanda L.
Martins, André Luiz
Lima, Ângela Barbosa
Fernandes, Daniella A.
Sanches, Patrícia Machado
Almeida, Walquiria A. F.
Rodrigues, Laura C.
Siqueira, Marilda Agudo Mendonça Teixeira de
Affilliation
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil / London School of Hygiene and Tropical Medicine.London, United Kingdom.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
London School of Hygiene and Tropical Medicine.London, United Kingdom.
Universidade Federal Fluminense. Niterói, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Municipal de Saúde de Paraty. Paraty, RJ, Brasil.
Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.
London School of Hygiene and Tropical Medicine.London, United Kingdom.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
London School of Hygiene and Tropical Medicine.London, United Kingdom.
Universidade Federal Fluminense. Niterói, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Especial de Saúde Indígena. Curitiba, PR, Brasil.
Secretaria Municipal de Saúde de Paraty. Paraty, RJ, Brasil.
Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.
London School of Hygiene and Tropical Medicine.London, United Kingdom.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Abstract
Analyses of the 2009 H1N1 influenza pandemic and post-pandemic years showed high attack rates and severity among indigenous populations. This study presents the characteristics of the first documented influenza outbreak in indigenous peoples in Brazil, that occurred from 30th March to 14th April 2016 in a Guarani village in Southeast Region. Acute respiratory infections were prospectively investigated. The majority of the 73 cases were influenza-like illness (ILI) (63.0%) or severe acute respiratory infection (SARI) (20.5%). The ILI+SARI attack rate (35.9%) decreased with increasing age. There was a high influenza vaccination rate (86.3%), but no statistically significant difference in vaccination rates between severe and non-severe cases was seen (p = 0.334). Molecular analyses of 19.2% of the cases showed 100% positivity for influenza A(H1N1)pdm09 and/or hRSV. Influenza A(H1N1)pdm09 was included in the 6B.1 genetic group, a distinct cluster with 13 amino acid substitutions of A/California/07/2009-like. The hRSV were clustered in the BA-like genetic group. The early arrival of the influenza season overlapping usual hRSV season, the circulation of a drifted influenza virus not covered by vaccine and the high prevalence of risk factors for infection and severity in the village jointly can explain the high attack rate of ARI, even with a high rate of influenza vaccination. The results reinforce the importance of surveillance of respiratory viruses, timely vaccination and controlling risk factors for infection and severity of in the indigenous populations in order to preventing disease and related deaths, particularly in children.
Keywords in Portuguese
Influenza A (H1N1) pdm09Surto
Doença respiratória aguda
Vírus sincicial respiratório humano
Aldeia Indígena
Brasil
Keywords
Influenza A(H1N1) pdm09Outbreak
Acute respiratory disease
Human respiratory syncytial viruses
indigenous village
Brazil
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