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Wanitda Watthanaworawit
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Respiratory syncitial virus (RSV) Real-time RT-PCR assays developed by the ... RSV was found more often in those aged under five ... RSV and hMPV predominated ... – PowerPoint PPT presentation
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Title: Wanitda Watthanaworawit
1
One year of ARI surveillance on
theThailand-Burma border
- Wanitda Watthanaworawit
- Molecular Biologist
- SMRU
2
Introduction
- Acute respiratory infections (ARI) are reported
to be a significant cause of morbidity and
mortality in migrant refugee populations on the
border - Epidemiology of ARI is poorly described in rural
SE Asia - A US-CDC and SMRU collaborative project was set
up in 2007 to improve ARI surveillance
3
Methods 1
- 2007
- Pilot study undertaken
- Collection of data and samples one week per month
over the second half of the year - 2008
- Establishment of the continuous
laboratory-enhanced surveillance system - Detection and investigation cases of
influenza-like illness (ILI) and pneumonia - AMI OPD1 in Maela camp
- SMRU clinic at Wang Pha
4
Methods 2
- Two days per week at each clinic
- Patients meeting clinical case criteria for ILI
or pneumonia were identified at triage - CRF completed
- Nasopharyngeal aspirate (NPA) collected
- NPAs were transported from the field in a cool
box and were stored at -80C prior to testing for
viral pathogens
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Case definitions
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Lab methods
- NPAs were tested for
- Human metapneumovirus (hMPV)
- Influenza A
- Influenza B
- Respiratory syncitial virus (RSV)
- Real-time RT-PCR assays developed by the CDC
7
Results 1
- 338 patients were reviewed and sampled
- 5 of the total number of patients given a clinic
diagnosis of ARI - 305 patients included in the analysis
- 24 patients did not meet the case definitions
- 9 patients had evidence of poor sample quality or
PCR inhibition - 163 patients (53) were seen in Maela and 142
(47) at Wang Pha - Median age was 2 years (range 1 month to 66
years) and 55 were male
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Results 2
- 85 single virus infections
- 48 RSV
- 22 Influenza A
- 9 Influenza B
- 6 hMPV
- 11 dual virus infections
- 5 RSVhMPV
- 4 fluBRSV
- 1 fluARSV
- 1 fluAhMPV
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Results 3
- 81 cases of ILI
- A virus was detected in 27 of cases (influenza
A or B in 16/22 73) - Odds ratio for detection of influenza virus was
2.3 (95 CI 1.2 4.8 p lt0.05) - 224 cases of pneumonia
- At least one virus was detected in 33 of cases
(RSV in 52/74 70) - Odds ratio for detection of RSV was 3.8 (95 CI
1.6 9.2 p lt0.05)
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Results 4
- Influenza viruses were significantly more likely
to be detected in patients aged five years or
more (plt0.001) - RSV was found more often in those aged under five
years (p0.002) - Treatment data was available in 229 cases (75)
- 19 patients were admitted to IPD (8 of cases
where the outcome was known) - All admitted patients were lt5 years old
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Discussion
- ARI is common in this rural SE Asian setting
- All of the target viruses were detected
- RSV and hMPV predominated in young infants
- Influenza viruses were more commonly detected in
older patients - Virus detection was highly seasonal, peaking for
all viruses during the wet season - None of the tested viruses were detected in 69
of patients - Other pathogens play a significant role in the
aetiology of ILI and pneumonia in these
populations
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Further work
- 2009
- Continue surveillance in Maela only
- Daily sampling (Monday Saturday)
- Also collect specimens from IPD cases
- Extend pathogen repertoire
- Adenovirus
- Streptococcus pneumoniae urinary antigen
detection in adult pneumonia cases - Sub-typing of influenza viruses including
detection of the new Influenza A H1N1 virus
(swine flu)
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Acknowledgements
- Clinic staff at Wang Pha and Maela
- CDC Thailand Len Peruski
- CDC Atlanta - BK Kapella, John Painter,
Christina Phares
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