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Fulltext Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008-2011

Gupta V, Dawood FS, Muangchana C, Lan PT, Xeuatvongsa A, Sovann L, et al.

PLoS One, 2012;7(12):e52842.
PMID: 23285200 DOI: 10.1371/journal.pone.0052842

Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales.

Matched MeSH terms: Influenza, Human/epidemiology
Fulltext Influenza-associated excess mortality in the Philippines, 2006-2015

Cheng KJG, Rivera AS, Lam HY, Ulitin AR, Nealon J, Dizon R, et al.

PLoS One, 2020;15(6):e0234715.
PMID: 32555618 DOI: 10.1371/journal.pone.0234715

Influenza-associated mortality has not been quantified in the Philippines. Here, we constructed multiple negative binomial regression models to estimate the overall and age-specific excess mortality rates (EMRs) associated with influenza in the Philippines from 2006 to 2015. The regression analyses used all-cause mortality as the dependent variable and meteorological controls, time, influenza A and B positivity rates (lagged for up to two time periods), and annual and semiannual cyclical seasonality controls as independent variables. The regression models closely matched observed all-cause mortality. Influenza was estimated to account for a mean of 5,347 excess deaths per year (1.1% of annual all-cause deaths) in the Philippines, most of which (67.1%) occurred in adults aged ≥60 years. Influenza A accounted for 85.7% of all estimated excess influenza deaths. The annual estimated influenza-attributable EMR was 5.09 (95% CI: 2.20-5.09) per 100,000 individuals. The EMR was highest for individuals aged ≥60 years (44.63 [95% CI: 4.51-44.69] per 100,000), second highest for children aged less than 5 years (2.14 [95% CI: 0.44-2.19] per 100,000), and lowest for individuals aged 10 to 19 years (0.48 [95% CI: 0.10-0.50] per 100,000). Estimated numbers of excess influenza-associated deaths were considerably higher than the numbers of influenza deaths registered nationally. Our results suggest that influenza causes considerable mortality in the Philippines-to an extent far greater than observed from national statistics-especially among older adults and young children.

Matched MeSH terms: Influenza, Human/epidemiology
Fulltext Modelling monthly influenza cases in Malaysia

Norrulashikin MA, Yusof F, Hanafiah NHM, Norrulashikin SM

PLoS One, 2021;16(7):e0254137.
PMID: 34288925 DOI: 10.1371/journal.pone.0254137

The increasing trend in the number new cases of influenza every year as reported by WHO is concerning, especially in Malaysia. To date, there is no local research under healthcare sector that implements the time series forecasting methods to predict future disease outbreak in Malaysia, specifically influenza. Addressing the problem could increase awareness of the disease and could help healthcare workers to be more prepared in preventing the widespread of the disease. This paper intends to perform a hybrid ARIMA-SVR approach in forecasting monthly influenza cases in Malaysia. Autoregressive Integrated Moving Average (ARIMA) model (using Box-Jenkins method) and Support Vector Regression (SVR) model were used to capture the linear and nonlinear components in the monthly influenza cases, respectively. It was forecasted that the performance of the hybrid model would improve. The data from World Health Organization (WHO) websites consisting of weekly Influenza Serology A cases in Malaysia from the year 2006 until 2019 have been used for this study. The data were recategorized into monthly data. The findings of the study showed that the monthly influenza cases could be efficiently forecasted using three comparator models as all models outperformed the benchmark model (Naïve model). However, SVR with linear kernel produced the lowest values of RMSE and MAE for the test dataset suggesting the best performance out of the other comparators. This suggested that SVR has the potential to produce more consistent results in forecasting future values when compared with ARIMA and the ARIMA-SVR hybrid model.

Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext Epidemiological and Evolutionary Dynamics of Influenza B Viruses in Malaysia, 2012-2014

Oong XY, Ng KT, Lam TT, Pang YK, Chan KG, Hanafi NS, et al.

PLoS One, 2015;10(8):e0136254.
PMID: 26313754 DOI: 10.1371/journal.pone.0136254

Epidemiological and evolutionary dynamics of influenza B Victoria and Yamagata lineages remained poorly understood in the tropical Southeast Asia region, despite causing seasonal outbreaks worldwide. From 2012-2014, nasopharyngeal swab samples collected from outpatients experiencing acute upper respiratory tract infection symptoms in Kuala Lumpur, Malaysia, were screened for influenza viruses using a multiplex RT-PCR assay. Among 2,010/3,935 (51.1%) patients infected with at least one respiratory virus, 287 (14.3%) and 183 (9.1%) samples were tested positive for influenza A and B viruses, respectively. Influenza-positive cases correlate significantly with meteorological factors-total amount of rainfall, relative humidity, number of rain days, ground temperature and particulate matter (PM10). Phylogenetic reconstruction of haemagglutinin (HA) gene from 168 influenza B viruses grouped them into Yamagata Clade 3 (65, 38.7%), Yamagata Clade 2 (48, 28.6%) and Victoria Clade 1 (55, 32.7%). With neuraminidase (NA) phylogeny, 30 intra-clade (29 within Yamagata Clade 3, 1 within Victoria Clade 1) and 1 inter-clade (Yamagata Clade 2-HA/Yamagata Clade 3-NA) reassortants were identified. Study of virus temporal dynamics revealed a lineage shift from Victoria to Yamagata (2012-2013), and a clade shift from Yamagata Clade 2 to Clade 3 (2013-2014). Yamagata Clade 3 predominating in 2014 consisted of intra-clade reassortants that were closely related to a recent WHO vaccine candidate strain (B/Phuket/3073/2013), with the reassortment event occurred approximately 2 years ago based on Bayesian molecular clock estimation. Malaysian Victoria Clade 1 viruses carried H274Y substitution in the active site of neuraminidase, which confers resistance to oseltamivir. Statistical analyses on clinical and demographic data showed Yamagata-infected patients were older and more likely to experience headache while Victoria-infected patients were more likely to experience nasal congestion and sore throat. This study describes the evolution of influenza B viruses in Malaysia and highlights the importance of continuous surveillance for better vaccination policy in this region.

Matched MeSH terms: Influenza, Human/epidemiology*
Emergence and predominance of an H5N1 influenza variant in China

Smith GJ, Fan XH, Wang J, Li KS, Qin K, Zhang JX, et al.

Proc Natl Acad Sci U S A, 2006 Nov 07;103(45):16936-41.
PMID: 17075062

The development of highly pathogenic avian H5N1 influenza viruses in poultry in Eurasia accompanied with the increase in human infection in 2006 suggests that the virus has not been effectively contained and that the pandemic threat persists. Updated virological and epidemiological findings from our market surveillance in southern China demonstrate that H5N1 influenza viruses continued to be panzootic in different types of poultry. Genetic and antigenic analyses revealed the emergence and predominance of a previously uncharacterized H5N1 virus sublineage (Fujian-like) in poultry since late 2005. Viruses from this sublineage gradually replaced those multiple regional distinct sublineages and caused recent human infection in China. These viruses have already transmitted to Hong Kong, Laos, Malaysia, and Thailand, resulting in a new transmission and outbreak wave in Southeast Asia. Serological studies suggest that H5N1 seroconversion in market poultry is low and that vaccination may have facilitated the selection of the Fujian-like sublineage. The predominance of this virus over a large geographical region within a short period directly challenges current disease control measures.

Matched MeSH terms: Influenza, Human/epidemiology
Representations of swine flu: perspectives from a Malaysian pig farm

Goodwin R, Haque S, Hassan SB, Dhanoa A

Public Underst Sci, 2011 Jul;20(4):477-90.
PMID: 21936262

Novel influenza viruses are seen, internationally, as posing considerable health challenges, but public responses to such viruses are often rooted in cultural representations of disease and risk. However, little research has been conducted in locations associated with the origin of a pandemic. We examined representations and risk perceptions associated with swine flu amongst 120 Malaysian pig farmers. Thirty-seven per cent of respondents felt at particular risk of infection, two-thirds were somewhat or very concerned about being infected. Those respondents who were the most anxious believed particular societal "out-groups" (homosexuals, the homeless and prostitutes) to be at higher infection risk. Although few (4%) reported direct discrimination, 46% claimed friends had avoided them since the swine flu outbreak. Findings are discussed in the context of evolutionary, social representations and terror management theories of response to pandemic threat.

Matched MeSH terms: Influenza, Human/epidemiology
Outbreak news. Avian influenza--spread of the virus to new countries

Wkly. Epidemiol. Rec., 2006 Feb 24;81(8):69-70.
PMID: 16671220
Matched MeSH terms: Influenza, Human/epidemiology*
Introduction: Avian influenza: from basic biology to pandemic planning

Loh LC, Hui DS, Beasley R

Respirology, 2008 Mar;13 Suppl 1:S1.
PMID: 18366520 DOI: 10.1111/j.1440-1843.2008.01245.x
Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext A novel data-driven methodology for influenza outbreak detection and prediction

Du L, Pang Y

Sci Rep, 2021 06 24;11(1):13275.
PMID: 34168200 DOI: 10.1038/s41598-021-92484-6

Influenza is an infectious disease that leads to an estimated 5 million cases of severe illness and 650,000 respiratory deaths worldwide each year. The early detection and prediction of influenza outbreaks are crucial for efficient resource planning to save patient's lives and healthcare costs. We propose a new data-driven methodology for influenza outbreak detection and prediction at very local levels. A doctor's diagnostic dataset of influenza-like illness from more than 3000 clinics in Malaysia is used in this study because these diagnostic data are reliable and can be captured promptly. A new region index (RI) of the influenza outbreak is proposed based on the diagnostic dataset. By analysing the anomalies in the weekly RI value, potential outbreaks are identified using statistical methods. An ensemble learning method is developed to predict potential influenza outbreaks. Cross-validation is conducted to optimize the hyperparameters of the ensemble model. A testing data set is used to provide an unbiased evaluation of the model. The proposed methodology is shown to be sensitive and accurate at influenza outbreak prediction, with average of 75% recall, 74% precision, and 83% accuracy scores across five regions in Malaysia. The results are also validated by Google Flu Trends data, news reports, and surveillance data released by World Health Organization.

Matched MeSH terms: Influenza, Human/epidemiology
Fulltext Hospitalised Malaysian children with pandemic (H1N1) 2009 influenza: clinical characteristics, risk factors for severe disease and comparison with the 2002-2007 seasonal influenza

Koh MT, Eg KP, Loh SS

Singapore Med J, 2016 Feb;57(2):81-6.
PMID: 26768169 DOI: 10.11622/smedj.2015146

The pandemic caused by the H1N1 influenza virus in 2009 resulted in extensive morbidity and mortality worldwide. As the virus was a novel virus, there was limited data available on the clinical effects of the virus on children in Malaysia. Herein, we describe the clinical characteristics of children hospitalised with H1N1 influenza in a tertiary care centre; we also attempted to identify the risk factors associated with disease severity.

Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext Hospitalised children with pandemic (H1N1) 2009 influenza

Joob B, Wiwanitkit V

Singapore Med J, 2016 Oct;57(10):586.
PMID: 27779280 DOI: 10.11622/smedj.2016168
Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext Comparative global epidemiology of influenza, respiratory syncytial and parainfluenza viruses, 2010-2015

Lam TT, Tang JW, Lai FY, Zaraket H, Dbaibo G, Bialasiewicz S, et al.

J Infect, 2019 10;79(4):373-382.
PMID: 31323249 DOI: 10.1016/j.jinf.2019.07.008

OBJECTIVES: To improve our understanding of the global epidemiology of common respiratory viruses by analysing their contemporaneous incidence at multiple sites.
METHODS: 2010-2015 incidence data for influenza A (IAV), influenza B (IBV), respiratory syncytial (RSV) and parainfluenza (PIV) virus infections were collected from 18 sites (14 countries), consisting of local (n = 6), regional (n = 9) and national (n = 3) laboratories using molecular diagnostic methods. Each site submitted monthly virus incidence data, together with details of their patient populations tested and diagnostic assays used.
RESULTS: For the Northern Hemisphere temperate countries, the IAV, IBV and RSV incidence peaks were 2-6 months out of phase with those in the Southern Hemisphere, with IAV having a sharp out-of-phase difference at 6 months, whereas IBV and RSV showed more variable out-of-phase differences of 2-6 months. The tropical sites Singapore and Kuala Lumpur showed fluctuating incidence of these viruses throughout the year, whereas subtropical sites such as Hong Kong, Brisbane and Sydney showed distinctive biannual peaks for IAV but not for RSV and PIV.
CONCLUSIONS: There was a notable pattern of synchrony of IAV, IBV and RSV incidence peaks globally, and within countries with multiple sampling sites (Canada, UK, Australia), despite significant distances between these sites.

Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext Component-specific effectiveness of trivalent influenza vaccine as monitored through a sentinel surveillance network in Canada, 2006-2007

Skowronski DM, De Serres G, Dickinson J, Petric M, Mak A, Fonseca K, et al.

J Infect Dis, 2009 Jan 15;199(2):168-79.
PMID: 19086914 DOI: 10.1086/595862

Trivalent inactivated influenza vaccine (TIV) is reformulated annually to contain representative strains of 2 influenza A subtypes (H1N1 and H3N2) and 1 B lineage (Yamagata or Victoria). We describe a sentinel surveillance approach to link influenza variant detection with component-specific vaccine effectiveness (VE) estimation.

Matched MeSH terms: Influenza, Human/epidemiology*
Intercontinental circulation of human influenza A(H1N2) reassortant viruses during the 2001-2002 influenza season

Xu X, Smith CB, Mungall BA, Lindstrom SE, Hall HE, Subbarao K, et al.

J Infect Dis, 2002 Nov 15;186(10):1490-3.
PMID: 12404167

Reassortant influenza A viruses bearing the H1 subtype of hemagglutinin (HA) and the N2 subtype of neuraminidase (NA) were isolated from humans in the United States, Canada, Singapore, Malaysia, India, Oman, Egypt, and several countries in Europe during the 2001-2002 influenza season. The HAs of these H1N2 viruses were similar to that of the A/New Caledonia/20/99(H1N1) vaccine strain both antigenically and genetically, and the NAs were antigenically and genetically related to those of recent human H3N2 reference strains, such as A/Moscow/10/99(H3N2). All 6 internal genes of the H1N2 reassortants examined originated from an H3N2 virus. This article documents the first widespread circulation of H1N2 reassortants on 4 continents. The current influenza vaccine is expected to provide good protection against H1N2 viruses, because it contains the A/New Caledonia/20/99(H1N1) and A/Moscow/10/99(H3N2)-like viruses, which have H1 and N2 antigens that are similar to those of recent H1N2 viruses.

Matched MeSH terms: Influenza, Human/epidemiology
Fulltext Molecular analysis of 2009 pandemic influenza A(H1N1) in Malaysia associated with mild and severe infections

Balraj P, Sidek H, Suppiah J, Khoo AS, Saat Z

Malays J Pathol, 2011 Jun;33(1):7-12.
PMID: 21874745 MyJurnal

The 2009 pandemic influenza A(H1N1) was first detected in Malaysia in May 2009. It quickly spread in the general population and contributed to a number of influenza-like illness. The objective of the study is to characterize genetic changes in early Malaysian isolates of mild and severe illness of the novel influenza, and to compare sequences of viruses circulating in Malaysia to those in other countries between May to September 2009. Viral isolates of 56 mild cases and 10 severe (intensive care unit or fatal) cases were sequenced for haemagglutinin (HA) and neuraminidase (NA). Genome sequencing of the viral RNA was conducted on 5 isolates (3 were from fatal cases). Highly conserved sequences with few sporadic variations were identified in HA and NA. E374K and D222N were identified in 2 viral isolates from patients with severe illness. Phylogenetic analysis showed close genetic relatedness to the vaccine strain A/California/07/09 and other isolates circulating worldwide during the same period. Sporadic variations were identified in the viral isolates, however a larger sample size is required to make associations with disease severity.

Matched MeSH terms: Influenza, Human/epidemiology*
An outbreak of Hongkong influenza in a youth camp in West Malaysia

Tan DS, Dhillon GS, Omar M, Eapen JS

Med J Malaya, 1971 Jun;25(4):263-8.
PMID: 4261297
Matched MeSH terms: Influenza, Human/epidemiology*
An outbreak of influenza due to type B virus in a residential boys' school in Malaya

GORDON SMITH CE, THOMSON WG

Med J Malaya, 1956 Jun;10(4):332-7.
PMID: 13399536
Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext Breastfeeding--anti-viral potential and relevance to the influenza virus pandemic

Prameela KK

Med J Malaysia, 2011 Jun;66(2):166-9; quiz 170.
PMID: 22106709

Essential nutritive and immunological ingredients abundantly present in breastmilk make it the choice infant nutrition. The uniqueness of mother's milk, in contrast to most therapeutics and immunizations, lies in its potential to adapt itself to the requirements of the infant so that timely immune defenses are tapped from its constituents by immune regulation, modulation and immune acceleration to stimulate novel substances; these render it pertinent as defense when faced with challenging organisms. While it is appreciated that immunity can be transferred from mother to infant through breastmilk following maternal influenza vaccination, the immense benefits conferred by breastfeeding per se during influenza pandemics may not be fully valued. This is substantiated by debates and ambiguities for continued breastfeeding in the face of maternal influenza infections. This article emphasises the utmost importance of breastfeeding in viral pandemics in the light of the changing immunological strategies used by viruses at different times and the urgent need for such opportune defenses. The prolific interaction of its constituents is frequently understated as enormous advantages to the suckling infant.

Matched MeSH terms: Influenza, Human/epidemiology
Fulltext Influenza A (H1N1) 2009 pandemic virus: learning from the first wave, preparing for the second

Lee CK

Med J Malaysia, 2010 Mar;65(1):1-2.
PMID: 21265237

In a short period of two months, the novel influenza A/H1N1 virus has circumnavigated the entire planet leaving behind in its wake approximately 3000 reported deaths worldwide. Fortunately, in many areas around the world, September 2009 brought a lull in the number of new H1N1 infections. This brought welcomed relief in many countries that had earlier experienced high respiratory disease activity in their communities. However, based on previous influenza pandemics, this reprieve may well be short-lived. As the Northern hemisphere approaches its winter months, many experts are now predicting a second wave of influenza A/H1N1 infections. This prediction maybe well placed as all 3 influenza pandemics in the last century reported second or even subsequent waves of new infections, all of which appeared to be more severe than the primary event (ref). The timing of these second waves have varied from 6 months to 3 years and invariably seemed to be linked to the winter months. It is unclear precisely what changes caused the increased severity seen during the second waves; one possibility is the progressive adaptation of the novel influenza virus to its new human host . Molecular analysis, for example, suggests that the 1918 Spanish influenza virus that emerged during the second wave had undergone changes in the hemagglutinin binding site that increased the binding specificity for human receptors. This is thought to have increased the replicative capacity and hence, the pathogenicity of the virus. It is also evident that as the H1N1 2009 pandemic virus continues to spread, opportunities for adaptation that increases virulence will also increase. Nonetheless, the changes needed for such adaptation and for increased virulence are unpredictable and by no means inevitable

Matched MeSH terms: Influenza, Human/epidemiology*
Fulltext Pandemic influenza A (H1N1) 2009 in Malaysia--the next phase

Sam IC, Abu Bakar S

Med J Malaysia, 2009 Jun;64(2):105-7.
PMID: 20058566

In recent years, zoonotic RNA viruses such as Nipah, SARS coronavirus, avian influenza (H5N1) and Chikungunya have emerged with global impact. The latest has now been designated by World Health Organization (WHO) as pandemic (H1N1) 2009 virus. It was first reported as an outbreak in Mexico in April, and has now caused the first influenza pandemic since 1968. By July 11, 2009, there were 105,304 confirmed cases and 463 deaths in 143 countries, including 627 cases in Malaysia1 . The rapid spread of the disease has been matched by the speed of dissemination of information and protocols, co-ordinated by WHO. The experiences of SARS and H5N1 have been enormously beneficial in preparing the world for a pandemic.

Matched MeSH terms: Influenza, Human/epidemiology*

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