In the months of July and August 2003, an outbreak of acute respiratory illness caused by influenza A virus occurred among students in seven residential schools situated in the northern part (Perak) of Peninsular Malaysia. Out of 4989 students, aged 13 to 18 years (mean = 15.9), 1419 (28%) were effected by influenza-like illness. All patients were treated as outpatients except for 36 students who required admission for high fever, severe coughing and shortness of breath. Abnormal chest X-ray findings were noted for those that required inpatient management. Influenza A virus was isolated from 37 sputum specimens, 20 throat swabs and three nasal swab specimens from a total of 278 clinical samples obtained from 180 patients. Isolates from each of the outbreaks were sent to WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia for antigenic and genetic analysis. One school outbreak was due to influenza A (H1N1), A/New Caledonia/20/99-like virus while the other six school outbreaks were due to influenza A (H3N2) viruses which were A/Fujian/411/2002-like).
Influenza outbreaks in tropical countries are rarely reported. This article reports four cases of influenza within a psychiatric ward of a tertiary hospital in Malaysia. These were patients with severe mental illness who were involuntarily admitted and did not show the classical triad of influenza-like-illness (ILI) at the beginning. However, severe respiratory complications developed requiring intubation. Referral and cooperation with the infectious disease team was initiated to help manage the outbreak while continuing psychiatric treatment. Incidences of influenza among hospitalised psychiatric patients should be treated seriously with immediate multidisciplinary approach to prevent severe unwanted complications.
From 2005 to 2009, the Institute for Medical Research (IMR), Kuala Lumpur received a total of 7,117 respiratory specimens from patients with influenza-like illness (ILI) for influenza screening. Seasonal influenza virus was isolated from 17.3% of patients with ILI in 2005, 31.6% in 2006, 12.8% in 2007, 10.2% in 2008 and 13.5% in 2009. There were one or more influenza A and B virus strains circulating in Malaysia throughout the year, with distinctly a peak in May to August. The predominant circulating strains of seasonal influenza A were A/California/7/2004-like (H3N2) in 2005, A/New Caledonia/20/99-like (H1N1) in 2006, A/ Brisbane/10/2007-like (H3N2) in 2007 and 2008, and A/Perth/16/2009-like (H3N2) virus in 2009. The predominant circulating strains of influenza B were B/Hong Kong/330/2001-like in 2005, B/Malaysia/2506/2004-like in 2006, B/Florida/4/2006-like in 2007 and 2008, and B/Brisbane/60/2008-like in 2009.
The 2009 pandemic influenza A(H1N1) infection in Malaysia was first reported in May 2009 and oseltamivir was advocated for confirmed cases in postexposure prophylaxis. However, there are cases of oseltamivir-resistance reported among H1N1-positive patients in other countries. Resistance is due to substitution of histidine by tyrosine at residue 275 (H275Y) of neuraminidase (NA). In this study, we have employed Sanger sequencing method to investigate the occurrence of mutations in NA segments of 67 pandemic 2009 A(H1N1) viral isolates from Malaysian patients that could lead to probable oseltamivir resistance. The sequencing analysis did not yield mutation at residue 275 for all 67 isolates indicating that our viral isolates belong to the wild type and do not confer resistance to oseltamivir.
The aims of the study were to determine the attack rate of influenza-like illness among inhabitants of five old folk homes nationwide using influenza vaccine as a probe and the effectiveness of influenza vaccination in prevention of influenza-like illness. We conducted a nonrandomized, single-blind placebo control study from June 2003 to February 2004. VAXIGRIP(R) 2003 Southern hemisphere formulation was used. Among 527 subjects, the attack rates of influenza-like illness in the influenza vaccine group were 6.4, 4.6 and 2.4% during the first, second and third 2-month periods, respectively. The attack rates of influenza-like illness in the placebo group were 17.7, 13.8 and 10.1%. Influenza vaccination reduced the risk of contracting influenza-like illness by between 14, and 45%. The vaccine effectiveness in reducing the occurrence of influenza-like illness ranged from 55 to 76%, during the 6-month study followup. The presence of cerebrovascular diseases significantly increased the risk of influenza-like illness (p < 0.005). Vaccine recipients had fewer episodes of fever, cough, muscle aches, runny nose (p < 0.001) and experience fewer sick days due to respiratory illness. Subjects who received influenza vaccination had clinically and statistically significant reductions in the attack rate of influenza-like illness. Our data support influenza vaccination of persons with chronic diseases and >50 year olds living in institutions.
Assessment of schoolchildren's knowledge, attitudes, and practices towards influenza A (H1N1) is crucial as schools play a major role in spreading the infection. The aims of this study were to determine the level of knowledge, attitudes, and practices on influenza A (H1N1) and the factors associated with practices of preventive behavior.A cross sectional study was conducted from July until December 2010. Two public secondary schools for two districts in Kelantan, Malaysia were randomly selected. Data were collected using a self-administered questionnaire. The questionnaire consisted of five constructs: sociodemographic, risk factors of containing influenza A (H1N1) infection, knowledge, attitudes, and practices. The questionnaire had been te,sted for its construct validity and reliability. General linear regression was applied in the data analysis. A sample of 436 secondary school students were recruited in this study involved Malay students aged 16 years old. The total knowledge, attitudes and practices scores for the overall respondents were 69.4, 82.2, and 73.8%, respectively. The significant influencing factors for the practices of preventive behavior were attended talk on H1N1 and attitudes score.This study suggested that health education is important for promoting the health of adolescents and contributing to the overall health of the public so that they will take precautions against the H1N1 infection.
Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.
In a very closed and overcrowding environment, influenza transmission during Hajj season is almost inevitable. The aim of this study was to determine the association between pre-morbid conditions and influenza-like illness (ILI) amongst Hajj pilgrims. A cross-sectional study was conducted amongst Malaysian Hajj pilgrims in year 2007. Survey forms were distributed at Madinatul-Hujjaj, Jeddah and Tabung Haji Clinic, Medina, Saudi Arabia where pilgrims stay on transit before returning to Malaysia. Allergic rhinitis was significantly associated with sore throat (p=0.047), longer duration of cough (p=0.017) and runny nose (p=0.016). Pilgrims who suffered from chronic obstructive pulmonary diseases (COPD) had significant association with longer duration of cough (p=0.041) and those with diabetes mellitus had significant association with longer duration of sore throat (p=0.048). Underlying asthma was significantly associated with severe influenza like illness requiring admission to hospital for further treatment of respiratory symptoms (p=0.016). Based on these findings, we suggest those with underlying asthma should be discouraged from participating in the hajj and they should seek early treatment if they develop respiratory symptoms.
Evidence of influenza A virus (IAV) infection in dogs, a major companion animal of humans, suggests the possibility that they may constitute a new source for transmission of novel influenza viruses to humans. The potential public health risk posed by this possibility of interspecies spread of IAV between dogs and humans necessitated surveillance for the virus in dogs and their human contacts. Sera from 239 asymptomatic pet and hunting dogs in Oyo state, Nigeria were screened for anti-IAV nucleoprotein antibodies using competitive enzyme-linked immunosorbent assay (ELISA) while haemagglutination inhibiting (HI) antibodies in the positive sera were detected using influenza virus H3 and H5 subtypespecific antigens. Suspensions prepared from 239 and 39 nasal swabs from dogs and human contacts, respectively were tested for presence of the highly conserved IAV matrix gene by reverse transcriptase-polymerase chain reaction (RT-PCR). Only 4 (1.7%) of the 239 sera tested were positive by the ELISA. The HI test confirmed the presence of H3 influenza virus subtype-specific antibodies in one (25.0%) of the 4 ELISA-positive sera with a titre of 1:128 while none was positive for H5 subtype-specific antibodies. All the nasal swabs assayed by RT-PCR were negative for IAV nucleic acid. The detection of IAV antibodies in pet and hunting dogs in this study, although at a low rate, suggests that these dogs could play a crucial role in the zoonotic transmission of influenza viruses especially considering the close interaction between them and their human contacts. Continuous surveillance for IAV among dog populations in Oyo State (and Nigeria) is therefore advocated to facilitate early detection of infection or emergence of novel influenza virus strains that could be potentially harmful to humans and or animals.
The study evaluated the immunogenicity and efficacy of a trivalent subunit MF59-adjuvanted influenza vaccine (A/Wisconsin/67/05 (H3N2), A/Solomon Islands/3/06 (H1N1) and B/Malaysia/2506/04) in preventing serologically diagnosed infections in a group of 67 institutionalized elderly volunteers during 2007/2008 winter, characterized by co-circulation of drifted A/H3N2, A/H1N1 and B influenza viruses. Influenza vaccination induced a significant increase in the amounts of hemagglutination inhibiting antibodies, both against the vaccine and the epidemic drifted strains. However, vaccination did not prevent the circulation of the new drifted influenza B virus (B/Florida/4/06-like), belonging to the B/Yamagata/16/88-lineage, antigenically and genetically distinct from B/Victoria/2/87-lineage viruses from which the vaccine B strain was derived.
ESWI recommends that the 25 European Union nations strive to vaccinate one-third of their collective population every year by 2010. This translates into an annual vaccine usage of 150 million doses for a population of 455 million. However, the current vaccine usage in Europe is 79 million doses, meaning that only 40% of ESWI's recommended target population is being vaccinated in the EU-25. Indeed, the EU's current risk groups equal about 28% of its population, but it is estimated that less than 62% are being vaccinated with the current vaccine supply--the equivalent of 17% of the total population. Clearly, as ESWI noted in its concluding position paper at the Malta conference, "a large proportion of those traditionally assumed to be at most risk from influenza are not being vaccinated." How to change this and minimize the consequences of a pandemic? "It's very interesting how the arithmetic works, given the goal of immunizing 75 percent of Europe's high-risk group, " said Dr K.Nichol of the University of Minnesota Medical Center who chaired the session. "If you go from a trivalent vaccine to a monovalent one, then you triple the number of doses you can manufacture. Thus, you could produce enough doses for the entire population of the EU." However, there is no coordinated approach in Europe, meaning such an optimistic scenario is unlikely in the medium-term. For the time being, emphasis must be on raising public awareness and raising vaccination rates at the local level, starting with health care workers themselves. Here the role and attitude of health policy officials and--critically--health care workers are crucial. These front-line policy and healthcare professionals constitute both the problem and the solution to a more effective influenza vaccine effort in Europe: they know first-hand the institutional obstacles blocking progress--i.e., lack of resources, poorly focused public information campaigns, etc.--but their own work practices and attitudes can be misdirected, too. To identify the issues and help the participants produce a set of recommendations, ESWI brought in Penny Lawson from to facilitate Dr.K. Nichol to steer this session's workshop debate. The participants were a diverse group of 35 health care workers from Australia, Finland, France, Germany, Malaysia, Malta, Netherlands, Norway, Poland, Portugal, Spain, Sweden and the UK.
Influenza is an important health hazard among Hajj pilgrims. For the last ten years, pilgrims are being recommended to take influenza vaccine before attending Hajj. Vaccination coverage has increased in recent years, but whether there has been any change in the prevalence of influenza-like illness (ILI) is not known. In this analysis, we examined the changes in the rate of ILI against seasonal influenza vaccine uptake among Hajj pilgrims over the last decade.
The fourth roundtable meeting of the Global Influenza Initiative (GII) was held in Hong Kong, China, in July 2015. An objective of this meeting was to gain a broader understanding of the epidemiology, surveillance, vaccination policies and programs, and obstacles to vaccination of influenza in the Asia-Pacific region through presentations of data from Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Taiwan, Thailand, and Vietnam. As well as a need for improved levels of surveillance in some areas, a range of factors were identified that act as barriers to vaccination in some countries, including differences in climate and geography, logistical challenges, funding, lack of vaccine awareness and education, safety concerns, perceived lack of vaccine effectiveness, and lack of inclusion in national guidelines. From the presentations at the meeting, the GII discussed a number of recommendations for easing the burden of influenza and overcoming the current challenges in the Asia-Pacific region. These recommendations encompass the need to improve surveillance and availability of epidemiological data; the development and publication of national guidelines, where not currently available and/or that are in line with those proposed by the World Health Organization; the requirement for optimal timing of vaccination programs according to local or country-specific epidemiology; and calls for advocacy and government support of vaccination programs in order to improve availability and uptake and coverage. In conclusion, in addition to the varied epidemiology of seasonal influenza across this diverse region, there are a number of logistical and resourcing issues that present a challenge to the development of optimally effective vaccination strategies and that need to be overcome to improve access to and uptake of seasonal influenza vaccines. The GII has developed a number of recommendations to address these challenges and improve the control of influenza.
Numerous reports have described the epidemiological and clinical characteristics of influenza A (H1N1) 2009 infected patients. However, data on the effects of bacterial coinfection on these patients are very scarce. Therefore, this study explores the impact of bacterial coinfection on the clinical and laboratory parameters amongst H1N1 hospitalized patients.
To investigate the epidemiological characteristics of influenza B viruses and explore the genetic evolution characteristics of the hemagglutinin(HA) and neuraminidase(NA) genes of local isolated strains in Ningbo, Southeast China, during 2010 to 2012.