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      Pan-India influenza-like illness (ILI) and Severe acute respiratory infection (SARI) surveillance: epidemiological, clinical and genomic analysis

      research-article
      1 , 2 , 2 , 2 , 1 , 1 , 2 , * , , 2 , 2 , 3 , 3 , 4 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 11 , 12 , 13 , 14 , 15 , 15 , 16 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 27 , 27 , 28 , 29 , ILI-SARI Surveillance Team
      Frontiers in Public Health
      Frontiers Media S.A.
      influenza, integrated surveillance, SARS-CoV-2, SARI, ILI

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          Abstract

          Background

          Over time, COVID-19 testing has significantly declined across the world. However, it is critical to monitor the virus through surveillance. In late 2020, WHO released interim guidance advising the use of the existing Global Influenza Surveillance and Response System (GISRS) for the integrated surveillance of influenza and SARS-CoV-2.

          Methods

          In July 2021, we initiated a pan-India integrated surveillance for influenza and SARS-CoV-2 through the geographically representative network of Virus Research and Diagnostic Laboratories (VRDLs) across 26 hospital and laboratory sites and 70 community sites. A total of 34,260 cases of influenza-like illness (ILI) and Severe acute respiratory infection (SARI) were enrolled from 4 July 2021 to 31 October 2022.

          Findings

          Influenza A(H3) and B/Victoria dominated during 2021 monsoon season while A(H1N1)pdm09 dominated during 2022 monsoon season. The SARS-CoV-2 “variants of concern” (VoC) Delta and Omicron predominated in 2021 and 2022, respectively. Increased proportion of SARI was seen in extremes of age: 90% cases in < 1 year; 68% in 1 to 5 years and 61% in ≥ 8  years age group. Approximately 40.7% of enrolled cases only partially fulfilled WHO ILI and SARI case definitions. Influenza- and SARS-CoV-2-infected comorbid patients had higher risks of hospitalization, ICU admission, and oxygen requirement.

          Interpretation

          The results depicted the varying strains and transmission dynamics of influenza and SARS-CoV-2 viruses over time, thus emphasizing the need to continue and expand surveillance across countries for improved decision making. The study also describes important information related to clinical outcomes of ILI and SARI patients and highlights the need to review existing WHO ILI and SARI case definitions.

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          Most cited references25

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          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges

          Highlights • Emergence of 2019 novel coronavirus (2019-nCoV) in China has caused a large global outbreak and major public health issue. • At 9 February 2020, data from the WHO has shown >37 000 confirmed cases in 28 countries (>99% of cases detected in China). • 2019-nCoV is spread by human-to-human transmission via droplets or direct contact. • Infection estimated to have an incubation period of 2–14 days and a basic reproduction number of 2.24–3.58. • Controlling infection to prevent spread of the 2019-nCoV is the primary intervention being used.
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            MEGA4: Molecular Evolutionary Genetics Analysis (MEGA) software version 4.0.

            We announce the release of the fourth version of MEGA software, which expands on the existing facilities for editing DNA sequence data from autosequencers, mining Web-databases, performing automatic and manual sequence alignment, analyzing sequence alignments to estimate evolutionary distances, inferring phylogenetic trees, and testing evolutionary hypotheses. Version 4 includes a unique facility to generate captions, written in figure legend format, in order to provide natural language descriptions of the models and methods used in the analyses. This facility aims to promote a better understanding of the underlying assumptions used in analyses, and of the results generated. Another new feature is the Maximum Composite Likelihood (MCL) method for estimating evolutionary distances between all pairs of sequences simultaneously, with and without incorporating rate variation among sites and substitution pattern heterogeneities among lineages. This MCL method also can be used to estimate transition/transversion bias and nucleotide substitution pattern without knowledge of the phylogenetic tree. This new version is a native 32-bit Windows application with multi-threading and multi-user supports, and it is also available to run in a Linux desktop environment (via the Wine compatibility layer) and on Intel-based Macintosh computers under the Parallels program. The current version of MEGA is available free of charge at (http://www.megasoftware.net).
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              Immunological considerations for COVID-19 vaccine strategies

              The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most formidable challenge to humanity in a century. It is widely believed that prepandemic normalcy will never return until a safe and effective vaccine strategy becomes available and a global vaccination programme is implemented successfully. Here, we discuss the immunological principles that need to be taken into consideration in the development of COVID-19 vaccine strategies. On the basis of these principles, we examine the current COVID-19 vaccine candidates, their strengths and potential shortfalls, and make inferences about their chances of success. Finally, we discuss the scientific and practical challenges that will be faced in the process of developing a successful vaccine and the ways in which COVID-19 vaccine strategies may evolve over the next few years.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/1567645/overview
                URI : https://loop.frontiersin.org/people/2000264/overview
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                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                20 October 2023
                2023
                : 11
                : 1218292
                Affiliations
                [1] 1ICMR-National Institute of Virology , Pune, India
                [2] 2Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research , New Delhi, India
                [3] 3Biomedical Informatics (BMI) Division, Indian Council of Medical Research , New Delhi, India
                [4] 4ICMR-National Institute of Epidemiology , Chennai, India
                [5] 5VRDL, All India Institute of Medical Sciences , Nagpur, India
                [6] 6VRDL, Government Mohan Kumaramangalam Medical College , Salem, India
                [7] 7VRDL, Gandhi Medical College , Secunderabad, India
                [8] 8VRDL, Jawaharlal Institute of Postgraduate Medical Education and Research , Puducherry, India
                [9] 9VRDL, Sher-i-Kashmir Institute of Medical Sciences , Srinagar, India
                [10] 10VRDL, Government Medical College , Haldwani, India
                [11] 11ICMR-National Institute of Cholera and Enteric Diseases , Kolkata, India
                [12] 12ICMR-Regional Medical Research Centre , Port Blair, India
                [13] 13ICMR-Regional Medical Research Centre , Bhubaneswar, India
                [14] 14VRDL, Government Medical College , Agartala, India
                [15] 15ICMR-Rajendra Memorial Research Institute of Medical Sciences , Patna, India
                [16] 16VRDL, All India Institute of Medical Sciences , Raipur, India
                [17] 17VRDL, Dr. Sampurnanand Medical College , Jodhpur, India
                [18] 18VRDL, Sri Venkateswara Institute of Medical Sciences , Tirupati, India
                [19] 19VRDL, All India Institute of Medical Sciences , Bhopal, India
                [20] 20VRDL, BJ Medical College , Ahmedabad, India
                [21] 21ICMR-Regional Medical Research Centre , Dibrugarh, India
                [22] 22VRDL, Government Medical College , Trivandrum, India
                [23] 23VRDL, Post Graduate Institute of Medical Education and Research , Chandigarh, India
                [24] 24VRDL, Government Medical College , Aurangabad, India
                [25] 25VRDL, King Institute of Preventive Medicine and Research , Chennai, India
                [26] 26VRDL, Bangalore Medical College and Research Institute , Bangalore, India
                [27] 27VRDL, All India Institute of Medical Sciences , New Delhi, India
                [28] 28VRDL, Sawai Man Singh Medical College , Jaipur, India
                [29] 29VRDL, King George’s Medical University , Lucknow, India
                Author notes

                Edited by: Sergio E. Rodriguez, Centers for Disease Control and Prevention (CDC), United States

                Reviewed by: Shobha Broor, Shree Guru Gobind Singh Tricentenary University, India; Fabio Tramuto, University of Palermo, Italy

                *Correspondence: Nivedita Gupta, drguptanivedita@ 123456gmail.com

                These authors have contributed equally to this work and share first authorship

                These authors have contributed equally to this work and share senior authorship

                Article
                10.3389/fpubh.2023.1218292
                10624221
                37927860
                77f4ca91-2cb5-4a9e-842f-0c7e5895bc20
                Copyright © 2023 Potdar, Vijay, Mukhopadhyay, Aggarwal, Bhardwaj, Choudhary, Gupta, Kaur, Narayan, Kumar, Singh, Abdulkader, Murhekar, Mishra, Thangavel, Nagamani, Dhodapkar, Fomda, Varshney, Majumdar, Dutta, Vijayachari, Turuk, Majumdar, Sahoo, Pandey, Bhargava, Negi, Khatri, Kalawat, Biswas, Khandelwal, Borkakoty, Manjushree, Singh, Iravane, Kaveri, Shantala, Brijwal, Choudhary, Dar, Malhotra, Jain and ILI-SARI Surveillance Team.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 06 May 2023
                : 18 September 2023
                Page count
                Figures: 7, Tables: 5, Equations: 0, References: 36, Pages: 16, Words: 8969
                Funding
                Funded by: Department of Health Research, Ministry of Health and Family Welfare, New Delhi
                Award ID: R.15013/01/2021-HR/VRDL
                This ILI/SARI surveillance program was supported by the Department of Health Research, Ministry of Health and Family Welfare, New Delhi (Grant No. R.15013/01/2021-HR/VRDL).
                Categories
                Public Health
                Original Research
                Custom metadata
                Infectious Diseases: Epidemiology and Prevention

                influenza,integrated surveillance,sars-cov-2,sari,ili
                influenza, integrated surveillance, sars-cov-2, sari, ili

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