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      Increased symptom severity but unchanged neuraminidase inhibitor effectiveness for A(H1N1)pdm09 in the 2010–2011 season: comparison with the previous season and with seasonal A(H3N2) and B

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          Abstract

          Background  No studies of the clinical symptoms before starting therapy or of the effectiveness of neuraminidase inhibitors (NAIs) have been carried out of the 2009–2010 and 2010–2011 seasons that compare A(H1N1)pdm09 or the three circulating types of influenza virus.

          Methods  The clinical symptoms and duration of fever (body temperature ≥37·5°C) after the first dose of an NAI (oseltamivir, zanamivir, laninamivir) were analyzed. PCR was carried out for 365 patients with A(H1N1)pdm09 in the 2009–2010 season and for 388 patients with one of the three types of influenza circulating in the 2010–2011 season. IC 50 for the three NAIs was also analyzed in 51 patients in the 2010–2011 season.

          Results  The peak body temperature was significantly higher in 2010–2011 than in 2009–2010 for patients under 20 years with A(H1N1)pdm09, and in the 2010–2011 season for children 15 years or younger with A(H1N1)pdm09 than for those with other virus types. The percentage of A(H1N1)pdm09 patients with loss of appetite or fatigue was significantly higher in 2010–2011 than in the previous season. The duration of fever was not affected by the kind of NAI or by age in multiple regression analysis. The percentage of patients afebrile at 48 hours after the first dose of NAI was significantly higher for A(H1N1)pdm09 than for A(H3N2) (laninamivir) or B (oseltamivir and laninamivir).

          Conclusion  Although the clinical symptoms of A(H1N1)pdm09 were slightly more severe in the 2010–2011 season, the effectiveness of the NAIs remained high in comparison with 2009–2010 and with other types of seasonal influenza.

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          Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China.

          Bin Cao, Xing-Wang Li, Yu Mao … (2009)
          The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease. During May and June 2009, we observed 426 persons infected with the 2009 pandemic influenza A (H1N1) virus who were quarantined in 61 hospitals in 20 provinces. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection, the clinical features of the disease were closely monitored, and 254 patients were treated with oseltamivir within 48 hours after the onset of disease. The mean age of the 426 patients was 23.4 years, and 53.8% were male. The diagnosis was made at ports of entry (in 32.9% of the patients), during quarantine (20.2%), and in the hospital (46.9%). The median incubation period of the virus was 2 days (range, 1 to 7). The most common symptoms were fever (in 67.4% of the patients) and cough (69.5%). The incidence of diarrhea was 2.8%, and the incidence of nausea and vomiting was 1.9%. Lymphopenia, which was common in both adults (68.1%) and children (92.3%), typically occurred on day 2 (range, 1 to 3) and resolved by day 7 (range, 6 to 9). Hypokalemia was observed in 25.4% of the patients. Duration of fever was typically 3 days (range, 1 to 11). The median length of time during which patients had positive real-time RT-PCR test results was 6 days (range, 1 to 17). Independent risk factors for prolonged real-time RT-PCR positivity included an age of less than 14 years, male sex, and a delay from the onset of symptoms to treatment with oseltamivir of more than 48 hours. Surveillance of the 2009 H1N1 virus in China shows that the majority of those infected have a mild illness. The typical period during which the virus can be detected with the use of real-time RT-PCR is 6 days (whether or not fever is present). The duration of infection may be shortened if oseltamivir is administered. 2009 Massachusetts Medical Society
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            Long-acting neuraminidase inhibitor laninamivir octanoate versus oseltamivir for treatment of influenza: A double-blind, randomized, noninferiority clinical trial.

            , Daniel Chu, Akira Watanabe … (2010)
            A single administration of laninamivir octanoate, a long-acting neuraminidase inhibitor, against influenza infection has been proven effective in nonclinical studies. This study evaluated the clinical efficacy of laninamivir octanoate for the treatment of adult influenza patients. A double-blind, randomized controlled trial examined whether laninamivir octanoate was noninferior to oseltamivir. A total of 1003 patients aged ≥ 20 years with febrile influenza symptoms for no more than 36 h were randomized to receive either 40 mg of laninamivir octanoate, 20 mg of laninamivir octanoate, or oseltamivir. Laninamivir octanoate was inhaled once on day 1, and oseltamivir (75 mg) was administered orally twice daily for 5 days. The primary end point was the time to illness alleviation. A total of 996 patients were included in the primary analysis (40-mg laninamivir octanoate, n = 334; 20-mg laninamivir octanoate, n = 326; and oseltamivir, n = 336). The median time to illness alleviation in the 40-mg laninamivir octanoate, 20-mg laninamivir octanoate, and oseltamivir groups was 73.0, 85.8, and 73.6 h, respectively. The difference between laninamivir octanoate and oseltamivir was -0.6 h (95% confidence interval, -9.9 to 6.9 h) for the 40-mg group and 12.2 h (95% confidence interval, -1.5 to 17.2 h) for the 20-mg group. The upper limits of the 95% confidence intervals were less than the prespecified noninferiority margin (18 h). The proportion of patients shedding virus at day 3 was significantly lower in the 40-mg laninamivir octanoate group than in the oseltamivir group (P = .006). A single inhalation of laninamivir octanoate is effective for the treatment of seasonal influenza, including that caused by oseltamivir-resistant virus, in adults. NCT00803595.
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              Multiplex PCR for typing and subtyping influenza and respiratory syncytial viruses.

              J Stockton, M Zambon, Jonathan P Clewley … (1998)
              A multiplex reverse transcription (RT)-PCR method that has been developed is capable of detecting and subtyping influenza A (H1N1 and H3N2) and B viruses as well as respiratory syncytial virus (RSV) types A and B in respiratory clinical samples taken as part of a national community-based surveillance program of influenza-like illness in England and Wales. The detection of each different pathogen depended on distinguishing five amplification products of different sizes on agarose gels following RT-PCR with multiple primer sets. The multiplex RT-PCR was tested with 65 nasopharyngeal apirates from which RSV had been isolated and 237 combined nose and throat swabs from which influenza A (H1N1 and H3N2) or B virus had been detected by virus isolation, as well as 40 respiratory samples from which other viruses including cytomegalovirus, herpes simplex virus, enteroviruses, and parainfluenza viruses had been grown. For the typing and subtyping of influenza A and B viruses and RSV types A and B, the multiplex RT-PCR gave an excellent (100%) correlation with the results of conventional typing and subtyping with specific antisera. Multiplex RT-PCR can also be used to accurately detect more than one viral template in the same reaction mixture, allowing viral coinfections to be identified with the same respiratory specimen.
              Article 0 comments Cited 69 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Influenza Other Respir Viruses
                Journal ID (iso-abbrev): Influenza Other Respir Viruses
                Journal ID (doi): 10.1111/(ISSN)1750-2659
                Journal ID (publisher-id): IRV
                Title: Influenza and Other Respiratory Viruses
                Publisher: Blackwell Publishing Ltd (Oxford, UK )
                ISSN (Print): 1750-2640
                ISSN (Electronic): 1750-2659
                Publication date (Electronic): 16 August 2012
                Publication date (Print): May 2013
                Volume: 7
                Issue: 3 , Part 2 A(H1N1)pdm09 Papers ( doiID: 10.1111/irv.2013.7.issue-3 )
                Pages: 448-455
                Affiliations
                [ 1 ]Japan Physicians Association, Tokyo Medical Association Building 3F, Tokyo, Japan.
                [ 2 ]Department of Clinical Trials, Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan.
                Author notes
                [*]Naoki Kawai, Kawai Clinic, 4‐9 Tonomachi, Gifu City, 500‐8116, Japan. E‐mail: nkawai@ 123456city.gifu.med.or.jp
                [†]

                These authors contributed equally to this work.

                Article
                Publisher ID: IRV421
                DOI: 10.1111/j.1750-2659.2012.00421.x
                PMC ID: 5779821
                PubMed ID: 22897904
                SO-VID: b65e0ca4-04b1-4ae6-bafc-52b1025a9473
                Copyright © © 2012 Blackwell Publishing Ltd
                History
                Page count
                Figures: 3, Tables: 5, Pages: 8
                Categories
                Subject: Part 2 A(H1N1)pdm09 Papers
                Subject: Original Articles
                Subject: Original Article
                Custom metadata
                source-schema-version-number 2.0
                cover-date May 2013
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:4.6.9 mode:remove_FC converted:04.11.2015

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: a(h1n1)pdm09,clinical symptom,ic50,laninamivir,neuraminidase inhibitor
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: a(h1n1)pdm09, clinical symptom, ic50, laninamivir, neuraminidase inhibitor

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