common viral infections in africa: surveillance for hai ... · common viral infections in africa:...
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Common Viral infections in Africa: Surveillance for HAI Resp infections
4th Nov 2014, 5th ICAN/ICAZ conference
Division of Global Disease Detection and Emergency Response
Center for Global Health
Dr. Linus Ndegwa, MPHE, HCS,SHEA AmbInfection Control, Manager
Global Disease Detection-GDD
Centers for Disease Control and Prevention-Kenya
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Influenza
Influenza: serious respiratory illness, can be debilitating and cause complications leading to hospitalization and death
Most affected: very young, persons with underlying medical conditions and elderly
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Global impact of influenza
Globally, seasonal influenza causes 3-5 million cases of severe illness and 300,000-500,000 deaths
Past pandemic influenza associated with millions of deaths
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
20-40 million deaths 1-4 million deaths 1-4 million deaths 3
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Influenza virus
Influenza A and B viruses are of epidemiological interest in humans
Types B and C limited to humans
Type A viruses are more virulent and affect many species
Antigenic determinants of influenza A and B are: Haemagglutinin (HA) and Neuraminidase (NA) glycoproteins
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Influenza Virus
Hemagglutinin It is a glycoprotein Receptor that binds host cells
inducing penetration of the virus
Antigenic sites at the outer surface
Antibodies to HA are protective
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Influenza Virus
Neuraminidase (NA): 9 known
Helps release virions from cells
Antibody to NA can help modify disease severity
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Influenza Virus
Antigenic drift and shift:
arises from mutations in the antigenic sites reducing biding of neutralizing antibodies
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Influenza Virus
Antigenic shift (genome re-assortment)
arises when the HA is exchanged in a virus e.g. H1 replaced by H5
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Influenza virus
Influenza A viruses subtypes:
– 16 HA (H1-H17)
– 9 NA (N1-N9) subtypes
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Epidemiology of Influenza
Virological Pattern: Northern Hemisphere
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Epidemiology of Influenza
Virological Pattern: Southern Hemisphere
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Epidemiology of InfluenzaVirological Pattern: Kenya
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Burden of seasonal influenza in Kenya
Influenza circulates at least 11 months per year Influenza detected in : 10-12% of respiratory hospitalizations annually, >30% during periods of peak circulation 8.7% of rHAI in 30months surveillance
Highest rates in children < 6 months Influenza-associated hospitalizations in children
<5 years are 3-7 times higher than in the United States, despite less care-seeking
persons with HIV more likely to spread influenza in their homes
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Current Epidemic and Pandemic Threats!
Pathogen Date of first report
Laboratory-confirmedcases
Deaths Case Fatality Proportion
Date of last reportedcase
A(H5N1) January, 2004 668 393 58.8% Sep, 2014
A(H7N9) February, 2013
453 175 38.6% Aug, 2014
Middle East Respiratory SyndromeCoronavirus
June, 2012 885 319 36% Oct, 2014
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Transmission
Influenza viruses transmitted via air droplets Close contact (up to 3-6 feet) is required for transmission Transmission may also occur through:
– direct skin-to-skin contact – indirect contact with respiratory secretions – Touching contaminated surfaces then touching the eyes,
nose or mouth)
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Transmission
Incubation period 1-2 days
Individuals may spread influenza virus from up to 2 days before to 5 days after onset of symptoms
Children can spread the virus for 10 days or longer
Immunocompromized persons also tend to shed the virus longer
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Clinical Presentation
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Complications of Human Influenza
Pneumonia– primary influenza pneumonia the most severe– secondary bacterial pneumonia being the most common – mixed viral and bacterial pneumonia frequently occurs
Secondary bacterial pneumonia is most commonly caused by :– Streptococcus pneumoniae, – Staphylococcus aureus– Haemophilus influenzae
Chronic cardiac and pulmonary disease predispose Reye’s syndrome in children with Flu B
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Influenza Prevention and Control
Non pharmacologic– Surveillance – Isolation and quarantine– Social distancing– Respiratory protection– Cough and sneeze etiquette– Hand washing
Pharmacologic– Vaccination– Antiviral drugs
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Historically no routine
surveillance for HAIs
Kenyan hospitals:
– Patient overcrowding
– Inadequate hand hygiene
We set up surveillance
for respiratory HAI started
Infection Control and Prevention in Kenya
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Objectives
To document respiratory HAIs occurring on selected wards in 3 Kenyan hospitals
To identify the viruses causing respiratory HAIs
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Surveillance sites Prospective surveillance
Site: 3 selected hospitals
– Kenyatta National hospital: 1800 beds
– Mbagathi District hospital: 200 beds
Apr 1, 2010
Wards
– Medical
– Pediatric
– The ICU
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Surveillance Sites
Hospitals
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Case Definition: Respiratory HAIs
Inclusion Criteria:
– Patients admitted >3 calendar days• Admit date: Day 1
– New onset fever/hypothermia
• (≥38°C or <35°C)
• No fever/hypothermia in past 3 days
– New onset of cough or sore throat
Written consent
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Laboratory tests
Nasopharyngeal/oropharyngeal swabs collected
Samples tested by real time RT-PCR
Samples collected and tested for:
– Influenza A & B
– Adenovirus
– Respiratory syncytial virus (RSV)
– Human metapneumovirus (HMPV)
– Parainfluenza virus 1, 2 and 3. (PIV 1,2,3)
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Laboratory tests
Specimens positive for influenza A were subtyped
– Seasonal H1N1
– Pandemic H1N1
– H5N1
– H3N2
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Surveilance
Surveillance officers at each site
Review of in-patients records for new onset of signs and symptoms
Approved by:
– Kenya Medical Research institute ERC
– CDC- Atlanta IRB
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Results
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Sampling for Respiratory HAI
18545 cases of fever or hypothermia
documented
1255 occurred >3days after admission
with no fever in past 3days
379 with respiratory symptoms
concurrent with fever/hypothermia
In 17 instances, patient
refused swabbing or no
consent obtained112 Swabbed
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Respiratory HAIs : Demographics
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Conclusion
Surveillance showed that rHAI occurred consistently during the 30 months period
Rates are similar to those in other developing nations
Most cases were positive for at least 1 viral pathogen
Infection control should be strengthened
Continued HAI surveillance critical to monitor the burden of HAIs and impact of control measures
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Acknowledgements
ICAN president: Prof. Shaheen
ICAN president: prof Val
Founder and president OASIS: Prof SolomKin
Kenyatta National Hospital
Mbagathi District Referral Hospital
New Nyanza Provincial Hospital
Ministry of Health – Kenya
CDC – Kenya
Div. Healthcare Quality Promotion
CDC – Atlanta
The findings and conclusions in this presentation/report are those of the
author and do not necessarily represent the views of the Centers for
Disease Control and Prevention
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Are there any questions?
Protect your patients. Protect yourself. Protect your family.
Asante Sana (Thank you)