[Source: PLoS One, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Investigation of an outbreak of acute respiratory disease in an indigenous village in Brazil: Contribution of Influenza A(H1N1)pdm09 and human respiratory syncytial viruses
Andrey Moreira Cardoso , Paola Cristina Resende , Enny S. Paixao , Felipe G. Tavares , Yasmin N. Farias , Carla Tatiana G. Barreto , Lídia N. Pantoja , Fernanda L. Ferreira , André Luiz Martins , Ângela Barbosa Lima , Daniella A. Fernandes , Patrícia Machado Sanches , Walquiria A. F. Almeida , Laura C. Rodrigues , Marilda M. Siqueira
Published: July 8, 2019 / DOI: https://doi.org/10.1371/journal.pone.0218925
Analyses of the 2009 H1N1 influenza pandemic and post-pandemic years showed high attack rates and severity among indigenous populations. This study presents the characteristics of the first documented influenza outbreak in indigenous peoples in Brazil, that occurred from 30th March to 14th April 2016 in a Guarani village in Southeast Region. Acute respiratory infections were prospectively investigated. The majority of the 73 cases were influenza-like illness (ILI) (63.0%) or severe acute respiratory infection (SARI) (20.5%). The ILI+SARI attack rate (35.9%) decreased with increasing age. There was a high influenza vaccination rate (86.3%), but no statistically significant difference in vaccination rates between severe and non-severe cases was seen (p = 0.334). Molecular analyses of 19.2% of the cases showed 100% positivity for influenza A(H1N1)pdm09 and/or hRSV. Influenza A(H1N1)pdm09 was included in the 6B.1 genetic group, a distinct cluster with 13 amino acid substitutions of A/California/07/2009-like. The hRSV were clustered in the BA-like genetic group. The early arrival of the influenza season overlapping usual hRSV season, the circulation of a drifted influenza virus not covered by vaccine and the high prevalence of risk factors for infection and severity in the village jointly can explain the high attack rate of ARI, even with a high rate of influenza vaccination. The results reinforce the importance of surveillance of respiratory viruses, timely vaccination and controlling risk factors for infection and severity of in the indigenous populations in order to preventing disease and related deaths, particularly in children.
Citation: Cardoso AM, Resende PC, Paixao ES, Tavares FG, Farias YN, Barreto CTG, et al. (2019) Investigation of an outbreak of acute respiratory disease in an indigenous village in Brazil: Contribution of Influenza A(H1N1)pdm09 and human respiratory syncytial viruses. PLoS ONE 14(7): e0218925. https://doi.org/10.1371/journal.pone.0218925
Editor: Eric HY Lau, The University of Hong Kong, CHINA
Received: September 27, 2018; Accepted: June 13, 2019; Published: July 8, 2019
Copyright: © 2019 Cardoso et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Influenza A(H1N1)pdm09 sequences obtained in this study were deposited in the Global Initiative on Sharing All Influenza Data (GISAID) database under the accession numbers EPI_ISL_271538, EPI_ISL_271539, EPI_ISL_274050, EPI_ISL_274051 and EPI_ISL_274061 and the hRSV strains in Genbank under the accession numbers (MH719234 and MH719235). Meritorious proposals for access to data will be considered subject to ethical and legal restrictions, the terms of the original informed consent agreement with participant community, and Guarani community protocols for authorizing studies. Due to the small size of the study community, the minimal dataset cannot be adequately anonymized to permit open access while protecting participants’ identities. Data requests may be sent to Reinaldo Souza dos Santos, Head of Department, Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, located at Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brazil. Phone: +55 (21) 2598-2683. Email: firstname.lastname@example.org.
Funding: This project was funded by the following institutions: Received by AMC – National Research Council (CNPq – www.cnpq.br) Universal 14/2011 – 47.4008/2011-8 and CNPq Universal 01/2016 – 428284/2016-7; Oswaldo Cruz Foundation (Fiocruz – www.fiocruz.br) – INOVA ENSP II 2013 – 25388.000556/2013-52, PAPES VII – Young scientist 2014 – 401789/2015-2 and ENSP 2016/2018 – 25388.000526/2017-70; Research Foundation of the State of Rio de Janeiro (FAPERJ – www.faperj.br) PPSUS FAPERJ/SES-RJ/MS-DECIT/CNPq 35/2013-E-26/110.275/2014; and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES – www.capes.gov.br) – Finance Code 001; Received by MMS – CNPq Universal 431975/2016-7, used for the molecular analysis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Keywords: Seasonal Influenza; H1N1pdm09; RSV; SARI; Brazil.