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. 2019 Jul 8;14(7):e0218925. doi: 10.1371/journal.pone.0218925. eCollection 2019.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Brazil / epidemiology
  • Child
  • Child, Preschool
  • Disease Outbreaks
  • Female
  • Humans
  • Infant
  • Influenza A Virus, H1N1 Subtype / pathogenicity
  • Influenza Vaccines / therapeutic use*
  • Influenza, Human / epidemiology*
  • Influenza, Human / prevention & control
  • Influenza, Human / virology
  • Male
  • Respiration Disorders / epidemiology*
  • Respiration Disorders / prevention & control
  • Respiration Disorders / virology
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / prevention & control
  • Respiratory Tract Infections / virology
  • Seasons
  • Vaccination

Substances

  • Influenza Vaccines

Grants and 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.