BackgroundThe 2009 H1N1 pandemic highlighted the need to routinely monitor severe influenza, which lead to the establishment of sentinel hospital-based surveillance of severe acute respiratory infections (SARI) in several countries in Europe. The objective of this study is to describe characteristics of SARI patients and to explore risk factors for a severe outcome in influenza-positive SARI patients.MethodsData on hospitalised patients meeting a syndromic SARI case definition between 2009 and 2012 from nine countries in Eastern Europe (Albania, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russian Federation and Ukraine) were included in this study. An exploratory analysis was performed to assess the association between risk factors and a severe (ICU, fatal) outcome in influenza-positive SARI patients using a multivariate logistic regression analysis.ResultsNine countries reported a total of 13,275 SARI patients. The majority of SARI patients reported in these countries were young children. A total of 12,673 SARI cases (95%) were tested for influenza virus and 3377 (27%) were laboratory confirmed. The majority of tested SARI cases were from Georgia, the Russian Federation and Ukraine and the least were from Kyrgyzstan. The proportion positive varied by country, season and age group, with a tendency to a higher proportion positive in the 15+ yrs age group in six of the countries. ICU admission and fatal outcome were most often recorded for influenza-positive SARI cases aged >15 yrs. An exploratory analysis using pooled data from influenza-positive SARI cases in three countries showed that age > 15 yrs, having lung, heart, kidney or liver disease, and being pregnant were independently associated with a fatal outcome.ConclusionsCountries in Eastern Europe have been able to collect data through routine monitoring of severe influenza and results on risk factors for a severe outcome in influenza-positive SARI cases have identified several risk groups. This is especially relevant in the light of an overall low vaccination uptake and antiviral use in Eastern Europe, since information on risk factors will help in targeting and prioritising vulnerable populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0722-x) contains supplementary material, which is available to authorized users.

Wenqing Zhang 2 | On behalf of the WHO RSV Surveillance Group This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

A dramatic increase of influenza activity in Russia since week 3 of 2016 significantly differs from previous seasons in terms of the incidence of influenza and acute respiratory infection (ARI) and in number of lethal cases. We performed antigenic analysis of 108 and whole‐genome sequencing of 77 influenza A(H1N1)pdm09 viruses from Moscow and Saint Petersburg. Most of the viruses were antigenically related to the vaccine strain. Whole‐genome analysis revealed a composition of specific mutations in the internal genes (D2E and M83I in NEP, E125D in NS1, M105T in NP, Q208K in M1, and N204S in PA‐X) that probably emerged before the beginning of 2015/2016 epidemic season.

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Existing influenza surveillance system is constantly improved to obtain comprehensive information for understanding of continuously changing situation with the influenza, which is a consequence of the highest variability of the pathogen, its ability to reassortment and the imminence of emergence a new shift-variants of the virus that could cause the next pandemic events. For this purpose, since the 2010 - 2011 epidemic season, in addition to the traditional surveillance system (TS) a new well standardized sentinel surveillance system (SS) for rapid clinical and epidemiological data obtaining was introduced in Russia. A total 7812 hospitalized patients with severe acute respiratory infection (SARI) and 9854 outpatients with influenza-like illness and acute respiratory infection (ILI/ARI) were investigated during the 6-year period in SS. Percent of SARI among all hospitalized patients ranged from 1.7 to 3.1%; about 5.3 - 7.5% SARI patients were placed in the Intensive Care Unit. Etiological monitoring using PCR showed influenza spread trends in SS similar to those registered in the TS: a clear predominance of influenza A (H1N1) pdm09 among SARI and ILI/ARI in 2010 - 2011 and 2015 - 2016 epidemic seasons, influenza A (H3N2) in the epidemic seasons 2011 - 2012 and 2014 - 2015, the co-circulation of these pathogens in 2012 - 2013, 2013 - 2014 seasons in Russia. SARI caused by influenza B virus were detected less frequently than influenza A but increased influenza B activity was registered in the epidemic of 2014 -2015, when Yamagata lineage changed suddenly for the Victorian one. The average frequency of influenza diagnosis among SARI between the seasons varied in the range 12.5 - 27.1%, at the peak of the epidemic it reached 44.8 - 73.5% and was the highest during the season with active circulation of influenza A (H1N1) pdm09 virus. The rate of influenza diagnosis among ILI/ARI has always been lower than that among SARI. Studies have also shown the importance of rhinovirus, RS-virus and parainfluenza infections in SARI development. The frequency of registration of coronaviruses, metapneumovirus and bocavirus infection was very low in SARI and ILI/ARI. It was found that in all studied seasons most of SARI patients with influenza have not been vaccinated. Among ILI/ARI outpatients with influenza, the frequency of vaccinated individuals for the entire period of the study was estimated as 10.1%, which was 4.2 times higher than that in SARI, where only 2.4% of patients were vaccinated. In addition, it was found that for all six seasons the SARI patients with influenza were treated with antivirals drugs 2 times less often compared to outpatients. Analysis of data on concomitant diseases and conditions in SARI patients with influenza confirmed the leading role of pregnancy as a risk factor for hospitalization in all influenza epidemics, irrespective of their etiology. In addition, diabetes and cardiovascular disease were recognized as risk factors for influenza associated SARI development.

Влияние гриппа различной этиологии на другие ОРВИ у детей и взрослых в 2014-2016 годах Резюме Для оценки связи между заболеваемостью гриппом и РС-, корона-, метапневмо-, адено-рино-, бока-вирусными инфекциями и парагриппом проведен корреляционный анализ случаев гриппа и каждой из вышеперечисленных инфекций в возрастных группах населения 24 городов РФ. Возрастная структура заболевших имела значительные отличия. Среди взрослого населения чаще выявляли грипп, больше А(H1N1)pdm09 (61,4%), ОРВИ не гриппозной этиологии-среди детей 0-2 лет, особенно бокавирусную и РС-вирусную (72,5-62,8%) инфекции. Доля взрослых была больше, чем детей 3-6 лет, при корона-, рино-и парагриппозной инфекциях. Подтверждена выраженная зимне-весенняя сезонность гриппа. РС-, корона-и метапневмо-вирусные инфекции имели сдвиг на весенний период, а аденовирусная, парагрипп, бока-и рино-вирусные инфекции-на осенний. Показана прямая положительная корреляционная связь заболеваемости гриппом населения в целом с РС-, корона-, метапневмо-, адено-вирусными инфекциями и парагриппом, но не было значимой корреляции с рино-и бокавирусными инфекциями. Корреляционные связи у взрослого населения с гриппом были больше (сильная-при РС-инфекции) и выявлялись раньше, чем у детей. Продолжительность корреляционной связи с гриппом зависела от этиологии ОРВИ, этиологии гриппа и от возраста.

Ключевые слова: заболеваемость гриппом и ОРВИ, РС-вирусная инфекция, города и Федеральные округа The Spread of RS-virus Infection and other ARVI not Influenza Etiology in Children and Adults in the Regions Relevance. Respiratory syncytial virus (RSV) is the leading viral cause of acute lower respiratory tract infections in infants and young children in whom this virus is the cause of the primary infection. Goal. The aim of the study is to study the spread of diseases with MS infection in federal districts of Russia Materials and methods. The Federal Influenza Center collects and automates the processing of weekly information from 24 cities on the number of influenza and acute respiratory viral infections in the total and diagnosed cases (according to polymerase chain reaction) of influenza, RS virus and other acute respiratory viral infections in children (0-2, 6, 7-14 years) and adults (15 years and older).Results. The average annual incidence of influenza and ARVI, RS virus and Rhino-viral infections, Paragripp and Adenovirus, Boca, Meta and coronas-viral

Etiology of respiratory virus infections among 1699 hospitalized patients (HP) was determined by PCR during the period of increased influenza activity in 2012 - 2013 season. The rate of accidence of influenza virus in dependence of gender, age, social and demographic factors and previous vaccination was analysed. Young children dominated in the age structure of HP, while the elderly were hospitalized very rarely. According to results obtained rate of influenza detection in HP was significantly higher among adults in comparison with children (63,5 and 30,7% of investigated patients, correspondingly). Respiratory syncytial virus and rhinoviruses were detected the most regularly (8.7 and 3.1%, correspondingly) in children, parainfluenza and adenoviruses were registered rarely (1.4 and 2.1%, correspondingly). Rate of detection of coronaviruses and bocavirus was low and varied in the range 0.3 - 0.6%. Indicated above ARI agents among hospitalized adults were detected rarely (0 - 1.5%) with exception of RSV which was detected among elderly (75 - 84 years) in 5.9% cases. No metapneumovirus cases were detected among HP in indicated period. Although males dominated (58%) among HP influenza cases, regardless of the type/subtype, were registered more frequently among girls in comparison with the boys of the same age groups. Influenza cases were registered more frequenly as well among smoking than in not smoking patients. Young children dominated in the age structure of HP, while the elderly were hospitalized very rarely.