a b s t r a c tBackground: Respiratory viral infections (RVI) are a leading cause of mortality worldwide. We compared the epidemiology and severity of RVI in Ecuador during 2009-2016. Methods: Respiratory specimens collected within the national surveillance system were tested for influenza viruses, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, and human metapneumovirus. Overall and virus-specific positive detection rate (PDR) were calculated and compared the timing of epidemics caused by the different viruses. Logistic regression models were used to compare the age distribution and risk of death across respiratory viruses. Results: A total of 41,172 specimens were analyzed: influenza (PDR = 14.3%) and respiratory syncytial virus (RSV) (PDR = 9.5%) were the most frequently detected viruses. Influenza epidemics typically peaked in December-January and RSV epidemics in March; seasonality was less evident for the other viruses. Compared to adults, children were more frequently infected with RSV, adenovirus, parainfluenza, and influenza B, while the elderly were less frequently infected with influenza A(H1N1)p. The age-adjusted risk of death was highest for A(H1N1)p (odds ratio [OR] 1.73, 95% confidence intervals [CI] 1.38-2.17), and lowest for RSV (OR 0.75, 95%CI 0.57-0.98). Conclusions: Whilst influenza and RSV were the most frequently detected pathogens, the risk of death differed by RVI, being highest for pandemic influenza and lowest for RSV.

Characterisation of SARS-CoV-2 genetic diversity through space and time can reveal trends in virus importation and domestic circulation, and permit the exploration of questions regarding the early transmission dynamics. Here we present a detailed description of SARS-CoV-2 genomic epidemiology in Ecuador, one of the hardest hit countries during the early stages of the COVID-19 pandemic. We generated and analysed 160 whole genome sequences sampled from all provinces of Ecuador in 2020. Molecular clock and phylogeographic analysis of these sequences in the context of global SARS-CoV-2 diversity enable us to identify and characterise individual transmission lineages within Ecuador, explore their spatiotemporal distributions, and consider their introduction and domestic circulation. Our results reveal a pattern of multiple international importations across the country, with apparent differences between key provinces. Transmission lineages were mostly introduced before the implementation of non-pharmaceutical interventions (NPIs), with differential degrees of persistence and national dissemination.

Background : The COVID-19 pandemic has caused significant supply shortages worldwide for SARS-CoV-2 molecular diagnosis, like RNA extraction kits. Objective : The aim of our study was to evaluate the clinical performance and analytical sensitivity of a simple SARS-CoV-2 diagnosis protocol based on heat shock without RNA extraction using both "CDC" (N gene) and "Charite" (E gene) RT-qPCR protocols. Results : 1,036 nasopharyngeal samples, 543 of them SARS-CoV-2 positive, were analyzed. The heat shock method correctly identified 68,8% (232/337) and 89.4% (202/226) SARS-CoV-2 positive samples for N gene and E gene, respectively. Analytical sensitivity was assessed for heat shock method using the CDC RT-qPCR protocol, obtaining sensitivity values of 98,6%, 93,3% and 84,8% for limit of detection of 100.000, 50.000 and 20.000 viral RNA copies/mL of sample. Conclusions : Our findings show that a simple heat shock SARS-CoV-2 RT-qPCR diagnosis method without RNA extraction is a reliable alternative for potentially infectious SARS-CoV-2 positive patients. This affordable protocol can help to overcome the cost and supply shortages for SARS-CoV-2 diagnosis, especially in developing countries. In Ecuador, it has been used already by laboratories in the public health system for more than 100.000 specimens.

No abstract

Background The presence of subclinical inflammation promotes the progression of morphostructural joint damage in RA patients. Currently, clinical remission is based on the count of swollen and painful joints associated with acute phase reactants. Adding an image technique like grey scale (GS) US and power Doppler (PD) increases the capability to detect active synovitis. There are no studies on the association between active synovitis as defined by PD and more specific markers of inflammation like cytokines in patients with RA in clinical remission Objectives To identify subclinical synovitis in patients with RA in clinical remission using US and to characterize the biological profile of this group of patients by determining inflammatory cytokines Methods RA patients in clinical remission according to ACR/EULAR criteria were enrolled. Clinical evaluation was performed and DAS28 calculated. Cytokines (IL1b, 10, 6. 5, 2, 4, 8, GMCS, TNFa, IFNg,) were determined using ELISA kit (Human ultrasensitive cytokine 10 -plex panel [Invitrogen, CA, USA]). GS and PD ultrasound was assessed in 7 joints according to Backhaus et al (2). Esaote MyLab ® 25 ultrasound machine with 12-18 MHz linear probe was used. Results 21 patients were included. Clinical and demographic data are shown in the table. N=21 Age (years) 44.81 (25–69) Disease duration (months) 100.76 (28–353) Duration in clinical remission (months) 12.15 (1–43) DAS28 1.35 (0.99–2.42) Rheumatoid factor (positive) 95% (n=20) antiCCP (positive) 52% (n=11) GS synovitis was found in 95%, and tenosynovitis in 9.5%. PD was detected in 57%. There was no association between DAS28 and duration in clinical remission, disease duration and US-defined active synovitis (p=0.84, 0.309 and 0.762 respectively). Pro-inflammatory cytokines levels were elevated in patients with less than 6 months and in those with 13 to 24 months in clinical remission. Nevertheless, there was no correlation with US-defined synovitis (p=NS) Conclusions US detected a high percentage of subclinical synovitis in RA patients in clinical remission. Cytokine levels did not correlate with DAS 28 or ultrasound-defined active synovitis. References Brown AK, Conaghan P, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continues structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58(10): 2958-2967 Backhaus M, Ohrndorf S, Kellner H, et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009; 61(9): 1194-1201 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4855