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Report
Epidemiological
Secretariat of Health Surveillance - Ministry of Health
Influenza: Monitoring until Epidemiological Week 44 of 2016
Surveillance of influenza in Brazil is made up of sentinel surveillance of influenza-like illness (SG)
1 of
Severe Acute Respiratory Syndrome (SARS) in
2 patients admitted to Intensive Care Unit
(ICU) and universal SARS surveillance.
Sentinel surveillance relies on a network of units distributed across all geographic regions of the
Country, and its main objective is to identify circulating respiratory viruses, in addition to allowing
Monitoring the demand for care for this disease. SRAG's universal surveillance monitors the
Hospitalizations and deaths with the objective of identifying the behavior of influenza in the country to
To guide decision-making in situations that require new positions from the Ministry of Health
And State and Municipal Health Secretariats. The data is collected through forms
Standardized and inserted in the online information systems: SIVEP-Influenza and SINAN Influenza Web.
The information presented in this report refers to the period comprising the weeks
Epidemiological (SE) 01 to 44 of 2016, that is, cases with onset of symptoms from 01/01/2016 to 05/11/2016.
SUMMARY OF THE EPIDEMIOLOGICAL WEEK
▪ Positivity for influenza, other respiratory viruses and other etiological agents between
Samples processed in sentinel units was 20.9% (2,936 / 14,062) for SG and 29.7%
(744 / 2.502) for SRAG in ICU.
▪ Influenza was confirmed for 28.1% (11,769 / 41,867) of the total samples with classification
Of SARS cases reported in universal surveillance, with a prevalence of influenza virus
A (H1 N1) pdm09. Among reports of SARS deaths, 31.8% (2,156 / 6,778) were confirmed
For influenza, with a predominance of influenza A (H1N1) pdm09.
INFLUENZA SENTINATION SURVEILLANCE
The information on influenza sentinel surveillance presented in this report is based on the
Data inserted in the SIVEP-Influenza by the sentinel units distributed in all regions of the country. THE
Sentinel surveillance continues to be expanded and in the next bulletins will be incorporated, so
The data of the new sentinel units.
flu syndrome
1
ILI (SG): a
person with a
fever, even said, accompanied by cough or sore throat and onset of symptoms in the last 07 days.
2
S ?ndrome Acute Respiratory (SARS): individual hospitalized with fever, even said, accompanied by cough or sore throat and
Dyspnoea. The following signs may also be observed: O2 saturation less than 95% or respiratory discomfort or
respiratory frequency.
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By SE 44 of 2016, SG sentries collected 17,473 samples -
Collection of 05 weekly samples per sentinel unit. Of these, 14,062 (80.5%) were processed and 20.9%
(2,936 / 14,062) had positive results for respiratory viruses, of which 2,169 (73.9%) were positive
For influenza and 768 (26.2%) for other respiratory viruses (RSV, Parainfluenza and Adenovirus). Between the
Positive samples for influenza, 1,502 (69.2%) were due to influenza A (H1N1) pdm09, 511
(23.6%) of influenza B, 128 (5.9%) of non-subtyped influenza A and 27 (1.2%) of influenza A (H3N2). In between
The other respiratory viruses were predominantly circulating 405 (52.7%) of RSV (Figure 1).
The South and Southeast regions present the highest amounts of positive samples,
For the circulation of influenza A (H1N1) pdm09 and RSV in the South, and influenza A (H1N1) pdm09 and Influenza B in
Southeast region. In the Northern region, the circulation of the RSV virus is highlighted. In the Northeast and Center-
The circulation of influenza A (H1N1) pdm09, (Annex 1 - B).
As for virus distribution by age group, individuals over 10 years of age predominate
Circulation of influenza A (H1N1) viruses pdm09. Among individuals under the age of 10, there was
Circulation of RSV.
Figure 1. Distribution of respiratory viruses identified in sentinel units of flu-like illness, by
Epidemiological week of onset of symptoms. Brazil, from 2016 to SE 44.
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Severe Acute Respiratory Syndrome in ICU
Regarding the samples collected by the SRAG sentinel units in the ICU, 2,862
Collections, of which 2,502 (87.4%) were processed. Of these, 744 (29.7%) tested positive for viruses
Respiratory diseases (Influenza, RSV, Parainfluenza and Adenovirus), of which 410 (55.1%) for influenza and 334
(44.9%) for other respiratory viruses (RSV, Parainfluenza and Adenovirus). From the positive samples to
Influenza A (H1N1) pdm09, 36 (8.8%) for influenza A
Subtype, 22 (5.4%) for influenza B and 4 (1.0%) influenza A (H3N2). Among other respiratory viruses
There was a predominance of 266 (79.6%) RSV circulation (Figure 2).
Figure 2. Distribution of respiratory viruses identified in sentinel units of Respiratory Syndrome
Acute Severity in Intensive Care Unit, per epidemiological week of onset of symptoms. Brazil,
2016 to SE 44.
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UNIVERSAL SURVEILLANCE OF SERIOUS ACUTE RESPIRATORY SYNDROME
Epidemiological Profile of Cases
Up to SE 44 of 2016, 51,842 cases of SARS were reported, of which 41,867 (80.7%) were sample
Processed. Of these, 28.1% (11,769 / 41,867) were classified as SARS by influenza and 11.1%
(4,630 / 41,867) as other respiratory viruses. Among the cases of influenza 10,388 (88.3%) were influenza
A (H1N1) pdm09, 811 (6.9%) non-subtyped influenza A, 528 (4.5%) influenza B and 42 (0.4%) influenza
A (H3N2), (Figure 3 and Annex 2).
Figure 3. Distribution of cases of Severe Acute Respiratory Syndrome second etiologic agent and
Of the onset of symptoms. Brazil, from 2016 to SE 44.
The cases of SARS due to influenza had a median age of 39 years, varying from 0 to
110 years old. In relation to the geographical distribution (Annexes 2 to 4), the Southeast region registered the highest
Of SARS cases for influenza 56% (6,590 / 11,769).
Epidemiological Profile of Deaths
Up to SE 44 of 2016, 6,778 deaths were reported by SARS, corresponding to 13.1%
(6,778 / 51,842) of the total number of cases. Of the total reported deaths, 2,156 (31.8%) were confirmed for viruses
Influenza A (H1N1) pdm09, 163 (7.6%) influenza A
Subtyped 45 (2.1%) for influenza B and 8 (0.4%) influenza A (H3N2) (Figure 4 and Annex 2). The state with the
The highest number of deaths due to influenza was S?o Paulo, totaling 38.7% (835 / 2,156) in the country (Annex 4).
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Figure 4. Distribution of deaths from SARS second etiologic agent and
Of the onset of symptoms. Brazil, from 2016 to SE 44.
Among influenza deaths, the median age was 53 years, ranging from 0 to 99 years. The fee of
Mortality in Brazil is at 0.98 / 100,000 inhabitants. Of the 2,156 individuals who died
Influenza, 1,510 (70.0%) presented at least one risk factor for complications, with a
For adults ≥ 60 years old, those with heart disease, diabetics and those with pneumopathies (Table 1).
In addition, 1,671 (77.5%) used antiviral drugs, with a median of 4 days between the first symptoms and
Beginning of treatment, ranging from 0 to 64 days. It is recommended to start treatment within the first 48 hours.
Figure 5. Distribution of SARS deaths from influenza second risk factor and use of antiviral.
Brazil, from 2016 to SE 44.
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COMPLEMENTARY TECHNICAL INFORMATION
The Laboratory of Respiratory Viruses and Measles, FIOCRUZ, Rio de Janeiro, National Center for
Influenza in Brazil
reports the detection of an influenza A H1N2 variant (H1N2v) detected in unit
Of the sentinel surveillance network of Gripal Syndrome (SG) in the state of Paran?.
It is known that H1N2 virus normally circulates in swine, being reported sporadically
Cases of human infections caused by viral subtype. The case reported here is patient
Who presented symptoms of flu-like illness (fever, cough, sore throat, chest pain and myalgia) with onset
On November 23, 2015, the patient had no risk factor, had not previously received
The influenza vaccine and did not use the antiviral Oseltamivir Phosphate. Because it is a sentinel unit
The nasopharynx aspirate was done on November 27, 2015 and following the
flows of the sample surveillance network was referred to the
state LACEN, which was performed
Diagnosis by real-time RT-PCR technique and given the result of non-subtyped influenza A virus,
on 11 December 2015. On 17 December 2015 the sample was sent to the
National Influenza
Center (NIC) Fiocruz / RJ - reference to the state of Paran? - for further analysis and
Initial characterization gave results indicating H1pdm09, thus, this sample was sent to the
Genetic characterization routine where a distinct phylogenetic HA (hemagglutinin) pattern was detected.
Due to the lack of reagents, sequencing only started on March 28, 2016 and the entire genome
Was obtained on May 25, 2016.
http://portalsaude.saude.gov.br/ima...forme-Epidemiologico_Influenza-2016-SE-44.pdf
