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Eurosurv. Letter to the editor: Just a coincidence? Two severe human cases due to swine influenza (SIV) A(H1N1)v in Europe, October 2016

tetano

tetano

Editor, Senior Moderator
Eurosurveillance, Volume 22, Issue 10, 09 March 2017
Letter

Letter to the editor: Just a coincidence? Two severe human cases due to swine influenza (SIV) A(H1N1)v in Europe, October 2016


C Adlhoch [SUP]1[/SUP] , P Penttinen [SUP]1[/SUP]
+ Author affiliations
1. European Centre for Disease Prevention and Control, Solna, Sweden


Correspondence: Cornelia Adlhoch (cornelia.adlhoch@ecdc.europa.eu)



To the editor: We read with concern the reports of two human cases infected with swine influenza virus (SIV) that both occurred in October 2016 in Europe [1,2]. One case was a school-aged child in the Netherlands with history of eczema, while the other was a middle-aged man in Italy with obesity as underlying condition. The similarities of these cases were striking: both developed severe respiratory symptoms with a rapid progression, finally requiring admission to intensive care and use of extracorporeal membrane oxygenation (ECMO). Antiviral treatment was initiated in both cases more than three days after onset of symptoms, and only after the symptoms worsened, invasive mechanical ventilation and ECMO support were initiated. Both cases recovered and were discharged from hospital.
Eurasian avian-like SIV A(H1N1)v were identified in both patients. In Europe, these viruses circulate widely in the pig population [3]. The viruses isolated from the patients differed genetically from each other. Both cases had presumably visited pig farms before onset of symptoms, suggesting direct contact or indirect exposure to infected pigs, e.g. through contaminated surfaces or via aerosol. In both cases, an initial positive influenza A detection with subsequent inconclusive typing results was followed by whole genome sequencing, which identified the swine virus origin. The same virus was also detected in the pigs at the visited farm in the Netherlands.

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http://www.eurosurveillance.org/View...rticleId=22734
 
Eurosurveillance, Volume 22, Issue 10, 09 March 2017
Letter

Authors? reply: Two severe human cases due to swine influenza A (H1N1)v in October 2016 in Europe were chronologic coincident yet distinct events


F Rovida [SUP]1[/SUP] , A Piralla [SUP]1[/SUP] , FC Marzani [SUP]2[/SUP] , A Moreno [SUP]3[/SUP] , G Campanini [SUP]1[/SUP] , F Mojoli [SUP]2[/SUP] [SUP]4[/SUP] , M Pozzi [SUP]2[/SUP] , A Girello [SUP]1[/SUP] , C Chiapponi [SUP]5[/SUP] , F Vezzoli [SUP]6[/SUP] , P Prati [SUP]7[/SUP] , E Percivalle [SUP]1[/SUP] , A Pavan [SUP]8[/SUP] , M Gramegna [SUP]9[/SUP] , GA Iotti [SUP]2[/SUP] [SUP]4[/SUP] , F Baldanti [SUP]1[/SUP] [SUP]10[/SUP]
+ Author affiliations
1. SS Virologia Molecolare, SC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
2. Anestesia e Rianimazione, Dipartimento di Emergenza ed Urgenza, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
3. Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Brescia, Italy
4. Unit? di Anestesia, Rianimazione e Terapia Antalgica, Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universit? degli Studi di Pavia, Pavia, Italy
5. Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Parma, Italy
6. Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Lodi, Italy
7. Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia Romagna, Pavia, Italy
8. Agenzia di Tutela della Salute, Pavia, Italy
9. Direzione Generale Sanit?, Regione Lombardia, Milano, Italy
10. Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Universit? degli Studi di Pavia, Pavia, Italy


Correspondence: Fausto Baldanti (f.baldanti@smatteo.pv.it)







Citation style for this article: Rovida F, Piralla A, Marzani FC, Moreno A, Campanini G, Mojoli F, Pozzi M, Girello A, Chiapponi C, Vezzoli F, Prati P, Percivalle E, Pavan A, Gramegna M, Iotti GA, Baldanti F. Authors? reply: Two severe human cases due to swine influenza A (H1N1)v in October 2016 in Europe were chronologic coincident yet distinct events. Euro Surveill. 2017;22(10):pii=30480. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.10.30480

Received:02 March 2017; Accepted:09 March 2017
To the editor: Indeed, the similarities between the cases reported by Fraaij et al. from the Netherlands [1] and our group in Italy [2] are somewhat striking. Both cases occurred in October 2016, both cases presented with severe respiratory syndrome and in both cases, a swine influenza virus (SIV) strain circulating in a nearby pig farm was detected in the patient. In the paper by Fraaij et al., the patient had visited a pig farm, but not had direct contact with pigs [1]. In our paper, the patient stated that he had no contact with infected pigs, but his brother worked on a pig farm. Although the data presented in our paper strictly adhere with official reports [2], we also agree that unreported visits to a pig farm or direct contact with infected pigs through contaminated surfaces or via aerosol are possibilities that cannot be excluded. However, a major difference between the Dutch and Italian case were the SIV strains recovered from the patients, indicating the occurrence of chronologically coincidental yet distinct events.
We share all the concerns raised by the Authors of the Letter to the editor [3]. In particular: (i) attention to severe zoonotic influenza A infections in humans should be as high in Europe as in any other region of the world. (ii) Both reported cases occurred earlier than the influenza season in humans and this event may have had an impact on established surveillance procedures and reporting which are activated at the beginning of the season. (iii) Virus whole genome sequencing should be the gold standard for specimens with inconclusive results or nontypeable influenza strains (indeed, this approach was followed by both the Dutch and Italian groups). (iv) We strongly recommend the inclusion of pan-influenza A molecular assays in the work-up of all patients with severe respiratory syndromes, irrespective of seasonality. (v) We fully support the need for unrestricted sharing of biological materials as well as epidemiological, clinical and sequence data.

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http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22736
 
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