Saturday, December 19, 2020

Brazil: Paraná Health Reports Novel H1N2 Flu Case


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For the second time this year (see last July's WHO: Influenza A(H1N2) variant virus – Brazil), Brazil is reporting a novel H1N2 flu virus in a human. In last summer's case, involving a 22-y.o. woman from Ibiporã,  the virus was described as a swine variant virus.  

Phylogenetic characterization of this latest virus is pending. 

In 2015, in EID Journal: Influenza A Viruses of Human Origin in Swine, Brazil, we looked at the rising threat of swine variant viruses in South America. A year later, in EID Journal: Characterization of a Novel Human Influenza A(H1N2) Virus Variant, Brazil, we looked at a report of a swine-variant H1N2 virus virus isolated from a Brazilian teenage pig farmer late in 2015.

One that turned out to be a triple reassortant with genetic contributions from H1N2 (hemagglutinin), H3N2 (neuraminidase), and pandemic H1N1 (remaining genes).

While most swine variant infections don't appear to transmit well in humans, the CDC's IRAT (Influenza Risk Assessment Tool) lists 3 North American swine viruses as having some pandemic potential (2 added in 2019).

H1N2 variant [A/California/62/2018]  Jul   2019  5.8  5.7 Moderate
H3N2 variant [A/Ohio/13/2017]          Jul   2019  6.6  5.8 Moderate
H3N2 variant [A/Indiana/08/2011]      Dec 2012   6.0  4.5 Moderate

And we follow a number of other swine variants around the world with similar potential.  Recently China's EA H1N1 `G4' virus has garnered a lot of attention (see ECDC Risk Assessment: Eurasian avian-like A(H1N1) swine influenza viruses), as have other swine around the globe.

And as we've often (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?) - most swine influenza viruses are either H1, H2, or H3 - giving them a distinct advantage, as those are the only influenza subtypes known to have sparked a human influenza pandemic in the last 130 years. 

Details on this latest detection in Brazil are scant, but we should learn more once FIOCRUZ (Fundação Oswaldo Cruz) completes its analysis. 

This (translated) report from the Paraná SECRETARY OF HEALTH.

12/19/2020 - 08:39

The Paraná Department of Health detected yet another case of H1N2, an unusual subtype of the Influenza A virus, in the municipality of Rebouças, in the 4th Regional of Irati.

The virus was detected in the analysis of a sample collected from a 4-year-old girl living in the countryside. It is the second case discovered in the state this year; the first was identified in April, in Ibiporã, in a 22-year-old woman who recovered quickly.

The newly infected child is also doing well, being monitored at home. The parents took the girl to the Darcy Vargas Hospital, on November 16, with a fever of 39ºC, dyspnea, respiratory distress, runny nose and headache.

A sample was collected for respiratory virus research, evaluated with detection of the virus as Influenza A by the Central Laboratory of the State (Lacen). Then, the sample was sent to the National Reference Laboratory, of IOC-Fiocruz in Rio de Janeiro, which sequenced the complete viral genome and determined the H1N2 subtype.

As the occurrence is of compulsory notification, the MS will report to the World Health Organization (WHO) and the Pan American Health Organization (PAHO).

At this moment, professionals from the technical areas of Health Surveillance at Sesa Paraná, the State Central Laboratory, the Ministry of Health, the Ministry of Agriculture and Fiocruz are articulating investigation and control actions of the case.

A team from the Strategic Information Center for Health Surveillance (CIEVS) and Sesa's Communicable Disease Surveillance Division was, during this week, in Rebouças carrying out the retrospective analysis of the case, collecting new materials and researching the network of contacts. of the family of the infected child, with support from the Municipal Health Department of Rebouças and the 4th. Regional Health Institute of Irati.

“In the midst of the Covid-19 pandemic, any new virus with identified epidemic potential deserves Sesa's full attention and immediate implementation of prevention and control measures,” says Secretary of State for Health, Beto Preto.

H1N2 - H1N2 is a subtype of the Influenza A virus and, at this moment, the Fiocruz Laboratory performs phylogenetic analysis for a detailed understanding of the strain found here.

"It is a fundamental measure because we have to work with all epidemiological scenarios and, even, with the possible emergence of the virus in the human host. It is hoped that this will not happen and that the cycle will be closed in this one contaminated”, explains the coordinator of Epidemiological Surveillance of Sesa, Acácia Nasr.

Paraná carries out two types of Surveillance for respiratory viruses: with weekly collections of samples from people who show flu-like symptoms in the 34 sentinel units of the health department and with the mandatory collection of material from hospitalized patients due to Severe Acute Respiratory Syndrome (SRAG).

“In the State, every patient who is admitted, whether in the ICU or in a sickbed, with suspected flu syndrome or severe acute respiratory syndrome, performs the collection”, he adds. “So, with these two types of collections, in sentinel units and inpatient units, we developed a research panel for 15 respiratory viruses; it is the most extensive panel in the country and for this reason the monitoring work developed here is a national model ”, added the technical director of Lacen-PR, Irina Riediger.