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Influenza C Virus Infection in Children, Spain

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Influenza C Virus Infection in Children, Spain LETTERS Ravindra K. Gupta,* Martina Toby,† Influenza C Virus as previously described (7). Primers Gagori Bandopadhyay,‡ were specific for the nucleoprotein Mary Cooke,* David Gelb,* Infection in gene segment of influenza virus, the and Jonathan S. Nguyen-Van-Tam* Children, Spain fusion gene of RSV, and the hexon *Centre for Infections, London, United gene of adenoviruses. Kingdom; †University of Sheffield Medical To the Editor: Influenza viruses An internal amplification control School, Sheffield, United Kingdom; and cause serious respiratory illness, par- was included in the reaction mixture ‡University of Nottingham Medical School, ticularly in infants <24 months of age Nottingham, United Kingdom to exclude false-negative results (1). Despite serologic studies of caused by specimen inhibitors or French adults that showed an influen- References extraction failure. Given the high sen- za virus seroprevalence of 60%–70%, sitivity of nested PCR, precautions 1. Nguyen-Van-Tam JS, Hampson AW. The influenza C infections have rarely were taken to prevent reactions from epidemiology and clinical impact of pan- been described (2). Given the techni- being contaminated with previously demic influenza. Vaccine. 2003;21:1762–8. cal difficulties involved in isolating 2. Schoch-Spana M. Implications of pandem- amplified product, as well as to pro- influenza C virus in cell cultures, ic influenza for bioterrorism response. Clin tect target RNA or DNA from other Infect Dis. 2000;31:1409–13. diagnosis is made only in certain lab- specimens and controls. All proce- 3. Abdullah AS, Tomlinson B, Cockram CS, oratories. Detection of viral genome dures were performed in laboratory Thomas GN. Lessons from the severe acute by reverse transcription (RT)–PCR in respiratory syndrome outbreak in Hong safety cabinets at locations different nasopharyngeal aspirates allows etio- Kong. Emerg Infect Dis. 2003;9:1042–5. from those where amplified products 4. DiGiovanni C, Bowen N, Ginsberg M, logic diagnosis of these infections (3). were analyzed. Detection levels of 0.1 Giles G. Quarantine stressing voluntary Mild upper respiratory infections in and 0.01 50% tissue culture infectious compliance. Emerg Infect Dis. adults and adolescents are attributed 2005;11:1778–9. doses of influenza A and B viruses to this virus (4,5). Some cases of 5. O’Connor RE, Bord RJ, Fisher A. Rating and 1–10 molecules of cloned ampli- threat mitigators: faith in experts, govern- lower respiratory infections have also fied products of influenza C virus, ments, and individuals themselves to create been described in children (6). RSV-A, RSV-B, and adenovirus a safer world. Risk Anal. 1998;18:547–56. A prospective study was conduct- 6. Fielding R, Lam WW, Ho EY, Lam TH, serotype 1 were achieved. ed from September 1999 through July Hedley AJ, Leung GM. Avian influenza risk A total of 706 hospitalized infants perception, Hong Kong. Emerg Infect Dis. 2003. We determined the incidence were enrolled in the study; 496 speci- 2005;11:677–82. and clinical manifestations associated mens were positive for virus (76.1% 7. World Health Organization. WHO global with influenza C infection in all chil- influenza preparedness plan. Geneva: The were RSV). Thirty children were dren <24 months of age admitted to Organization. [cited 2006 Jan 31]. infected with influenza virus (4.3% of Available from http://www.who.int/csr/ Severo Ochoa Hospital in Madrid, all respiratory infections and 6% of all resources/publications/influenza/WHO_ Spain, with respiratory tract infections confirmed viral infections). Six CDS_CSR_GIP_2005_5.pdf both with and without fever. All 8. Limbu YR, Malla R, Regmi SR, Dahal R, patients had confirmed influenza C patients were evaluated by an attend- Nakarmi HL, Yonzan G, et al. Public virus infections. Three of them had knowledge of heart attack in a Nepalese ing physician. The study was co-infections, 2 with RSV and 1 with population survey. Heart Lung. approved by the Fondo de adenovirus. Clinical characteristics of 2006;35:164–9. Investigaciones Sanitarias Committee 9. Viswanath K, Breen N, Meissner H, Moser these 6 patients are shown in the of Spain. RP, Hesse B, Steele WR, et al. Cancer Table. Although clinical characteris- knowledge and disparities in the informa- Specimens of nasopharyngeal tics for 24 influenza A virus infections tion age. J Health Commun. 2006;11(Suppl aspirates were obtained from each were similar to those for influenza C 1):1–17. patient on admission (Monday to 10. Hoevenaars JG, Schouten JS, van den virus infections (no influenza B virus Friday) and sent to the Respiratory Borne B, Beckers HJ, Webers CA. was identified), statistical analysis Socioeconomic differences in glaucoma Virus Laboratory at the National was not conducted because of small patients’ knowledge, need for information Microbiology Center in Madrid for sample size. and expectations of treatments. Acta virologic studies. Specimens were Ophthalmol Scand. 2006;84:84–91. Influenza virus infections are a processed within 24 hours of collec- major cause of hospitalization and ill- tion. Address for correspondence: Jonathan S. ness in young children, particularly A multiplex RT-PCR was used for Nguyen-Van-Tam, Health Protection Agency those <2 years of age (1). Influenza A direct detection of respiratory syncy- Pandemic Influenza Office, Centre for virus infections are more common tial virus A (RSV-A), RSV-B, aden- Infections, London NW9 5EQ, UK; email: than influenza B virus infections oviruses, and influenza A, B, and C [email protected] (75% vs 25%) (8). Our results indi- viruses in all nasopharyngeal samples, cate that influenza C virus is present Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 10, October 2006 1621 LETTERS Table. Characteristics of 6 children with influenza C virus infections, Spain 1999–2003* Patient Characteristic 1 2 3 4 5 6 Age, mo. 12 15 24 3.5 11 7 Admission date Jan 2000 Feb 2000 Mar 2000 Jan 2002 Nov 2002 Feb 2003 Sex F M M F M F Temperature >38.5°C Yes Yes Yes Yes Yes Yes Fever duration, d 15 5 3 10 2 2 Chest radiograph Infiltrate Normal Infiltrate Normal Normal Infiltrate Diagnosis Wheeze Wheeze Pneumonia Bronchiolitis Wheeze Wheeze O2 saturation <95% No Yes No No Yes Yes Days in hospital 9 8 2 2 2 13 Coinfection No No Adenovirus RSV-B RSV-B No Diarrhea Yes† No Yes‡ No No Yes† *RSV-B, respiratory syncytial virus B. †Rotavirus in feces. ‡Adenovirus in feces. in infants hospitalized with respirato- patients. They found clinical results 3. Claas EC, Sprenger MJ, Kleter GE, van ry infections. similar to ours (lower respiratory Beek R, Quint WG, Masurel N. Type-spe- cific identification of influenza viruses A, In contrast to data for adults, in infections). However, we could not B, and C by the polymerase chain reaction. whom influenza C virus infection is make any conclusions about influenza J Virol Methods. 1992;39:1–13. associated with mild upper respiratory C virus infections in nonhospitalized 4. Greenbaum E, Morag A, Zakay-Rones Z. infections (5), our study showed that children. Isolation of influenza C virus during out- break of influenza A and B viruses. J Clin this infection in infants may be asso- Influenza C virus infection in hos- Microbiol. 1998;36:1441–2. ciated with illness severe enough to pitalized infants is responsible for a 5. Hirsilä M, Kauppila J, Tuomaala K, require hospitalization. Clinical clinical condition with high fever and Grekula B, Puhakka T, Ruuskanen O, et al. symptoms of influenza C virus infec- respiratory symptoms severe enough Detection by reverse transcription-poly- merase chain reaction of influenza C in tion in our patients, such as high fever to require hospitalization. This virus nasopharyngeal secretions of adults with a and respiratory symptoms, were simi- should be studied in respiratory infec- common cold. J Infect Dis. lar to those described for infections tions in hospitalized infants to further 2001;183:1269–72. with influenza A and B viruses clarify its role. 6. Moriuchi H, Katsushima N, Nishimura H, Nakamura K, Numazaki Y. Community- (1,8,9). Nonrespiratory symptoms acquired influenza C virus infection in chil- such as fever or diarrhea have often dren. J Pediatr. 1991;118:235–8. This study was partially supported by been associated with influenza A and 7. Coiras MT, Perez-Brena P, Garcia ML, the Fondo de Investigaciones Sanitarias B virus infections (9). Three patients Casas I. Simultaneous detection of influen- (FIS no. 98/0310). za A, B, and C viruses, respiratory syncytial with influenza C virus infections had virus, and adenoviruses in clinical samples diarrhea; 2 had rotavirus and aden- by multiplex reverse transcription nested- ovirus detected in feces, and 1 had Cristina Calvo,* PCR assay. J Med Virol. 2003;69:132–44. rotavirus detected in feces. However, Maria Luz García-García,* 8. Neuzil KM, Zhu Y, Griffin MR, Edwards Miriam Centeno,* Pilar Pérez- KM, Thompson JM, Tollefson SJ, et al. the high incidence of co-infections Burden of interpandemic influenza in chil- makes clarifying the role of influenza Breña,† and Inmaculada Casas† dren younger than 5 years: a 25-year C virus as a causative agent in these *Severo Ochoa Hospital, Madrid, Spain; prospective study. J Infect Dis. 2002;185: conditions difficult. and †Instituto de Salud Carlos III, Madrid, 147–52. Spain 9. Ploin D, Liberas S, Thouvenot D, Fouilhoux Few studies have investigated A, Gillet Y, Denis A, et al. Influenza burden influenza C virus infection in chil- in children newborn to eleven months of age References dren. Katagiri et al. (10) described an in a pediatric emergency department during outbreak characterized by fever and 1. Iwane MK, Edwards KM, Szilagyi PG, the peak of an influenza epidemic. Pediatr Infect Dis J. 2003;22:S218–22. symptoms of upper respiratory infec- Walker FJ, Griffin MR, Weinberg GA, et al.
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