Background Acute respiratory illnesses and influenza-like illnesses (ILI) are a significant source of morbidity and mortality worldwide. Despite the public health importance, little is known about the etiology of these acute respiratory illnesses in many regions of South America. In 2006, the Peruvian Ministry of Health (MoH) and the US Naval Medical Research Center Detachment (NMRCD) initiated a collaboration to characterize the viral agents associated with ILI and to describe the clinical and epidemiological presentation of the affected population. Methodology/Principal Findings Patients with ILI (fever ≥38°C and cough or sore throat) were evaluated in clinics and hospitals in 13 Peruvian cities representative of the four main regions of the country. Nasal and oropharyngeal swabs, as well as epidemiological and demographic data, were collected from each patient. During the two years of this study (June 2006 through May 2008), a total of 6,835 patients, with a median age of 13 years, were recruited from 31 clinics and hospitals; 6,308 were enrolled by regular passive surveillance and 527 were enrolled as part of outbreak investigations. At least one respiratory virus was isolated from the specimens of 2,688 (42.6%) patients, with etiologies varying by age and geographical region. Overall the most common viral agents isolated were influenza A virus (25.1%), influenza B virus (9.7%), parainfluenza viruses 1, 2, and 3, (HPIV-1,-2,-3; 3.2%), herpes simplex virus (HSV; 2.6%), and adenoviruses (1.8%). Genetic analyses of influenza virus isolates demonstrated that three lineages of influenza A H1N1, one lineage of influenza A H3N2, and two lineages of influenza B were circulating in Peru during the course of this study. Conclusions To our knowledge this is the most comprehensive study to date of the etiologic agents associated with ILI in Peru. These results demonstrate that a wide range of respiratory pathogens are circulating in Peru and this fact needs to be considered by clinicians when treating patients reporting with ILI. Furthermore, these data have implications for influenza vaccine design and implementation in South America.
References
[1]
Monto AS (2002) Epidemiology of viral respiratory infections. Am J Med 112: Suppl 6A4S–12S.
[2]
Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C (2002) Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis 2: 25–32.
[3]
McMillan JA, Weiner LB, Higgins AM, Lamparella VJ (1993) Pharyngitis associated with herpes simplex virus in college students. Pediatr Infect Dis J 12: 280–284.
[4]
Portes SA, Da Silva EE, Siqueira MM, De Filippis AM, Krawczuk MM (1998) Enteroviruses isolated from patients with acute respiratory infections during seven years in Rio de Janeiro (1985–1991). Rev Inst Med Trop Sao Paulo 40: 337–342.
[5]
World Health Organization (2003) Influenza Fact Sheet.
[6]
Cox NJ, Subbarao K (1999) Influenza. Lancet 354: 1277–1282.
[7]
Cox NJ, Subbarao K (2000) Global epidemiology of influenza: past and present. Annu Rev Med 51: 407–421.
[8]
Garcia-Garcia J, Ramos C (2006) [Influenza, an existing public health problem]. Salud Publica Mex 48: 244–267.
[9]
World Health Organization (2002) WHO Global Influenza Programme: survey on capacities of national influenza centres, January–June 2002. Wkly Epidemiol Rec 77: 350–358.
[10]
World Health Organization (2007) Programa Mundial de la OMS contra la Gripe.
[11]
World Health Organization (2007) Recommendations for influenza vaccines.
[12]
Oficina General de Epidemiologia/Instituto Nacional de Salud (2000) Influenza. Lima-Peru: Ministerio de Salud.
[13]
Ministerio de Salud del Peru (2005) Plan Nacional de Preparación y Respuesta Frente a una Potencial Pandemia de Influenza. Lima-Peru.
[14]
Ministerio de Salud del Peru (2005) Directiva N° 057 MINSA/OGE-V.01 “Vigilancia centinela de la influenza y otros virus respiratorios”. Lima-Peru.
[15]
Swofford DL (1998) Phylogenetic Analysis Using Parsimony (and Other Methods).
[16]
Wilgenbusch JC, Swofford D (2003) Inferring evolutionary trees with PAUP*. Curr Protoc Bioinformatics Chapter 6: Unit 6 4.
[17]
Saldarriaga T, Laguna-Torres VA, Arrasco J, Guillén L, águila J (2008) Características clínicas y moleculares de un brote de influenza en dos bases militares, Tumbes- Perú, 2007. Rev Peru Med Exp Salud Publica 25: 35–43.
[18]
Avila M, Salomon H, Carballal G, Ebekian B, Woyskovsky N (1990) Isolation and identification of viral agents in Argentinian children with acute lower respiratory tract infection. Rev Infect Dis 12: Suppl 8S974–981.
[19]
Straliotto SM, Siqueira MM, Muller RL, Fischer GB, Cunha ML (2002) Viral etiology of acute respiratory infections among children in Porto Alegre, RS, Brazil. Rev Soc Bras Med Trop 35: 283–291.
[20]
da Cunha AJ, Amaral J, e Silva MA (2003) inappropriate antibiotic prescription to children with acute respiratory infection in Brazil. Indian Pediatr 40: 7–12.
[21]
Gonzalez Ochoa E, Armas Perez L, Bravo Gonzalez JR, Cabrales Escobar J, Rosales Corrales R (1996) Prescription of antibiotics for mild acute respiratory infections in children. Bull Pan Am Health Organ 30: 106–117.
[22]
García J, Sovero M, Laguna-Torres VA, Gomez J, Douce R (2009) Antiviral resistance in influenza viruses circulating in Central and South America based on the detection of established genetic markers. Influenza and Other Respiratory Viruses 3: 69–74.
[23]
Rothberg MB, Haessler SD, Brown RB (2008) Complications of viral influenza. Am J Med 121: 258–264.
