Severe Influenza Outbreak in Western Ukraine in 2009 – a molecular-epidemiological study

Janusz Kocik 1, Marcin Niemcewicz 2, Matthew Johns 3, Kurt Jerke 4, Aleksander Michalski 5, Anna Bielecka 6, Krzysztof Lasocki 5, Jerzy Gaweł 5, Agata Bielawska-Drózd 5, Justyna Joniec 5, Marcin Kołodziej 5, Grzegorz Graniak 5, Mariusz Goniewicz 7, Leszek Kubiak 6
1 - Military Institute of Hygiene and Epidemiology, Department of Epidemiology, Warsaw, Poland
2 - Biological Threat Identification and Countermeasure Centre, Pulawy, Poland
3 - Armed Forces Health Surveillance Center, Department of Global Outbreak Alert and Response & IHR Implementation, Division of Global Emerging Infections Surveillance, USA
4 - Landstuhl Regional Medical Center Laboratory, Landstuhl, Germany
5 - Biological Threat Identification and Countermeasure Centre, Pulawy, Poland
6 - Military Institute of Hygiene and Epidemiology, Department of Epidemiology, Warsaw, Poland
7 - Emergency Medicine Unit, Medical University of Lublin, Poland
Ann Agric Environ Med
2013; 20 (3):
ICID: 1067431
Article type: Review article
Introduction: In the autumn of 2009 the authors participated in a humanitarian operation in Western Ukraine by undertaking an epidemiological investigation of an influenza-like-illness (ILI) in the L’viv Oblast region. Mobile biological survey teams took samples from civilian patients with severe acute respiratory distress syndrome, rapid transportation of the samples, and their molecular analysis in Poland to provide accurate results.
Objective: The aim of the study was the molecular and epidemiological analysis of the biological samples collected.
Material and Methods: Real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR), multiplex PCR techniques, traditional Sanger Sequencing and classical viral culture methods were used.
Results: Among the 124 influenza-like illness cases, ~50% (58) were positive for influenza A virus in WHO-CDC molecular assay, including subtyping. The specimens were further analyzed to confirm results and determine the genetic sequence. Phylogenetically, the nucleotide similarity of both the Ukraine specimens and reference A/California/7/2009 (pH1N1) was 99.2–99.3%. Oseltamivir resistance was not registered. HA1 region characterization showed an overall protein identity of 98.5–99.4%.
Conclusions: An unexpected high contribution of influenza A was confirmed among ILI patients, as well as a very limited number of other detected viruses, indicate that the 2009 epidemic in western Ukraine was strongly related to novel influenza A/H1N1. The importance of swift sharing of information and reference laboratories networking in surveillance, as well as serving governments and international agencies in pursuing adequate actions, should be stressed.
PMID 24069856 - click here to show this article in PubMed

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