Influenza B Outbreak on a Cruise Ship off the São Paulo Coast, Brazil

Fernandes, Eder Gatti; Souza, Priscila Bochi de; Oliveira, Maria Emília Braite de; Lima, Gisele De; Pellini, Alessandra Cristina Guedes; Ribeiro, Maria Fernanda Muzetti; Sato, Helena Keico; Ribeiro, Ana Freitas; Yu, Ana Lúcia Frugis

doi:10.1111/jtm.12132

Cited by 28 publications

(24 citation statements)

References 14 publications

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“…Australia typically has a single winter peak, and summer influenza outbreaks are uncommon. Globally, there are reports of summer influenza or out‐of‐season outbreaks in institutions, as well as among travellers on cruise ships . International travel is a source of importation of influenza during the Australian summer, and the public health implications of inter‐seasonal influenza activity need to be better understood to inform use of influenza vaccine and other preventive measures for influenza control and prevention.…”

Section: Discussionmentioning

confidence: 99%

Inter‐seasonality of influenza in Australia

Moa

Adam

MacIntyre

2019

Influenza Resp Viruses

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Background It appears inter‐seasonal influenza notifications have been increasing in summer months in Australia. This study aims to determine changes in inter‐seasonal influenza activity in Australia over time. Methods Routine influenza surveillance data and hospitalisations data were analysed to study the epidemiology of inter‐seasonal influenza and to examine the impact of inter‐seasonal influenza on morbidity in Australia at a national level. To adjust for changes in testing over time, we calculated a ratio of summer‐to‐winter notifications for each year in the study. A P ‐value of <0.05 was used for statistical significance. Results Nationally, 18 933 notifications were reported during summer months from December to February 2005‐2016. There have been increasing summer notifications over time, which corresponded to similarly increased notifications in winter. A significant upward trend was observed for rate of notification during summer period over these years, P < 0.01. However, the ratio of summer‐to‐winter notifications demonstrated that while notifications have increased, the ratio has not increased markedly over the years and did not show a significant trend. No seasonal trend in rates of hospitalisation for influenza and pneumonia, respiratory and circulatory diagnosis was observed over the studied years. Conclusion This study provides a clearer understanding of the epidemiology and burden of inter‐seasonal influenza and trends over time in Australia. The ratio of summer‐to‐winter notifications remains relatively constant and is supported by reasonably constant hospitalisation rates over the years.

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Section: Discussionmentioning

confidence: 99%

Inter‐seasonality of influenza in Australia

Moa

Adam

MacIntyre

2019

Influenza Resp Viruses

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“…Influenza B virus was believed to have a slower rate of antigenic evolution than influenza A,6 and to cause milder illness than influenza A in the past 7. Like influenza A, influenza B has caused localised outbreaks, including in mass gatherings 2, 8, 9, 10, 11. Moreover, influenza B infection may be underidentified compared with influenza A in healthcare settings,12 so the true burden of influenza B may be underestimated.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of influenza B in Australia: 2001‐2014 influenza seasons

Moa

Muscatello

Turner

et al. 2016

Influenza Resp Viruses

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BackgroundInfluenza B is characterised by two antigenic lineages: B/Victoria and B/Yamagata. These lineages circulate together with influenza A during influenza seasons, with varying incidence from year to year and by geographic region.ObjectiveTo determine the epidemiology of influenza B relative to influenza A in Australia.MethodsLaboratory‐confirmed influenza notifications between 2001 and 2014 in Australia were obtained from the Australian National Notifiable Diseases Surveillance System.ResultsA total of 278 485 laboratory‐confirmed influenza cases were notified during the study period, comprising influenza A (82.2%), B (17.1%) and ‘other and untyped’ (0.7%). The proportion of notifications that were influenza B was highest in five‐ to nine‐year‐olds (27.5%) and lowest in persons aged 85 years and over (11.5%). Of all B notifications with lineage determined, 77.1% were B/Victoria and 22.9% were B/Yamagata infections. Mismatches between the dominant B lineage in a season and the trivalent vaccine B lineage occurred in over one‐third of seasons during the study years. In general, influenza B notifications peaked later than influenza A notifications.ConclusionThe proportion of circulating influenza B in Australia during 2001‐2014 was slightly lower than the global average and was dominated by B/Victoria. Compared with influenza A, influenza B infection was more common among older children and young adults and less common in the very elderly. Influenza B lineage mismatch with the trivalent vaccine occurred about one‐third of the time.

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“…Additionally, cruise ship influenza outbreaks have been shown to be prolonged if newly susceptible passengers join the cruise ship at different destinations at ports along the itinerary. 17 Since we do not know if new passengers or crew embarked along the itinerary for either ship in this report, we are unable to assess whether this mechanism contributed to either of the outbreaks we describe.…”

Section: Discussionmentioning

confidence: 86%

“…16 Influenza outbreaks on cruise ships have previously been reported as occurring during and outside of traditional influenza seasons. 2,17 Furthermore, since cruise ships frequently carry passengers from many different countries, 5 it may be prudent to consider their influenza “season” to be year-round, regardless of the itinerary. The outbreaks described in this report are similar to previous cruise ship outbreaks in that both were large and one involved multiple co-circulating strains of influenza.…”

Section: Discussionmentioning

confidence: 99%

Influenza Outbreaks among Passengers and Crew on Two Cruise Ships: a Recent Account of Preparedness and Response to an Ever-Present Challenge

et al. 2015

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Background During spring 2014, two large influenza outbreaks occurred among cruise ship passengers and crew on trans-hemispheric itineraries. Methods Passenger and crew information for both ships was obtained from components of the ship medical records. Data included demographics, diagnosis of influenza-like illness (ILI) or acute respiratory illness (ARI), illness onset date, passenger cabin number, crew occupation, influenza vaccination history, and rapid influenza diagnostic test (RIDT) result, if performed. Results In total, 3.7% of passengers and 3.1% of crew on Ship A had medically attended acute respiratory illness (MAARI). On Ship B, 6.2% of passengers and 4.7% of crew had MAARI. In both outbreaks, passengers reported illness prior to the ship’s departure. Influenza activity was low in the places of origin of the majority of passengers and both ships’ ports of call. The median age of affected passengers on both ships was 70 years. Diagnostic testing revealed three different co-circulating influenza viruses [influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B] on Ship A and one circulating influenza virus (influenza B) on Ship B. Both ships voluntarily reported the outbreaks to the Centers for Disease Control and Prevention (CDC) and implemented outbreak response plans including isolation of sick individuals and antiviral treatment and prophylaxis. Conclusions Influenza activity can become widespread during cruise ship outbreaks and can occur outside of traditional influenza seasons. Comprehensive outbreak prevention and control plans, including prompt antiviral treatment and prophylaxis, may mitigate the impact of influenza outbreaks on cruise ships.

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Influenza B Outbreak on a Cruise Ship off the São Paulo Coast, Brazil

Cited by 28 publications

References 14 publications

Inter‐seasonality of influenza in Australia

Inter‐seasonality of influenza in Australia

Epidemiology of influenza B in Australia: 2001‐2014 influenza seasons

Influenza Outbreaks among Passengers and Crew on Two Cruise Ships: a Recent Account of Preparedness and Response to an Ever-Present Challenge

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