Susceptibilities to rimantadine of influenza A/H1N1 and A/H3N2 viruses isolated during the epidemics of 1988 to 1989 and 1989 to 1990

Clinical isolates of influenza A viruses identified during outbreaks in two winters were tested for their rimantadine susceptibilities by an enzyme-linked immunosorbent assay modified from that described previously by Belshe et al. (R. B. Belshe, B. Burk, F. Newman, R. L. Cerruti, and I. S. Sim, J. Virol. 62:1508-1512, 1988). The infectivity titer and the 50% inhibitory concentration of rimantadine were calculated for each virus. Of 105 influenza virus A isolates tested, 28 influenza A/H1N1 isolates from the 1988 and 1989 outbreak and 77 influenza A/H3N2 isolates from the outbreak in following year, were susceptible to the antiviral action of rimantadine.     

4-Guanidino-2,4-dideoxy-2,3-dehydro-N-acetylneuraminic acid is a highly effective inhibitor both of the sialidase (neuraminidase) and of growth of a wide range of influenza A and B viruses in vitro

The sialidase (neuraminidase) inhibitor 4-guanidino-2,4-dideoxy-2,3-dehydro-N-acetylneuraminic acid (4-guanidino-Neu5Ac2en) has been examined for the ability to inhibit the growth of a wide range of influenza A and B viruses in vitro in comparison with amantadine, rimantadine, and ribavirin. 4-Guanidino-Neu5Ac2en inhibited plaque formation by laboratory-passaged strains of influenza A and B viruses, with 50% inhibitory concentrations ranging from 0.005 to 0.014 microM. A wider range of values (0.02 to 16 microM) was obtained with more recent clinical isolates, but in all cases 4-guanidino-Neu5Ac2en inhibited influenza A and B virus replication at lower concentrations than amantadine, rimantadine, or ribavirin. Inhibition by 4-guanidino-Neu5Ac2en was not obviously affected by the passage history of the viruses or by resistance to amantadine or rimantadine. 4-Guanidino-Neu5Ac2en was a very potent inhibitor of the sialidases of all the influenza viruses examined, with 50% inhibitory concentrations ranging from 0.00064 to 0.0079 microM. No cytotoxicity was observed with 4-guanidino-Neu5Ac2en at up to 10 mM. 4-Guanidino-Neu5Ac2en therefore represents a new potent and selective inhibitor of influenza A and B virus sialidase activity and replication in vitro.     

Use of antivirals in influenza in the elderly: prophylaxis and therapy

Amantadine and rimantadine inhibit H1N1, H2N2, and H3N2 strains of influenza A, but not influenza B. Rimantadine exerts somewhat greater antiviral activity than amantadine, and there are several potentially important differences between the pharmacokinetic profiles and elimination pathways of the two drugs in favour of rimantadine. Adverse effects are more prominent in the elderly but can be minimized by dosage reductions. Both drugs are effective prophylactically and therapeutically and can be used for 'seasonal' prophylaxis, postexposure prophylaxis, outbreak control in residential care, and treatment during community outbreaks of influenza A. Drug-resistant strains of influenza have been recovered in up to half the subjects undergoing treatment, and prophylaxis may fail in homes where drug is given for both prophylaxis and therapy. Elderly residential patients and others identified by national immunization policies may benefit most from prophylactic administration of drug when influenza is first identified locally and for the duration of the outbreak.     

The mini-micro-epididymal sperm aspiration for sperm retrieval: a study of urological outcomes

Susceptible adults (n = 105) were enrolled into a randomized double-blind study of rimantadine treatment of experimental influenza A infection. Subjects were cloistered for 8 days and challenged with a rimantadine-sensitive strain of influenza A H1N1 virus at the end of the first day. Forty-eight hours after challenge and for 8 days, 54 subjects received placebo and 51 received rimantadine (100 mg orally, twice a day). Symptoms, signs, and pathophysiologies were monitored. Nine subjects were not infected. Seventeen subjects (38%) in the rimantadine and 26 (53%) in the placebo group became ill. A beneficial effect of rimantadine was documented for virus shedding, symptom load, and sinus pain. Rimantadine had no effect on nasal patency, mucociliary clearance, nasal signs, or on symptoms and signs of otologic complications. These results do not support a preventive effect of rimantadine on the development of otologic manifestations of influenza A infection in adults.     

Therapeutic effectiveness of bonafton and rimantadine in influenza

The therapeutic effectiveness of bonaphthone and rimantadine was studied by treatment of 439 patients with influenza between 18 and 21 years of age (bonaphthone 94, controls 105, rimantadine 120, controls 120). No therapeutic effectiveness of bonaphthone was established in the study. When rimantadine was given to the patients from the 1st day of the disease, shorter intervals of normalization of the temperature, disappearance of toxicity and catarrhal symptoms were observed than in patients treated with symptomatic drugs. During the period of rimantadine therapy the rate of findings the influenza antigen in smears from the nasal mucosa was lower, but after termination of the course of treatment the antigen was found twice as frequently as in the control group. With the positive therapeutic effect in patients treated with rimantadine, the diagnostic rise of antibody in this group was observed in a lower per cent of cases than in the control group (13 and 20%, respectively). The results of immunofluorescent and serological studies indicate a possible virus reproduction-inhibiting effect of rimantadine. This, however, requires further study. On the basis of the above observations rimantadine may be recommended for treatment of patients with influenza.     

A study of influenza A virus in the city of Calcutta, India, high lighting the strain prevalence

A decade wide (from 1981 to the end of 1993) study on incidences of influenza was carried out in the city of Calcutta, India, by virus isolation and strain identification. Over 3500 patients with acute respiratory infections were examined and 1950 throat swab specimens were inoculated in embryonated chicken eggs. Only 339 haemagglutinating agents were isolated, which comprised 233 strains of influenza A virus. One hundred forty six (62.66%) of these strains were identified as H3N2, eighty one as H1N1 (34.76%), and only two were H2N2 (0.86%) strains of influenza A viruses, as estimated by haemagglutination inhibition test. This observation indicates that H3N2 is the major prevalent strain followed by H1N1 strains of influenza A virus in Calcutta.     

Naturally acquired immunity to influenza type A: a clinical and laboratory study

After type A influenza virus had undergone major antigenic change in mid 1968, it was noted that individuals previously infected by strains of the old subtype (Asian), especially late strains, appeared to be unexpectedly resistant to clinical attack by the new subtype (Hong Kong). Prospective studies have since shown that, during the A/England/42/72 influenza epidemic of 1972, in which the incidence was approximately 7% in the community, clinical influenza due to this virus was not found in 229 subjects previously confirmed as having had A/Hong Kong/1/68 influenza, even though vaccine which had been effective against A/Hong Kong/1/68 was ineffective against A/England/42/72. During the A/Port Chalmers/1/73 influenza epidemic of 1974, clinical influenza resulting from Port Chalmers virus was not found in a closely monitored group of 176 unvaccinated subjects previously infected by A/Hong Kong/1/68 or A/England/42/72, although laboratory studies demonstrated Port Chalmers infection in five of these (2-8%). By contrast, among 99 subjects who had no such history of earlier infection, 22 developed laboratory-proven Port Chalmers influenza and most of them had typical illness.     

Cross-protection of mice immunized with different influenza A (H2) strains and challenged with viruses of the same HA subtype

Cross-protection of mice immunized with inactivated preparations of human and avian influenza A (H2) viruses was determined after lethal infection with mouse-adapted (MA) variants of human A/Jap x Bell/57 (H2N1) and avian A/NJers/78 (H2N3) viruses. The MA variants differed from the original strains by acquired virulence for mice and changes in the HA antigenicity. These studies indicated that mice vaccinated with human influenza A (H2) viruses were satisfactorily protected against challenge with A/Jap x Bell/57-MA variant; the survival rate was in the range of 61%-88.9%. Immunization of mice with the same viral preparations provided lower levels of protection against challenge with A/NJers/78-MA variant. Vaccination of mice with the avian influenza A (H2) viruses induced better protection than with human strains against challenge with both MA variants. Challenge with A/NJers/78-MA variant revealed that 76.2%-95.2% of animals were protected when vaccinated with avian influenza virus strains isolated before 1980, and that the protection reached only 52.4%-60.0% in animals vaccinated with strains isolated in 1980-1985. The present study revealed that cross-protection experiments in a mouse model could provide necessary information for the development of appropriate influenza A (H2) virus vaccines with a potential for these viruses to reappear in a human population.     

Duration of antiviral prophylaxis during nursing home outbreaks of influenza A: a comparison of 2 protocols

BACKGROUND: We performed a randomized trial of 2 protocols guiding the duration of antiviral chemoprophylaxis during outbreaks of influenza A in a rural, 700-bed nursing home for veterans and their spouses with 14 nursing units in 4 buildings. METHODS: Half of all residents volunteered to participate. Nursing units were randomized, and the effectiveness of short-term (minimum, 14 days and 7 days without the onset of a case in the building) vs long-term (minimum, 21 days and 7 days without the onset of a case in the 4-building facility) prophylaxis was compared using amantadine hydrochloride in the influenza seasons of 1991-1992 and 1993-1994 and rimantadine hydrochloride in the influenza season of 1994-1995. A "case" is defined as an incident of a respiratory tract illness and the isolation of an influenza virus organism. We compared the number of cases after the discontinuation of short- vs long-term chemoprophylaxis. Prospective surveillance identified residents with new respiratory tract symptoms, and specimens for viral cultures were obtained even in the absence of temperature elevation. RESULTS: We documented influenza A virus activity during 3 seasons (32, 68, and 12 patients, respectively). During the 1991-1992, 1993-1994, and 1994-1995 influenza seasons, the patients on 11 floors were assigned to receive short-term chemoprophylaxis and those on 10 floors were assigned to long-term chemoprophylaxis. Only in 1993-1994 did chemoprophylaxis extend beyond 14 or 21 days when new cases continued beyond 14 days. Amantadine-resistant strains were circulating at that time. None of the participants in the prospective, controlled study had influenza develop after the termination of short- or long-term chemoprophylaxis. CONCLUSION: Antiviral chemoprophylaxis can be administered for the longer duration of 14 days or, in the absence of new culture-confirmed illness in the nursing building, for 7 days.     

Influenza A virus infection increases IgE production and airway responsiveness in aerosolized antigen-exposed mice

BACKGROUND: Respiratory viral infection is known clinically to promote sensitization to antigen inhalation and the development of asthma. OBJECTIVE: The purpose of this investigation was to determine whether influenza type A virus infection enhances inhalation sensitization and increases airway responsiveness in mice. METHODS: Mice were infected by intranasal inoculation with influenza A viruses (strains: H1N1 and H3N2) or PBS. Animals were exposed to aerosols of ovalbumin on day 3. Two weeks after ovalbumin sensitization, mice were challenged with ovalbumin aerosols; 24 hours later, airway responsiveness (AR) to inhaled methacholine, levels of ovalbumin-specific IgE, and bronchoalveolar lavage fluid (BALF) were examined. RESULTS: Neither influenza A virus (H1N1 nor H3N2) alone nor ovalbumin sensitization alone caused changes in AR or IgE. However, ovalbumin sensitization after inoculation with either influenza A virus increased AR and levels of ovalbumin-specific IgE. On BALF-cell analysis, ovalbumin sensitization after inoculation with influenza virus A increased the number of lymphocytes but not the number of eosinophils. No difference in AR or IgE levels was observed between the 2 strains of influenza A viruses. Immmunostaining of BALF cells showed an increase in T cells, especially CD8(+) cells, with ovalbumin sensitization after inoculation with influenza virus A. CONCLUSION: Infection by influenza A virus enhances sensitization to inhaled antigens and airway responsiveness in mice by means of mechanisms including CD8(+) cells and antigen-specific IgE.     

Interferonogenic capacity of strains influenza B virus and their sensitivity to exogenous interferon

This study is a continuation of the investgation of the influence of endogenous and exogenous interferon on influenza infection. Influenza B virus strains, both laboratory and fresh isolates, were found to be poor interferon inducers in contrast to influenza A virus strains. The study also showed that influenza B virus strains not only induced endogenous interferon poorly but were also resistant to exogenous interferon. This evidence points to marked differences of the investigated influenza B virus strains not only induced endogenous interferon poorly but were also resistant to exogenous interferon. This evidence points to marked differences of the investigated influenza B virus strains from influenza A virus strains which further indicates their peculiar nature.     

Influenza infection in humans and pigs in southeastern China

The three last pandemic strains of influenza A virus-Asian/57, Hong Kong/68 and Russian/77-are believed to have originated in China. The strains responsible for the 1957 and 1968 human pandemics were reassortants incorporating both human and avian influenza viruses, which may have arisen in pigs. We therefore undertook a population-based study in the Nanchang region of Central China to establish the prevalence, types and seasonal pattern of human influenza infection and to screen serum samples from animals and humans for evidence of interspecies transmission of influenza viruses. Two definite influenza seasons were demonstrated, one extending from November to March and the other July to September. The profile of antibodies to commonly circulating human influenza viruses was no different in Nanchang and neighboring rural communities than in Memphis, Tennessee, USA. In particular, Chinese women who raised pigs in their homes were no more likely to have been exposed to influenza virus than were subjects who seldom or never had contact with pigs. However, we did obtain evidence using isolated H7 protein in an enzyme-linked immunoabsorbent assay for infection of pig farmers by an avian H7 influenza virus suggesting that influenza. A viruses may have been transmitted directly from ducks to humans. The results of the serological survey also indicated that pigs in or near Nanchang were infected by human H1N1 and H3N2 influenza viruses, but not with typical swine viruses. We found no serological evidence for H2 influenza viruses in humans after 1968.     

Disability among the population of the Russian Federation

Previously we demonstrated that in the course of intracellular reproduction of WSN influenza virus strain, part of monomeric nucleoprotein (NP) undergo polymerization into dimers and trimers, which dissociate into monomers after boiling. Further studies showed that different strains of influenza virus are characterized by different degree of NP-oligomerization. Specifically, Duck/ Ukraine/63 (H3N8) and Seal Massacuhsets 1/80 (H7N7) NP monomers are completely transformed into oligomers. As a result of 40-min chase and of prolonged label exposure only NP-oligomers but not monomers can be detected in unboiled samples of infected cells or in virions. NP monomers of A/Duck/Ukraine strain are detectable in unboiled samples only after a short period of labeling. Influenza virus NP oligomers are more hydrophobic than NP monomers. Oligomers are hypothesized to be the native functionally important form of influenza virus NP.     

Initial genetic characterization of the 1918 "Spanish" influenza virus

The "Spanish" influenza pandemic killed at least 20 million people in 1918-1919, making it the worst infectious pandemic in history. Understanding the origins of the 1918 virus and the basis for its exceptional virulence may aid in the prediction of future influenza pandemics. RNA from a victim of the 1918 pandemic was isolated from a formalin-fixed, paraffin-embedded, lung tissue sample. Nine fragments of viral RNA were sequenced from the coding regions of hemagglutinin, neuraminidase, nucleoprotein, matrix protein 1, and matrix protein 2. The sequences are consistent with a novel H1N1 influenza A virus that belongs to the subgroup of strains that infect humans and swine, not the avian subgroup.     

Independence of evolutionary and mutational rates after transmission of avian influenza viruses to swine

In 1979, an H1N1 avian influenza virus crossed the species barrier, establishing a new lineage in European swine. Because there is no direct or serologic evidence of previous H1N1 strains in these pigs, these isolates provide a model for studying early evolution of influenza viruses. The evolutionary rates of both the coding and noncoding changes of the H1N1 swine strains are higher than those of human and classic swine influenza A viruses. In addition, early H1N1 swine isolates show a marked plaque heterogeneity that consistently appears after a few passages. The presence of a mutator mutation was postulated (C. Scholtissek, S. Ludwig, and W. M. Fitch, Arch. Virol. 131:237-250, 1993) to account for these observations and the successful establishment of an avian H1N1 strain in swine. To address this question, we calculated the mutation rates of A/Mallard/New York/6750/78 (H2N2) and A/Swine/Germany/2/81 (H1N1) by using the frequency of amantadine-resistant mutants. To account for the inherent variability of estimated mutation rates, we used a probabilistic model for the statistical analysis. The resulting estimated mutation rates of the two strains were not significantly different. Therefore, an increased mutation rate due to the presence of a mutator mutation is unlikely to have led to the successful introduction of avian H1N1 viruses in European swine.     

Are there alternative avian influenza viruses for generation of stable attenuated avian-human influenza A reassortant viruses?

The present study evaluated gull influenza A viruses as donors of attenuating genes for the production of live, attenuated influenza A H1N1 and H3N2 avian-human (ah) reassortant viruses for use as vaccines to prevent disease due to influenza A viruses in humans. The previously evaluated duck influenza A viruses were abandoned as donors of attenuating avian influenza virus genes because clinical evaluation of H1N1 and H3N2 ah reassortant virus vaccines derived from duck viruses documented residual virulence of H1N1 reassortants for seronegative infants and young children. Gull influenza A viruses occupy an independent ecologic niche and are rarely isolated from species other than gulls. The possibility of using gull influenza A viruses as donors of internal gene segments in ah reassortant viruses was evaluated in the present study using three different gull viruses and three human influenza A viruses. Gull-human H3N2 reassortant influenza A viruses with the desired 6-2 genotype (six internal avian influenza virus genes and the two human influenza virus surface glycoprotein genes) were readily generated and were found to be attenuated for squirrel monkeys and chimpanzees. However, ah reassortant viruses with gull and human influenza A H1N1 genes were difficult to generate, and reassortants that had the desired genotype of six gull virus genes with human influenza A H1 and N1 genes were not isolated despite repeated attempts. The gull PB2, NP and NS genes were not present in any of the gull-human H1N1 reassortants generated. The under-representation of these three gene segments suggests that reassortants bearing one or more of these three gene segments might have reduced viability indicative of a functional incompatibility in their gene products. The difficulties encountered in the generation of a 6-2 gull-human H1N1 reassortant virus are sufficient to conclude that the gull influenza A viruses tested would not be useful as donors of sets of six internal genes to attenuate human influenza A viruses. This study also identifies influenza virus gene segments that appear to be incompatible for generation of reassortants. Elucidation of the molecular basis of this restriction may provide information on intergenic interactions involved in virion assembly or packaging.     

Influenza virus strains selectively recognize sialyloligosaccharides on human respiratory epithelium; the role of the host cell in selection of hemagglutinin receptor specificity

The complement of sialyloligosaccharides present on the surface of human tracheal epithelium has been implicated as an important factor in the selection of hemagglutinin receptor specificity of human influenza A virus. Human strains of influenza A virus preferentially recognize host cell receptors bearing SA alpha 2,6Gal sequences, a sequence which is found on the surface of ciliated tracheal epithelium. A fluorescently-labelled H3 human virus strain bound avidly to the apical surface of human tracheal epithelium, while a fluorescently-labelled receptor variant strain, which preferentially binds SA alpha 2,3Gal sequences, showed little binding to the epithelial surface and localized primarily to intracellular mucin droplets. Extracts of human bronchial mucin, which is known to contain sialic acid primarily in the SA alpha 2,3Gal linkage, was a potent inhibitor of the binding of the receptor variant strain to trachea sections, while the binding of the parent strain was unaffected by the presence of mucin. Human bronchial mucin also inhibited the binding of the receptor variant strains, but not the parent virus strains, to human erythrocytes derivatized to contain SA alpha 2,6Gal sequences. These results suggest that a combination of selection pressures present in the respiratory tract environment have resulted in the evolution of a hemagglutinin receptor specificity in human influenza A virus strains which optimizes recognition of, binding to and infection of host cells.     

Epidemic of influenza in Kyushu-Okinawa District (April 1994-March 1995)

The prevalence of influenza in Kyushu-Okinawa District in April 1994- March 1995 was studied as the prevalence of influenza virus, to determine the sero-type of influenza viruses isolated in Kyushu- Okinawa District prefectures and cities. As a result, three sero-types of influenza viruses, i.e. type A/H1N1, type H3N2 and type B, were isolated in Kyushu-Okinawa District in this season, but most of the isolates were type A/H3N2 and type B. Weekly changes of reported influenza patients and period of virus isolation at local public health institutes revealed that influenza epidemics of the earlier part in this season was caused by type A/H3N2 and the latter part due to type B. Type A/H3N2 spread all over Kyushu-Okinawa District in a shorter period (about 2 weeks) through the westside of Kyushu and down south, and type B stayed about one month in northern Kyushu and took about 7 weeks to spread all over Kyushu-Okinawa District. Based on these results, the spread of influenza virus in Kyushu-Okinawa District was visualized on the isopleth maps.