Research Article: Molecular epidemiology survey and characterization of human influenza A viruses circulating among Palestinians in East Jerusalem and the West Bank in 2015

Date Published: March 8, 2019

Publisher: Public Library of Science

Author(s): Maysoon Bakri, Monjed Samuh, Maysa Azzeh, Yongchang Cao.


Frequent typing and molecular characterization of influenza A (IAV) strains are crucial for the identification of circulating subtypes and for the selection of the subtypes’ lineages to be included in the annually prepared vaccine cocktail. We investigated IAV sampled from an underrepresented population from Palestine. 200 nasopharyngeal aspirates (NPA) were collected between February and May of 2015 from Palestinians in East Jerusalem and the West Bank suffering from mild to severe symptoms of upper respiratory infections. NPA were screened for the presence of IAV using RT-PCR. Epidemiological data, hemagglutinin (HA) and neuraminidase (NA) gene sequences were analyzed in IAV positive samples. 50 samples tested positive for IAV; 48% of which were identified as A(H1N1)pdm09 and 52% as A(H3N2), respectively. Infection with A(H1N1)pdm09 occurred mainly in April, while A(H3N2) infections were mainly detected in March. Most IAV infections in 6-year-olds and below were attributed to subtype A(H3N2), while A(H1N1)pdm09 was responsible for most infections in adults above 18-year-olds. Analyses of HA and NA amino acid sequences revealed numerous substitutions. Thereafter, and based on the HA analysis, the Palestinian A(H1N1)pdm09 isolates fell into clade 6B, while the A(H3N2) isolates fell into clades 3C.2 and 3C.3, respectively. This study is significant in providing the first insight into the epidemiology and genetic properties of IAV circulating in Palestine. In contrast to international reports for the same season, A(H3N2) was not the dominant subtype as in northern hemisphere, nor was A(H1N1)pdm09 as in WHO reports for the Middle East, however genetic properties of Palestinian A(H3N2) and A(H1N1)pdm09 were in line with global isolates.

Partial Text

Influenza A virus (IAV) infections cause significant mortality, morbidity, and socio-economic burden throughout the world. One of the diseases described in the ancient history of medicine by Hippocrates in 412 BC is believed to be influenza infection [1]. The first recognized influenza pandemic was in 1510 [2, 3]. Thereafter, another nine epidemics were identified prior to the well-known “Spanish” influenza pandemic of 1918/1919 [2, 3], the causative influenza virus strain of which was only identified and characterized definitely in 1997 [4, 5].

Human influenza A viruses continue to show significant impacts on public health and global economy by causing annual outbreaks and occasional pandemics. Though from 2015, hitherto, this is the first molecular epidemiology study on influenza A circulating in Palestine and is actually one of the few reports in that regard from and on the Middle East [19, 20].




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