Case reportThe virologist and the flu
Section snippets
Why this case is important
To our knowledge this is the first time that long-term (70 days) influenza A H3N2 virus RNA shedding occurs in an otherwise healthy individual while infectious virus could be detected by cell culture only up to 5 days after onset of symptoms.
Case description
A 55-year old virologist has been vaccinated with a trivalent-inactivated influenza vaccine (TIV) by the Occupational Health Service on November 8, 2013. He has been vaccinated against influenza each year since 1988.
The virologist has been in an age appropriate medical condition with no severe chronic disease. He does not take any immunomodulatory drugs.
On April 2, 2014 he developed a cough and on April 3, a more severe cough, chills, and fatigue. On that day, a throat swab was positive for
Other similar and contrasting cases in the literature
A randomised placebo-controlled trial showed that oseltamivir treatment started within 2 days following illness onset significantly reduced virus shedding on day 2, 4, and 7 in patients with uncomplicated influenza infections [2]. However, in a study from 45 public and private outpatient clinics in Hong Kong oseltamivir treatment was not associated with statistically significant reduction in the duration of viral shedding. Patients who had taken oseltamivir within 48 h experienced a
Discussion and references
Influenza infections occurring among vaccinated individuals (vaccine failures) have been described in the literature [4], [5]. So far this case is not uncommon however, this case is striking because, influenza virus RNA was detected until day 70 by PCR (with repeatedly negative results in between on day 10, 14, 16, 23, 25, 33, 34, 36, 38, 40–47), but infectious virus only for 5 days by cell culture (with negative results from day 6 day after symptom onset and day 5 after initiation of
Conflict of interest
The views in this article are the personal views of the authors and do not necessarily represent the views of the professional organizations or institutions of which we are members.
Funding
None.
Competing interests
Sabine Wicker is a member of the German Standing Committee on Vaccination (STIKO). She has received honoraria for non-product-related talks on influenza vaccination from GlaxoSmithKline, Sanofi Pasteur, AstraZeneca and Novartis and has participated in workshops about healthcare workers and vaccination sponsored by Abbot. Holger Rabenau has no conflict of interest.
Ethical approval
Not needed.
Contribution
SW and HR drafted the manuscript; HR performed the laboratory analysis and the interpretation of the data. Both authors read and approved the final manuscript.
References (16)
- et al.
Design and performance testing of quantitative real time PCR assays for influenza A and B viral load measurement
J. Clin. Virol.
(2004) - et al.
Efficacy of oseltamivir treatment started within 5 days of symptom onset to reduce influenza illness duration and virus shedding in an urban setting in Bangladesh: a randomised placebo-controlled trial
Lancet Infect. Dis.
(2014) - et al.
Prolonged shedding of pandemic influenza A(H1N1) 2009 virus in a pancreas-after-kidney transplant recipient
J. Clin. Virol.
(2014) - et al.
Effects of oseltamivir treatment on duration of clinical illness and viral shedding and household transmission of influenza virus
Clin. Infect. Dis.
(2010) - et al.
Efficacy studies of influenza vaccines: effect of end points used and characteristics of vaccine failures
J. Infect. Dis.
(2011) - et al.
Characteristics of vaccine failure in a randomized placebo-controlled trial of inactivated influenza vaccine in children
Pediatr. Infect. Dis. J.
(2014) - et al.
Longitudinal study of influenza molecular viral shedding in Hutterite communities
J. Infect. Dis.
(2012) - et al.
Viral load and duration of viral shedding in adult patients hospitalized with influenza
J. Infect. Dis.
(2009)
Cited by (1)
Potential sources, modes of transmission and effectiveness of prevention measures against SARS-CoV-2
2020, Journal of Hospital InfectionCitation Excerpt :However, in some cases RNA could still be found up to 51 days after the first positive test with negative results in between [15,83]. Influenza A virus RNA has even been released for up to 70 days with negative results in between although infectious virus was only detected for 5 days after symptom onset [84]. Age was also associated with high viral RNA load [15].