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Papers by Alfredo Bruno
The Lancet Regional Health - Americas
Ecuador was an early COVID-19 hotspot with substantial COVID-19-mortality. In developed countries... more Ecuador was an early COVID-19 hotspot with substantial COVID-19-mortality. In developed countries, low socioeconomic status is associated with COVID-19 infection and low compliance with non-pharmaceutical interventions (NPIs). However, if NPI were successful in resource-limited settings with high human mobility and informal labour is still unclear. We performed a retrospective observational molecular and serological study of Ecuador’s reference laboratory. We tested 1,950 respiratory samples from COVID-19 surveillance for SARS-CoV-2 and 12 respiratory viruses using RT-PCR, characterized 642 SARS-CoV-2 genomes, and examined SARS-CoV-2 seroprevalence in 1,967 samples from patients with fever in Ecuador’s reference laboratory during 2020-2021. Molecular and serological data were compared to NPI stringency in Bayesian, maximum-likelihood and modelling frameworks.SARS-CoV-2 (Pearson correlation test; r=-0.74; p=0.01) and other respiratory viruses (r=-0.68; p=0.02) detection correlated ne...
Nature communications, Feb 28, 2024
International Journal of Infectious Diseases
Influenza and Other Respiratory Viruses, 2021
BackgroundRespiratory syncytial virus (RSV) infections are one of the leading causes of lower res... more BackgroundRespiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary.ObjectivesThe main objective of this study was to contribute to a better understanding of RSV seasonality by examining the GERi multi‐country surveillance dataset.MethodsRSV seasons were included in the analysis if they contained ≥100 cases. Seasonality was determined using the “average annual percentage” method. Analyses were performed at a subnational level for the United States and Brazil.ResultsWe included 601 425 RSV cases from 12 countries. Most temperate countries experienced RSV epidemics in the winter, with a median duration of 10–21 weeks. Not all epidemics fit this pattern in a consistent manner, with some occurring later or in an irregular manner. More variation in timing was observed in (sub)trop...
SSRN Electronic Journal, 2020
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
PLOS ONE, 2020
Since the 2009 influenza pandemic, Latin American (LA) countries have strengthened their influenz... more Since the 2009 influenza pandemic, Latin American (LA) countries have strengthened their influenza surveillance systems. We analyzed influenza genetic sequence data from the 2017 through 2018 Southern Hemisphere (SH) influenza season from selected LA countries, to map the availability of influenza genetic sequence data from, and to describe, the 2017 through 2018 SH influenza seasons in LA. Methods We analyzed influenza A/H1pdm09, A/H3, B/Victoria and B/Yamagata hemagglutinin sequences from clinical samples from 12 National Influenza Centers (NICs) in ten countries (
PLOS ONE, 2019
There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in ... more There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in Latin America and the Caribbean (LAC) and most countries have a vaccine policy that includes the use of the trivalent influenza vaccine. We analyzed influenza surveillance data to inform decision-making in LAC about prevention strategies, such as the use of the quadrivalent influenza vaccine.
INSPILIP
El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declaró emergencia de salud públ... more El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declaró emergencia de salud pública de importancia internacional, debido al incremento vertiginoso de personas afectadas por un nuevo coronavirus denominado SARS CoV-2. El 11 de marzo de 2020, tras su diseminación global, se estableció como pandemia. Posteriormente se reportó a nivel internacional la aparición de nuevas variantes que implican escenarios epidemiológicos complejos para los que se requiere mantener sistemas de vigilancia genómica operativos, activos y robustos que permitan monitorizar la evolución de la pandemia a nivel mundial y de la epidemia en cada país La vigilancia mundial de las secuencias genéticas del SARS-CoV-2 sirve de apoyo a la respuesta ante la pandemia de COVID-19. Además facilita el seguimiento de la propagación geográfica y temporal del SARS-CoV-2, la pronta detección y evaluación de mutaciones que puedan influir en la capacidad patogénica, la transmisión del virus o en las medidas de ...
Journal of Travel Medicine
First case of human infection with highly pathogenic H5 avian influenza A virus in South America:... more First case of human infection with highly pathogenic H5 avian influenza A virus in South America: a new zoonotic pandemic threat for 2023?
Bulletin of the World Health Organization
Infection and Drug Resistance, 2021
Table S2. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age gro... more Table S2. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by categories of country ageing index. The Global Influenza B Study, 1999-2014. Table S3. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by percentage of outpatients among cases reported to the influenza surveillance system. The Global Influenza B Study, 1999-2014. Table S4. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by country latitude. The Global Influenza B Study, 1999-2014. Table S5. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by percentage of influenza cases caused by that influenza virus in the same season. The Global Influenza B Study, 1999-2014. Table S6. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and infl...
Figure S1. Forest plot of the Relative Illness Ratio for patients aged 0-4 years infected with A(... more Figure S1. Forest plot of the Relative Illness Ratio for patients aged 0-4 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S2. Forest plot of the Relative Illness Ratio for patients aged 5-17 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S3. Forest plot of the Relative Illness Ratio for patients aged 18-39 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S4. Forest plot of the Relative Illness Ratio for patients aged 40-64 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S5. Forest plot of the Relative Illness Ratio for patients aged 65+ years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. (DOCX 44 kb)
Table S1. Number of influenza cases caused by the difference influenza viruses that were included... more Table S1. Number of influenza cases caused by the difference influenza viruses that were included in the analysis. The Global Influenza B Study, 1999-2014. (DOCX 24 kb)
Clinical Infectious Diseases, 2021
Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% ... more Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 1...
Influenza and Other Respiratory Viruses, 2021
Virus Evolution, 2021
Characterisation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic diversit... more Characterisation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic diversity through space and time can reveal trends in virus importation and domestic circulation and permit the exploration of questions regarding the early transmission dynamics. Here, we present a detailed description of SARS-CoV-2 genomic epidemiology in Ecuador, one of the hardest hit countries during the early stages of the coronavirus-19 pandemic. We generated and analysed 160 whole genome sequences sampled from all provinces of Ecuador in 2020. Molecular clock and phylogeographic analysis of these sequences in the context of global SARS-CoV-2 diversity enable us to identify and characterise individual transmission lineages within Ecuador, explore their spatiotemporal distributions, and consider their introduction and domestic circulation. Our results reveal a pattern of multiple international importations across the country, with apparent differences between key provinces. Transmission li...
The Lancet Regional Health - Americas
Ecuador was an early COVID-19 hotspot with substantial COVID-19-mortality. In developed countries... more Ecuador was an early COVID-19 hotspot with substantial COVID-19-mortality. In developed countries, low socioeconomic status is associated with COVID-19 infection and low compliance with non-pharmaceutical interventions (NPIs). However, if NPI were successful in resource-limited settings with high human mobility and informal labour is still unclear. We performed a retrospective observational molecular and serological study of Ecuador’s reference laboratory. We tested 1,950 respiratory samples from COVID-19 surveillance for SARS-CoV-2 and 12 respiratory viruses using RT-PCR, characterized 642 SARS-CoV-2 genomes, and examined SARS-CoV-2 seroprevalence in 1,967 samples from patients with fever in Ecuador’s reference laboratory during 2020-2021. Molecular and serological data were compared to NPI stringency in Bayesian, maximum-likelihood and modelling frameworks.SARS-CoV-2 (Pearson correlation test; r=-0.74; p=0.01) and other respiratory viruses (r=-0.68; p=0.02) detection correlated ne...
Nature communications, Feb 28, 2024
International Journal of Infectious Diseases
Influenza and Other Respiratory Viruses, 2021
BackgroundRespiratory syncytial virus (RSV) infections are one of the leading causes of lower res... more BackgroundRespiratory syncytial virus (RSV) infections are one of the leading causes of lower respiratory tract infections and have a major burden on society. For prevention and control to be deployed effectively, an improved understanding of the seasonality of RSV is necessary.ObjectivesThe main objective of this study was to contribute to a better understanding of RSV seasonality by examining the GERi multi‐country surveillance dataset.MethodsRSV seasons were included in the analysis if they contained ≥100 cases. Seasonality was determined using the “average annual percentage” method. Analyses were performed at a subnational level for the United States and Brazil.ResultsWe included 601 425 RSV cases from 12 countries. Most temperate countries experienced RSV epidemics in the winter, with a median duration of 10–21 weeks. Not all epidemics fit this pattern in a consistent manner, with some occurring later or in an irregular manner. More variation in timing was observed in (sub)trop...
SSRN Electronic Journal, 2020
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
PLOS ONE, 2020
Since the 2009 influenza pandemic, Latin American (LA) countries have strengthened their influenz... more Since the 2009 influenza pandemic, Latin American (LA) countries have strengthened their influenza surveillance systems. We analyzed influenza genetic sequence data from the 2017 through 2018 Southern Hemisphere (SH) influenza season from selected LA countries, to map the availability of influenza genetic sequence data from, and to describe, the 2017 through 2018 SH influenza seasons in LA. Methods We analyzed influenza A/H1pdm09, A/H3, B/Victoria and B/Yamagata hemagglutinin sequences from clinical samples from 12 National Influenza Centers (NICs) in ten countries (
PLOS ONE, 2019
There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in ... more There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in Latin America and the Caribbean (LAC) and most countries have a vaccine policy that includes the use of the trivalent influenza vaccine. We analyzed influenza surveillance data to inform decision-making in LAC about prevention strategies, such as the use of the quadrivalent influenza vaccine.
INSPILIP
El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declaró emergencia de salud públ... more El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declaró emergencia de salud pública de importancia internacional, debido al incremento vertiginoso de personas afectadas por un nuevo coronavirus denominado SARS CoV-2. El 11 de marzo de 2020, tras su diseminación global, se estableció como pandemia. Posteriormente se reportó a nivel internacional la aparición de nuevas variantes que implican escenarios epidemiológicos complejos para los que se requiere mantener sistemas de vigilancia genómica operativos, activos y robustos que permitan monitorizar la evolución de la pandemia a nivel mundial y de la epidemia en cada país La vigilancia mundial de las secuencias genéticas del SARS-CoV-2 sirve de apoyo a la respuesta ante la pandemia de COVID-19. Además facilita el seguimiento de la propagación geográfica y temporal del SARS-CoV-2, la pronta detección y evaluación de mutaciones que puedan influir en la capacidad patogénica, la transmisión del virus o en las medidas de ...
Journal of Travel Medicine
First case of human infection with highly pathogenic H5 avian influenza A virus in South America:... more First case of human infection with highly pathogenic H5 avian influenza A virus in South America: a new zoonotic pandemic threat for 2023?
Bulletin of the World Health Organization
Infection and Drug Resistance, 2021
Table S2. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age gro... more Table S2. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by categories of country ageing index. The Global Influenza B Study, 1999-2014. Table S3. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by percentage of outpatients among cases reported to the influenza surveillance system. The Global Influenza B Study, 1999-2014. Table S4. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by country latitude. The Global Influenza B Study, 1999-2014. Table S5. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and influenza viruses by percentage of influenza cases caused by that influenza virus in the same season. The Global Influenza B Study, 1999-2014. Table S6. Summary Relative Illness Ratio (sRIR), 95% confidence intervals (95% CI) across age groups and infl...
Figure S1. Forest plot of the Relative Illness Ratio for patients aged 0-4 years infected with A(... more Figure S1. Forest plot of the Relative Illness Ratio for patients aged 0-4 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S2. Forest plot of the Relative Illness Ratio for patients aged 5-17 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S3. Forest plot of the Relative Illness Ratio for patients aged 18-39 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S4. Forest plot of the Relative Illness Ratio for patients aged 40-64 years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. Figure S5. Forest plot of the Relative Illness Ratio for patients aged 65+ years infected with A(H1N1) influenza virus. The Global Influenza B Study, 1999-2014. (DOCX 44 kb)
Table S1. Number of influenza cases caused by the difference influenza viruses that were included... more Table S1. Number of influenza cases caused by the difference influenza viruses that were included in the analysis. The Global Influenza B Study, 1999-2014. (DOCX 24 kb)
Clinical Infectious Diseases, 2021
Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% ... more Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 1...
Influenza and Other Respiratory Viruses, 2021
Virus Evolution, 2021
Characterisation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic diversit... more Characterisation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic diversity through space and time can reveal trends in virus importation and domestic circulation and permit the exploration of questions regarding the early transmission dynamics. Here, we present a detailed description of SARS-CoV-2 genomic epidemiology in Ecuador, one of the hardest hit countries during the early stages of the coronavirus-19 pandemic. We generated and analysed 160 whole genome sequences sampled from all provinces of Ecuador in 2020. Molecular clock and phylogeographic analysis of these sequences in the context of global SARS-CoV-2 diversity enable us to identify and characterise individual transmission lineages within Ecuador, explore their spatiotemporal distributions, and consider their introduction and domestic circulation. Our results reveal a pattern of multiple international importations across the country, with apparent differences between key provinces. Transmission li...