The Influenza Research Laboratory at Pasteur Institute of Iran initiated its activity in 1999 to research the influenza virus to develop suitable vaccines and carry out relevant projects. It was promoted to the "Department of Influenza and Respiratory Viruses" in 2014. Since 2015, this laboratory has been selected as a “National Collaborating Laboratory” for the diagnosis of influenza and got responsible to admit and evaluate the samples of influenza-suspected patients from three provinces of Zanjan, Semnan, and Markazi.

As per the defined criteria, the throat swab samples obtained from the influenza-suspected patients are transferred to this laboratory in the viral transport medium (VTM) by maintaining the cold chain. Each sample is given a single electronic code in the influenza disease care system, in which the patient-identifiable details are entered. In the laboratory, following the initial steps, the genomic RNA of the virus is extracted from the samples and analyzed by Real-time PCR method utilizing primers and probes recommended by the World Health Organization (WHO). Each sample is tested for influenza types A and B and subtypes H1 and H3 and the results are recorded in the relevant system.

To know more about the services of this department, we interviewed  Dr. Fatemeh Fotouhi, the head of the National Collaborating Laboratory, as follows.

Dr. Fatemeh Fatouhi is a graduate of Tarbiat Modares University; she received her Bachelor's degree in Microbiology from the University of Tehran, and Master's degree and a doctorate in Virology from Tarbiat Modares University, and served as a postdoctoral fellow at Queen's University in Canada for one year. She has been working in the Department of Influenza and Respiratory Viruses since 2008, and in addition to carrying out research projects and training students, she is responsible for the diagnosis of influenza in this department.

Formation of the “National Influenza Detection Network”

Since 2009, the diagnosis of the influenza virus at Pasteur Institute of Iran entered a new phase, and since then, we have been diagnosing influenza subtypes employing the Real-time PCR method. Since 2015, our laboratory has been recognized as a reference collaborative laboratory by obtaining the necessary standards, regularly evaluated and audited through the Health Reference Laboratory.

During the influenza pandemic in 2009, the volume of samples that had to be examined in the country became very large, and by purchasing the necessary equipment, the Pasteur Institute of Iran became a part of the national influenza network, with 13 laboratories as members across the country. With the onset of the Coronavirus pandemic, this network served as a basis to expand the laboratory services for COVID-19. The influenza laboratory network has a worldwide system, in which the information of countries is recorded and the types of influenza viruses circulating in any part of the world are monitored.

Receiving Influenza Samples from Three  Provinces

As for Influenza, Patients are not admitted to the Influenza Department. The samples are transferred to the Pasteur Institute of Iran from the Health centre of three provinces (Semnan, Zanjan, and Markazi) for evaluation and diagnosis. The results of types and subtypes are determined and registered in the system in the shortest possible time.

Samples are taken from the nasopharynx of the patients; in this case, if the patient has a respiratory problem and the doctor suspects influenza, a sample will be taken. Typically,  the results of the tests are released within 12 to 24 h after receiving the sample and being recorded in the system.

Influenza has types A, B and C. Although monitoring the type of circulating influenza virus is vitally important, supportive treatment is provided for all types of the virus. Of course, some drugs are specific for influenza type A. Firstly, we determine whether a person is infected with the flu and then determine the subtypes. We at the Pasteur Institute of Iran only diagnose human influenza viruses, and patients are not charged for the diagnosis.

Influenza Multiple Animal Hosts

Viruses are currently the cause of each of ten infectious health issues in the world as declared by the WHO; it means that viruses are now considered threats to human societies. Among viral diseases, those that are easily spread will have special importance. Some viruses may not be highly lethal, but they are noteworthy as they can be transmitted very quickly from one person to another. If we are prepared to monitor them shortly and see what virus is circulating, we shall contribute to the health system to look ahead for the next few months.

Among viral diseases, a distinguishing feature of the influenza virus is that it has multiple hosts. The origin of most of the influenza viruses that have threatened the world community over the last few centuries were usually birds. We have many historical experiences that epidemics and pandemics of influenza have surprised mankind.

 

Getting Prepared to Detect New Viruses

Due to the readiness during the COVID-19 pandemic, we have a large number of experienced experts that can be organized in a short time to conduct tests for a large number of samples. There are also automatic extraction machines in the department that can be utilized consecutively. Therefore, in case of a new respiratory virus spread, there is a capacity to act quickly to detect it.

The National Influenza Center is located at Tehran University of Medical Sciences, which is the representative of the World Health Organization in Iran. The information related to Iran is uploaded by them in the Global Influenza System.

In addition to the diagnosis of samples, many research projects are carried out on the influenza virus and other viral agents that cause respiratory diseases.  Field-related students are also working in this laboratory according to the activities of the department.

High Prevalence of Influenza in the Country

Prior to the Coronavirus pandemic, influenza was very common, but with the outbreak of COVID-19, the use of masks, the observance of some health precautions, and the school's closure, the prevalence of influenza dropped and there were very few reports of influenza in 2020. Schools are one of the main sources of the influenza virus spread. Children get infected in schools and transmit the virus to adults at home.

International travel can also play a decisive role in the spread of the influenza virus. If this disease spreads in one corner of the world, it can immediately spread all over the world.

In the current year, the restrictions were lifted much more compared to that over the last two years,  masks were used less, and the immunity level against the influenza virus was low, therefore, the flu became very common this year. Currently, most influenza A subtypes are of the H3N2 subtype, and some cases of influenza subtype H1N1 are reported.

Supportive Treatment for Influenza Patients

Influenza has no specific treatment. For people being hospitalized at home, supportive treatments are usually prescribed by the physician. Antipyretic and anti-cough medications, and sometimes anti-allergic drugs and dexamethasone are prescribed.

Fortunately, current influenza viruses do not cause mortality and do not lead to high rates of hospitalization, but people with underlying diseases are more prone to hospitalization.

Influenza Vaccine Recommendation

The influenza vaccine is quadrivalent recommended for sensitive groups who are at higher risk. This vaccine is especially recommended for pregnant mothers, people with immune system defects, and also children.