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From an epidemiological perspective, influenza A produces epidemics every year (flu season), while influenza B usually produces epidemics every 2–3 years, with average affectation rates of 20% (although they can range between 0 and 90%).<a class="elsevierStyleCrossRef" href="#bib0030">1</a>Influenza A generally affects people in all ages of life, but has a higher morbidity and mortality at extreme ages (<5 and >65). Conversely, influenza B appears to preferentially affect children (<15) due to a lack of prior immunity.<a class="elsevierStyleCrossRefs" href="#bib0030">1,2</a>During the last 2017–18 flu season, an unusual number of cases of influenza B were detected due to the predominant circulation of the Yamagata lineage (B/Phuket/3073/2013) not having been included in the recommended vaccine. On this basis, we studied its age distribution and compared it with the 2015–16 season in which the Victoria lineage mostly circulated (B/Brisbane/60/2008), to analyse the epidemiological pattern of influenza B based on the age of affected patients.A pharyngeal smear was taken from each patient with clinical suspicion of influenza or acute respiratory infection who consulted the emergency unit or were hospitalised. All samples were processed through a commercial RT-PCR molecular amplification technique, which allows simultaneous and differential detection of 16 different respiratory viruses (Allplex® Respiratory Full Panel Assay; Seegen, Korea South). Clinical data regarding the patients’ age were obtained from the virological analytic application sheets. Children aged under 15 were considered paediatric patients.During the 2017–18 season, 1025 cases of hospital flu were diagnosed, 488 corresponded to type B (47.6%) and 537 to type A (52.4%). For the 2015–16 season, 369 cases of influenza B (44.3%) and 464 cases of influenza A (55.7%) were detected.In the last season, 28.3% of cases of influenza B occurred in ages <15, compared with 62.6% of the 2015–16 season. Similarly, the detection percentages in ages >66 were 41.6 and 15.9%, respectively (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Of the 110 cases of severe influenza admitted in the last season, 10 (9%) died, eight of them (80%) due to Yamagata B flu: this lineage presented a global lethality of 13.7% (8/58 serious cases). In the 2015–16 season, 70 serious cases of influenza were diagnosed with nine deaths (12.9%), of which only one (11.1%) was caused by influenza B lineage Victoria: this lineage presented a global lethality of 4.5% (1/22 serious cases).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>A variety of studies show that there is an age difference in influenza infections caused by both influenza B lineages, without differences in sex, vaccination history or patient origin.<a class="elsevierStyleCrossRefs" href="#bib0035">2–4</a> Possible explanations could be that children have a lower immunological response to the NS1 protein of the Victoria lineage, that it evolves more rapidly in antigenically divergent clones or that it has a greater capacity for transmission and population diffusion.<a class="elsevierStyleCrossRefs" href="#bib0035">2–4</a>Socan et al.<a class="elsevierStyleCrossRef" href="#bib0040">3</a> have shown how patients infected with the Victoria lineage are significantly younger than those infected with the Yamagata lineage. Furthermore, the Victoria lineage predominates in the 15–34 age group in both community patients and outpatients. However, the lineages affect the younger population (0–4) equally (55 vs. 45%), although this may be due to the co-circulation of both lineages during the study period in similar percentages.The Yamagata lineage seems to preferentially affect the adult and elderly population with chronic cardiovascular diseases, determining an increase in hospital admissions.<a class="elsevierStyleCrossRefs" href="#bib0035">2–4</a> Despite this, the lethality associated globally with influenza B, without differentiating by lineages, is only 3–4% (2–4), but as we have seen in this study, it increases to 4.5% when the Victory lineage predominated and to 13.7% when the Yamagata lineage predominated.A study carried out by Harvala et al.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> analysed the age distribution of influenza B cases for the 2000–2012 period, and found that only 20.1% of cases occur in children aged under five and 41.2% in children aged under 15 (58.8% in adults). The incidence rate of influenza B in those aged over 65 was 10.4% in this study, lower than that observed in our study (41.6%), although the number of cases analysed in that study was much higher and also covered a longer period of time, without a prevalent circulation of a certain lineage.The epidemiological pattern of influenza B can be variable, to the extent that in one season it can mostly affect the child population and in another the adult. It seems certain that the Yamagata lineage has a special predilection for the adult population, and thus the idea that influenza B mainly affects the child population is invalidated. Therefore, the use of an adjuvant tetravalent vaccine against influenza should be recommended for people aged over 65 to ensure coverage against both influenza B lineages." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Reina J, López de Bilbao C, Riera M. Predominio de la gripe B linaje Yamagata en los adultos en la temporada gripal 2017-2018. Med Clin (Barc). 2020;154:29–30." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1015 "Ancho" => 1587 "Tamanyo" => 65254 ] ] "descripcion" => array:1 [ "en" => "Age distribution of influenza B Victoria and Yamagata lineages cases detected during each epidemic season." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influenza viruses: update on epidemiology, clinical features, treatment and vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Kidd" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0000000000000049" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "242" "paginaFinal" => "246" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24637227" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differing epidemiological dynamics of influenza B virus lineages in Guangzhou, Southern China, 2009–2010" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Tan" 1 => "W. Guan" 2 => "T.T. Lam" 3 => "S. Pan" 4 => "S. Wu" 5 => "Y. Zhan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JVI.01039-13" "Revista" => array:6 [ "tituloSerie" => "J Virol" "fecha" => "2013" "volumen" => "87" "paginaInicial" => "12447" "paginaFinal" => "12456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24027322" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of the demographic and clinical characteristics of laboratory-confirmed influenza B Yamagata and Victoria lineage infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Socan" 1 => "K. Prosenc" 2 => "V. Ucakar" 3 => "N. Berginc" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2014.06.018" "Revista" => array:6 [ "tituloSerie" => "J Clin Virol" "fecha" => "2014" "volumen" => "61" "paginaInicial" => "156" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25034374" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative epidemiology of influenza B Yamagata- and Victoria-lineage viruses in households" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Xu" 1 => "K.H. Chan" 2 => "T.K. Tsang" 3 => "V.J. Fang" 4 => "R.T. Fung" 5 => "D.K. Ip" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/aje/kwv110" "Revista" => array:6 [ "tituloSerie" => "Am J Epidemiol" "fecha" => "2015" "volumen" => "182" "paginaInicial" => "705" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26400854" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of influenza B virus infections in Scotland in 2012/13 and epidemiological investigations between 2000 and 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Harvala" 1 => "D. Smith" 2 => "K. Salvatierra" 3 => "R. Gunson" 4 => "B. von Wissmann" 5 => "A. Reynolds" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Euro Surveill" "fecha" => "2014" "volumen" => "19" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000001/v2_202002131702/S238702061930508X/v2_202002131702/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000001/v2_202002131702/S238702061930508X/v2_202002131702/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061930508X?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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