PandemieGrippaleV1, France, Analysis, bibRecord, 000452

Low Titers of Serum Antibodies Inhibiting Hemagglutination Predict Fatal Fulminant Influenza A(H1N1) 2009 Infection

Identifieur interne : 000452 ( France/Analysis ); précédent : 000451; suivant : 000453

Low Titers of Serum Antibodies Inhibiting Hemagglutination Predict Fatal Fulminant Influenza A(H1N1) 2009 Infection

Auteurs : Amélie Guihot [France] ; Charles-Edouard Luyt [France] ; Antoine Parrot [France] ; Dominique Rousset [France] ; Jean-Marc Cavaillon [France] ; David Boutolleau [France] ; Catherine Fitting [France] ; Priya Pajanirassa [France] ; Alain Mallet [France] ; Muriel Fartoukh [France] ; Henri Agut [France] ; Lucile Musset [France] ; Rima Zoorob [France] ; Amos Kirilovksy [France] ; Béhazine Combadiere [France] ; Sylvie Van Der Werf [France] ; Brigitte Autran [France] ; Guislaine Carcelain [France]

Source :

American journal of respiratory and critical care medicine [ 1073-449X ] ; 2014.

RBID : Pascal:14-0162506

Descripteurs français

Pascal (Inist)
- Pathologie de l'appareil respiratoire, Faible, Sérum, Anticorps, Hémagglutination, Prédiction, Facteur prédictif, Forme létale, Fulminant, Grippe A, 2009, Santé publique, Sérologie, Réponse immune, Unité soin intensif, Réanimation, Soin intensif, Virus grippal A(H1N1).
Wicri :
- topic : Santé publique.

English descriptors

KwdEn :
- 2009, Antibody, Fatal course, Fulminant, Hemagglutination, Immune response, Influenza A, Influenza A (H1N1), Intensive care, Intensive care unit, Low, Prediction, Predictive factor, Public health, Respiratory disease, Resuscitation, Serology, Serum.

Abstract

Rationale: The biology of fatal pandemic influenza infection remains undefined. Objectives: To characterize the virologic and immune parameters associated with severity or death in patients who required mechanical ventilation for A(H1N1) 2009 pneumonia of various degrees of severity during the two waves of the 2009-2011 pandemic in Paris, France. Methods: This multicenter study included 34 unvaccinated patients with very severe or fatal confirmed influenza A(H1N1) infections. It analyzed plasma A(H1N1) 2009 reverse-transcriptase polymerase chain reaction, hemagglutinin 222G viral mutation, and humoral and cellular immune responses to the virus, assessed in hemagglutination inhibition (HI), microneutralization, ELISA, lymphoproliferative, ELISpot IFN-γ, and cytokine and chemokine assays. Measurements and Main Results: The patients' median age was 35 years. Influenza A(H1N1) 2009 viremia was detected in 4 of 34 cases, and a 222G hemagglutinin mutation in 7 of 17 cases, all of them with sequential organ failure assessment greater than or equal to 8. HI antibodies were detectable in 19 of 26 survivors and undetectable in all six fatal fulminant cases. ELISA and microneutralization titers were concordant. B-cell immunophenotyping and plasma levels of immunoglobulin classes did not differ between patients who survived and died. After immune complex dissociation, influenza ELISA serology became strongly positive in the bronchoalveolar lavage of the two fatal cases tested. H1N1-specific T-cell responses in lymphoproliferative and IFN-γ assays were detectable in survivors' peripheral blood, and lymphoproliferative assays were negative in the three fatal cases tested. Plasma levels of IL-6 and IL-10 were high in fatal cases and correlated with severity. Finally, a negative HI serology 4 days after the onset of influenza symptoms predicted death from fulminant influenza (P = 0.04). Conclusions: Early negative A(H1N1) 2009 HI serology can predict death from influenza. This negative serology in fatal cases in young adults reflects the trapping of anti-H1N1 antibodies in immune complexes in the lungs, associated with poor specific helper T-cell response.

Affiliations:

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Pascal:14-0162506

Le document en format XML

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</titleStmt>
<publicationStmt><idno type="wicri:source">INIST</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Low Titers of Serum Antibodies Inhibiting Hemagglutination Predict Fatal Fulminant Influenza A(H1N1) 2009 Infection</title>
<author><name sortKey="Guihot, Amelie" sort="Guihot, Amelie" uniqKey="Guihot A" first="Amélie" last="Guihot">Amélie Guihot</name>
<affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Laboratory of Immunity and Infection, UPMC Univ Paris 06, UMR-S945</s1>
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</placeName>
</affiliation>
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</placeName>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Département d'Immunologie, Hôpital Pitié-Salpêtrière</s1>
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<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Luyt, Charles Edouard" sort="Luyt, Charles Edouard" uniqKey="Luyt C" first="Charles-Edouard" last="Luyt">Charles-Edouard Luyt</name>
<affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Service de Reanimation, Hôpital Pitié-Salpêtrière</s1>
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</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Parrot, Antoine" sort="Parrot, Antoine" uniqKey="Parrot A" first="Antoine" last="Parrot">Antoine Parrot</name>
<affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Service de Reanimation, AP-HP, Hôpital Tenon</s1>
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<sZ>3 aut.</sZ>
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</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Rousset, Dominique" sort="Rousset, Dominique" uniqKey="Rousset D" first="Dominique" last="Rousset">Dominique Rousset</name>
<affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Unité de Génétique Moléculaire des Virus à ARN, Département de Virologie, CNR du Virus Influenzae (Région-Nord), Institut Pasteur</s1>
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<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
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<country>France</country>
<placeName><region type="region">Île-de-France</region>
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</placeName>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="10"><s1>Université Paris Diderot Paris 7</s1>
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<country>France</country>
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</placeName>
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</affiliation>
</author>
<author><name sortKey="Cavaillon, Jean Marc" sort="Cavaillon, Jean Marc" uniqKey="Cavaillon J" first="Jean-Marc" last="Cavaillon">Jean-Marc Cavaillon</name>
<affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Unité Cytokines et Inflammation, Institut Pasteur</s1>
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<country>France</country>
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</author>
<author><name sortKey="Boutolleau, David" sort="Boutolleau, David" uniqKey="Boutolleau D" first="David" last="Boutolleau">David Boutolleau</name>
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<country>France</country>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Fitting, Catherine" sort="Fitting, Catherine" uniqKey="Fitting C" first="Catherine" last="Fitting">Catherine Fitting</name>
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<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Pajanirassa, Priya" sort="Pajanirassa, Priya" uniqKey="Pajanirassa P" first="Priya" last="Pajanirassa">Priya Pajanirassa</name>
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<sZ>1 aut.</sZ>
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<country>France</country>
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<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Laboratory of Immunity and Infection, INSERM, U945</s1>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Mallet, Alain" sort="Mallet, Alain" uniqKey="Mallet A" first="Alain" last="Mallet">Alain Mallet</name>
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<sZ>9 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Fartoukh, Muriel" sort="Fartoukh, Muriel" uniqKey="Fartoukh M" first="Muriel" last="Fartoukh">Muriel Fartoukh</name>
<affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Service de Reanimation, AP-HP, Hôpital Tenon</s1>
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<sZ>3 aut.</sZ>
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</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Agut, Henri" sort="Agut, Henri" uniqKey="Agut H" first="Henri" last="Agut">Henri Agut</name>
<affiliation wicri:level="3"><inist:fA14 i1="11"><s1>UPMC Univ Paris 06, ER1 DETIV, Service de Virologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP</s1>
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<country>France</country>
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<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Musset, Lucile" sort="Musset, Lucile" uniqKey="Musset L" first="Lucile" last="Musset">Lucile Musset</name>
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<country>France</country>
<placeName><region type="region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Zoorob, Rima" sort="Zoorob, Rima" uniqKey="Zoorob R" first="Rima" last="Zoorob">Rima Zoorob</name>
<affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Laboratory of Immunity and Infection, INSERM, U945</s1>
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<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="12"><s1>Université Paris Sud, Paris-XI</s1>
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<country>France</country>
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</placeName>
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</author>
<author><name sortKey="Kirilovksy, Amos" sort="Kirilovksy, Amos" uniqKey="Kirilovksy A" first="Amos" last="Kirilovksy">Amos Kirilovksy</name>
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<country>France</country>
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</placeName>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="12"><s1>Université Paris Sud, Paris-XI</s1>
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<s3>FRA</s3>
<sZ>13 aut.</sZ>
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</inist:fA14>
<country>France</country>
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</placeName>
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</affiliation>
</author>
<author><name sortKey="Combadiere, Behazine" sort="Combadiere, Behazine" uniqKey="Combadiere B" first="Béhazine" last="Combadiere">Béhazine Combadiere</name>
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</inist:fA14>
<country>France</country>
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<region type="old region">Île-de-France</region>
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</placeName>
</affiliation>
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</author>
<author><name sortKey="Van Der Werf, Sylvie" sort="Van Der Werf, Sylvie" uniqKey="Van Der Werf S" first="Sylvie" last="Van Der Werf">Sylvie Van Der Werf</name>
<affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Unité de Génétique Moléculaire des Virus à ARN, Département de Virologie, CNR du Virus Influenzae (Région-Nord), Institut Pasteur</s1>
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</inist:fA14>
<country>France</country>
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</placeName>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="09"><s1>CNRS, URA3015</s1>
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<sZ>4 aut.</sZ>
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</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="10"><s1>Université Paris Diderot Paris 7</s1>
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</inist:fA14>
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</placeName>
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</affiliation>
</author>
<author><name sortKey="Autran, Brigitte" sort="Autran, Brigitte" uniqKey="Autran B" first="Brigitte" last="Autran">Brigitte Autran</name>
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</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Laboratory of Immunity and Infection, INSERM, U945</s1>
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<sZ>1 aut.</sZ>
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<country>France</country>
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<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Département d'Immunologie, Hôpital Pitié-Salpêtrière</s1>
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<country>France</country>
<placeName><region type="region">Île-de-France</region>
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</placeName>
</affiliation>
</author>
<author><name sortKey="Carcelain, Guislaine" sort="Carcelain, Guislaine" uniqKey="Carcelain G" first="Guislaine" last="Carcelain">Guislaine Carcelain</name>
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<sZ>8 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Laboratory of Immunity and Infection, INSERM, U945</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>1 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Département d'Immunologie, Hôpital Pitié-Salpêtrière</s1>
<s2>Paris</s2>
<s3>FRA</s3>
<sZ>1 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>17 aut.</sZ>
<sZ>18 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">American journal of respiratory and critical care medicine</title>
<title level="j" type="abbreviated">Am. j. respir. crit. care med.</title>
<idno type="ISSN">1073-449X</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">American journal of respiratory and critical care medicine</title>
<title level="j" type="abbreviated">Am. j. respir. crit. care med.</title>
<idno type="ISSN">1073-449X</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>2009</term>
<term>Antibody</term>
<term>Fatal course</term>
<term>Fulminant</term>
<term>Hemagglutination</term>
<term>Immune response</term>
<term>Influenza A</term>
<term>Influenza A (H1N1)</term>
<term>Intensive care</term>
<term>Intensive care unit</term>
<term>Low</term>
<term>Prediction</term>
<term>Predictive factor</term>
<term>Public health</term>
<term>Respiratory disease</term>
<term>Resuscitation</term>
<term>Serology</term>
<term>Serum</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Pathologie de l'appareil respiratoire</term>
<term>Faible</term>
<term>Sérum</term>
<term>Anticorps</term>
<term>Hémagglutination</term>
<term>Prédiction</term>
<term>Facteur prédictif</term>
<term>Forme létale</term>
<term>Fulminant</term>
<term>Grippe A</term>
<term>2009</term>
<term>Santé publique</term>
<term>Sérologie</term>
<term>Réponse immune</term>
<term>Unité soin intensif</term>
<term>Réanimation</term>
<term>Soin intensif</term>
<term>Virus grippal A(H1N1)</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Santé publique</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Rationale: The biology of fatal pandemic influenza infection remains undefined. Objectives: To characterize the virologic and immune parameters associated with severity or death in patients who required mechanical ventilation for A(H1N1) 2009 pneumonia of various degrees of severity during the two waves of the 2009-2011 pandemic in Paris, France. Methods: This multicenter study included 34 unvaccinated patients with very severe or fatal confirmed influenza A(H1N1) infections. It analyzed plasma A(H1N1) 2009 reverse-transcriptase polymerase chain reaction, hemagglutinin 222G viral mutation, and humoral and cellular immune responses to the virus, assessed in hemagglutination inhibition (HI), microneutralization, ELISA, lymphoproliferative, ELISpot IFN-γ, and cytokine and chemokine assays. Measurements and Main Results: The patients' median age was 35 years. Influenza A(H1N1) 2009 viremia was detected in 4 of 34 cases, and a 222G hemagglutinin mutation in 7 of 17 cases, all of them with sequential organ failure assessment greater than or equal to 8. HI antibodies were detectable in 19 of 26 survivors and undetectable in all six fatal fulminant cases. ELISA and microneutralization titers were concordant. B-cell immunophenotyping and plasma levels of immunoglobulin classes did not differ between patients who survived and died. After immune complex dissociation, influenza ELISA serology became strongly positive in the bronchoalveolar lavage of the two fatal cases tested. H1N1-specific T-cell responses in lymphoproliferative and IFN-γ assays were detectable in survivors' peripheral blood, and lymphoproliferative assays were negative in the three fatal cases tested. Plasma levels of IL-6 and IL-10 were high in fatal cases and correlated with severity. Finally, a negative HI serology 4 days after the onset of influenza symptoms predicted death from fulminant influenza (P = 0.04). Conclusions: Early negative A(H1N1) 2009 HI serology can predict death from influenza. This negative serology in fatal cases in young adults reflects the trapping of anti-H1N1 antibodies in immune complexes in the lungs, associated with poor specific helper T-cell response.</div>
</front>
</TEI>
<affiliations><list><country><li>France</li>
</country>
<region><li>Île-de-France</li>
</region>
<settlement><li>Paris</li>
</settlement>
<orgName><li>Université Paris Diderot-Paris 7</li>
<li>Université Paris-Sud</li>
</orgName>
</list>
<tree><country name="France"><region name="Île-de-France"><name sortKey="Guihot, Amelie" sort="Guihot, Amelie" uniqKey="Guihot A" first="Amélie" last="Guihot">Amélie Guihot</name>
</region>
<name sortKey="Agut, Henri" sort="Agut, Henri" uniqKey="Agut H" first="Henri" last="Agut">Henri Agut</name>
<name sortKey="Autran, Brigitte" sort="Autran, Brigitte" uniqKey="Autran B" first="Brigitte" last="Autran">Brigitte Autran</name>
<name sortKey="Autran, Brigitte" sort="Autran, Brigitte" uniqKey="Autran B" first="Brigitte" last="Autran">Brigitte Autran</name>
<name sortKey="Autran, Brigitte" sort="Autran, Brigitte" uniqKey="Autran B" first="Brigitte" last="Autran">Brigitte Autran</name>
<name sortKey="Boutolleau, David" sort="Boutolleau, David" uniqKey="Boutolleau D" first="David" last="Boutolleau">David Boutolleau</name>
<name sortKey="Carcelain, Guislaine" sort="Carcelain, Guislaine" uniqKey="Carcelain G" first="Guislaine" last="Carcelain">Guislaine Carcelain</name>
<name sortKey="Carcelain, Guislaine" sort="Carcelain, Guislaine" uniqKey="Carcelain G" first="Guislaine" last="Carcelain">Guislaine Carcelain</name>
<name sortKey="Carcelain, Guislaine" sort="Carcelain, Guislaine" uniqKey="Carcelain G" first="Guislaine" last="Carcelain">Guislaine Carcelain</name>
<name sortKey="Cavaillon, Jean Marc" sort="Cavaillon, Jean Marc" uniqKey="Cavaillon J" first="Jean-Marc" last="Cavaillon">Jean-Marc Cavaillon</name>
<name sortKey="Combadiere, Behazine" sort="Combadiere, Behazine" uniqKey="Combadiere B" first="Béhazine" last="Combadiere">Béhazine Combadiere</name>
<name sortKey="Combadiere, Behazine" sort="Combadiere, Behazine" uniqKey="Combadiere B" first="Béhazine" last="Combadiere">Béhazine Combadiere</name>
<name sortKey="Fartoukh, Muriel" sort="Fartoukh, Muriel" uniqKey="Fartoukh M" first="Muriel" last="Fartoukh">Muriel Fartoukh</name>
<name sortKey="Fitting, Catherine" sort="Fitting, Catherine" uniqKey="Fitting C" first="Catherine" last="Fitting">Catherine Fitting</name>
<name sortKey="Guihot, Amelie" sort="Guihot, Amelie" uniqKey="Guihot A" first="Amélie" last="Guihot">Amélie Guihot</name>
<name sortKey="Guihot, Amelie" sort="Guihot, Amelie" uniqKey="Guihot A" first="Amélie" last="Guihot">Amélie Guihot</name>
<name sortKey="Kirilovksy, Amos" sort="Kirilovksy, Amos" uniqKey="Kirilovksy A" first="Amos" last="Kirilovksy">Amos Kirilovksy</name>
<name sortKey="Kirilovksy, Amos" sort="Kirilovksy, Amos" uniqKey="Kirilovksy A" first="Amos" last="Kirilovksy">Amos Kirilovksy</name>
<name sortKey="Luyt, Charles Edouard" sort="Luyt, Charles Edouard" uniqKey="Luyt C" first="Charles-Edouard" last="Luyt">Charles-Edouard Luyt</name>
<name sortKey="Mallet, Alain" sort="Mallet, Alain" uniqKey="Mallet A" first="Alain" last="Mallet">Alain Mallet</name>
<name sortKey="Musset, Lucile" sort="Musset, Lucile" uniqKey="Musset L" first="Lucile" last="Musset">Lucile Musset</name>
<name sortKey="Pajanirassa, Priya" sort="Pajanirassa, Priya" uniqKey="Pajanirassa P" first="Priya" last="Pajanirassa">Priya Pajanirassa</name>
<name sortKey="Pajanirassa, Priya" sort="Pajanirassa, Priya" uniqKey="Pajanirassa P" first="Priya" last="Pajanirassa">Priya Pajanirassa</name>
<name sortKey="Parrot, Antoine" sort="Parrot, Antoine" uniqKey="Parrot A" first="Antoine" last="Parrot">Antoine Parrot</name>
<name sortKey="Rousset, Dominique" sort="Rousset, Dominique" uniqKey="Rousset D" first="Dominique" last="Rousset">Dominique Rousset</name>
<name sortKey="Rousset, Dominique" sort="Rousset, Dominique" uniqKey="Rousset D" first="Dominique" last="Rousset">Dominique Rousset</name>
<name sortKey="Rousset, Dominique" sort="Rousset, Dominique" uniqKey="Rousset D" first="Dominique" last="Rousset">Dominique Rousset</name>
<name sortKey="Van Der Werf, Sylvie" sort="Van Der Werf, Sylvie" uniqKey="Van Der Werf S" first="Sylvie" last="Van Der Werf">Sylvie Van Der Werf</name>
<name sortKey="Van Der Werf, Sylvie" sort="Van Der Werf, Sylvie" uniqKey="Van Der Werf S" first="Sylvie" last="Van Der Werf">Sylvie Van Der Werf</name>
<name sortKey="Van Der Werf, Sylvie" sort="Van Der Werf, Sylvie" uniqKey="Van Der Werf S" first="Sylvie" last="Van Der Werf">Sylvie Van Der Werf</name>
<name sortKey="Zoorob, Rima" sort="Zoorob, Rima" uniqKey="Zoorob R" first="Rima" last="Zoorob">Rima Zoorob</name>
<name sortKey="Zoorob, Rima" sort="Zoorob, Rima" uniqKey="Zoorob R" first="Rima" last="Zoorob">Rima Zoorob</name>
</country>
</tree>
</affiliations>
</record>

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Low Titers of Serum Antibodies Inhibiting Hemagglutination Predict Fatal Fulminant Influenza A(H1N1) 2009 Infection

Low Titers of Serum Antibodies Inhibiting Hemagglutination Predict Fatal Fulminant Influenza A(H1N1) 2009 Infection

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