RESUMEN

Background: A key component of strategies to reduce antimicrobial resistance is better antimicrobial prescribing. The majority of antibiotics are prescribed in primary care. While many existing surveillance systems can monitor trends in the quantities of antibiotics prescribed in this setting, it can be difficult to monitor the quality of prescribing as data on the condition for which prescriptions are issued are often not available. We devised a standardized methodology to facilitate the monitoring of condition-specific antibiotic prescribing in primary care. Methods: We used a large computerized general practitioner database to develop a standardized methodology for routine monitoring of antimicrobial prescribing linked to clinical indications in primary care in the UK. Outputs included prescribing rate by syndrome and percentages of consultations with antibiotic prescription, for recommended antibiotic, and of recommended treatment length. Results: The standardized methodology can monitor trends in proportions of common infections for which antibiotics were prescribed, the specific drugs prescribed and duration of treatment. These data can be used to help assess the appropriateness of antibiotic prescribing and to assess the impact of prescribing guidelines. Conclusions: We present a standardized methodology that could be applied to any suitable national or local database and adapted for use in other countries.

Asunto(s)

Antiinfecciosos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Programas de Monitoreo de Medicamentos Recetados , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Reino Unido , Adulto Joven

RESUMEN

OBJECTIVE: The burden of respiratory syncytial virus (RSV) illness is not well characterised in primary care. We estimated the burden of disease attributable to RSV in children in the UK between 1995 and 2009. DESIGN: Time-series regression modelling. SETTING: A multiple linear regression model based on weekly viral surveillance (RSV and influenza, Public Health England), and controlled for non-specific seasonal drivers of disease, estimated the proportion of general practitioner (GP) episodes of care (counted as first visit in a series within 28 days; Clinical Practice Research Datalink, CPRD), hospitalisations (Hospital Episode Statistics, HES) and deaths (Office of National Statistics, ONS) attributable to RSV each season. PARTICIPANTS: Children 0-17 years registered with a GP in CPRD, or with a respiratory disease outcome in the HES or ONS databases. PRIMARY OUTCOME MEASURES: RSV-attributable burden of GP episodes, hospitalisations and deaths due to respiratory disease by age. RSV-attributable burden associated with selected antibiotic prescriptions. RESULTS: RSV-attributable respiratory disease in the UK resulted in an estimated 450 158 GP episodes, 29 160 hospitalisations and 83 deaths per average season in children and adolescents, with the highest proportions in children <6 months of age (14 441/100 000 population, 4184/100 000 and 6/100 000, respectively). In an average season, there were an estimated 125 478 GP episodes for otitis media and 416 133 prescriptions for antibiotics attributable to RSV. More GP episodes, hospitalisations and deaths from respiratory disease were attributable to RSV than to influenza in children under 5 years. CONCLUSIONS: The burden of RSV in children in the UK exceeds that of influenza. RSV in children and adolescents contributes substantially to GP office visits for a diverse range of illnesses, and was associated with an average 416 133 prescribed antibiotic courses per season. Effective antiviral treatments and preventive vaccines are urgently needed for the management of RSV infection in children. TRIAL REGISTRATION NUMBER: NCT01706302.

Asunto(s)

Prescripciones de Medicamentos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Otitis Media/epidemiología , Infecciones por Virus Sincitial Respiratorio/epidemiología , Estaciones del Año , Adolescente , Distribución por Edad , Antibacterianos/uso terapéutico , Niño , Preescolar , Costo de Enfermedad , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Lineales , Masculino , Atención Primaria de Salud , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Reino Unido/epidemiología

RESUMEN

BACKGROUND: Influenza is rarely confirmed with laboratory testing and accurate assessment of the overall burden of influenza is difficult. We used statistical modelling methods to generate updated, granular estimates of the number/rate of influenza-attributable hospitalisations and deaths in the United Kingdom. Such data are needed on a continuing basis to inform on cost-benefit analyses of treatment interventions, including vaccination. METHODS: Weekly age specific data on hospital admissions (1997-2009) and on deaths (1997-2009) were obtained from national databases. Virology reports (1996-2009) of influenza and respiratory syncytial virus detections were provided by Public Health England. We used an expanded set of ICD-codes to estimate the burden of illness attributable to influenza which we refer to as 'respiratory disease broadly defined'. These codes were chosen to optimise the balance between sensitivity and specificity. A multiple linear regression model controlled for respiratory syncytial virus circulation, with stratification by age and the presence of comorbid risk status (conditions associated with severe influenza outcomes). RESULTS: In the United Kingdom there were 28,516 hospitalisations and 7163 deaths estimated to be attributable to influenza respiratory disease in a mean season, with marked variability between seasons. The highest incidence rates of influenza-attributable hospitalisations and deaths were observed in adults aged 75+ years (252/100,000 and 131/100,000 population, respectively). Influenza B hospitalisations were highest among 5-17 year olds (12/100,000 population). Of all estimated influenza respiratory deaths in 75+ year olds, 50 % occurred out of hospital, and 25 % in 50-64 year olds. Rates of hospitalisations and death due to influenza-attributable respiratory disease were increased in adults identified as at-risk. CONCLUSIONS: Our study points to a substantial but highly variable seasonal influenza burden in all age groups, particularly affecting 75+ year olds. Effective influenza prevention or early intervention with anti-viral treatment in this age group may substantially impact the disease burden and associated healthcare costs. The high burden of influenza B hospitalisation among 5-17 year olds supports current United Kingdom vaccine policy to extend quadrivalent seasonal influenza vaccination to this age group. TRIAL REGISTRATION: ClinicalTrial.gov, NCT01520935.

Asunto(s)

Causas de Muerte , Hospitalización , Gripe Humana/epidemiología , Virus Sincitial Respiratorio Humano , Vacunación , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Lactante , Recién Nacido , Vacunas contra la Influenza , Gripe Humana/mortalidad , Gripe Humana/prevención & control , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Estaciones del Año , Reino Unido/epidemiología , Adulto Joven

RESUMEN

BACKGROUND: Growing evidence suggests respiratory syncytial virus (RSV) is an important cause of respiratory disease in adults. However, the adult burden remains largely uncharacterized as most RSV studies focus on children, and population-based studies with laboratory-confirmation of infection are difficult to implement. Indirect modelling methods, long used for influenza, can further our understanding of RSV burden by circumventing some limitations of traditional surveillance studies that rely on direct linkage of individual-level exposure and outcome data. METHODS: Multiple linear time-series regression was used to estimate RSV burden in the United Kingdom (UK) between 1995 and 2009 among the total population and adults in terms of general practice (GP) episodes (counted as first consultation ≥28 days following any previous consultation for same diagnosis/diagnostic group), hospitalisations, and deaths for respiratory disease, using data from Public Health England weekly influenza/RSV surveillance, Clinical Practice Research Datalink, Hospital Episode Statistics, and Office of National Statistics. The main outcome considered all ICD-listed respiratory diseases and, for GP episodes, related symptoms. Estimates were adjusted for non-specific seasonal drivers of disease using secular cyclical terms and stratified by age and risk group (according to chronic conditions indicating severe influenza risk as per UK recommendations for influenza vaccination). Trial registration NCT01706302 . Registered 11 October 2012. RESULTS: Among adults aged 18+ years an estimated 487,247 GP episodes, 17,799 hospitalisations, and 8,482 deaths were attributable to RSV per average season. Of these, 175,070 GP episodes (36 %), 14,039 hospitalisations (79 %) and 7,915 deaths (93 %) were in persons aged 65+ years. High- versus low-risk elderly were two-fold more likely to have a RSV-related GP episode or death and four-fold more likely be hospitalised for RSV. In most seasons since 2001, more GP episodes, hospitalisations and deaths were attributable to RSV in adults than to influenza. CONCLUSION: RSV is associated with a substantial disease burden in adults comparable to influenza, with most of the hospitalisation and mortality burden in the elderly. Treatment options and measures to prevent RSV could have a major impact on the burden of RSV respiratory disease in adults, especially the elderly.

Asunto(s)

Infecciones por Virus Sincitial Respiratorio/epidemiología , Adolescente , Adulto , Anciano , Enfermedad Crónica , Bases de Datos Factuales , Femenino , Hospitalización , Humanos , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Modelos Lineales , Masculino , Persona de Mediana Edad , Infecciones por Virus Sincitial Respiratorio/mortalidad , Infecciones por Virus Sincitial Respiratorio/virología , Virus Sincitiales Respiratorios/aislamiento & purificación , Estaciones del Año , Reino Unido/epidemiología , Adulto Joven

RESUMEN

Influenza B represents a high proportion of influenza cases in some seasons (even over 50%). The Influenza B study in General Practice (IBGP) is a multicenter study providing information about the clinical, demographic and socio-economic characteristics of patients affected by lab-confirmed influenza A or B. Influenza B patients and age-matched influenza A patients were recruited within the sentinel surveillance networks of France and Turkey in 2010-11 and 2011-12 seasons. Data were collected for each patient at the swab test day, after 9±2 days and, if not recovered, after 28±5 days. It was related to patient's characteristics, symptoms at presentation, vaccination status, prescriptions of antibiotics and antivirals, duration of illness, follow-up consultations in general practice or emergency room. We performed descriptive analyses and developed a multiple regression model to investigate the effect of patients and disease characteristics on the duration of illness. Overall, 774 influenza cases were included in the study: 419 influenza B cases (209 in France and 210 in Turkey) and 355 influenza A cases (205 in France and 150 in Turkey). There were no differences between influenza A and B patients in terms of clinical presentation and number of consultations with a practitioner; however, the use of antivirals was higher among influenza B patients in both countries. The average (median) reported duration of illness in the age groups 0-14 years, 15-64 years and 65+ years was 7.4 (6), 8.7 (8) and 10.5 (9) days in France, and 6.3 (6), 8.2 (7) and 9.2 (6) days in Turkey; it increased with age but did not differ by virus type; increased duration of illness was associated with antibiotics prescription. In conclusion, our findings show that influenza B infection appears not to be milder disease than influenza A infection.

Asunto(s)

Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/diagnóstico , Gripe Humana/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Francia/epidemiología , Humanos , Lactante , Recién Nacido , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Vigilancia de Guardia , Factores de Tiempo , Turquía/epidemiología , Adulto Joven

RESUMEN

OBJECTIVES: To measure trends in antibiotic prescribing in UK primary care in relation to nationally recommended best practice. PATIENTS AND METHODS: A descriptive study linking individual patient data on diagnosis and prescription in a large primary care database, covering 537 UK general practices during 1995-2011. RESULTS: The proportion of cough/cold episodes for which antibiotics were prescribed decreased from 47% in 1995 to 36% in 1999, before increasing to 51% in 2011. There was marked variation by primary care practice in 2011 [10th-90th percentile range (TNPR) 32%-65%]. Antibiotic prescribing for sore throats fell from 77% in 1995 to 62% in 1999 and then stayed broadly stable (TNPR 45%-78%). Where antibiotics were prescribed for sore throat, recommended antibiotics were used in 69% of cases in 2011 (64% in 1995). The use of recommended short-course trimethoprim for urinary tract infection (UTI) in women aged 16-74 years increased from 8% in 1995 to 50% in 2011; however, a quarter of practices prescribed short courses in ≤16% of episodes in 2011. For otitis media, 85% of prescriptions were for recommended antibiotics in 2011, increasing from 77% in 1995. All these changes in annual prescribing were highly statistically significant (P < 0.001). CONCLUSIONS: The implementation of national guidelines in UK primary care has had mixed success, with prescribing for coughs/colds, both in total and as a proportion of consultations, now being greater than before recommendations were made to reduce it. Extensive variation by practice suggests that there is significant scope to improve prescribing, particularly for coughs/colds and for UTIs.

Asunto(s)

Antibacterianos/uso terapéutico , Prescripciones de Medicamentos/normas , Utilización de Medicamentos/normas , Atención Primaria de Salud/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Quimioterapia/normas , Femenino , Adhesión a Directriz , Política de Salud , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Reino Unido , Adulto Joven

RESUMEN

BACKGROUND: Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries. METHODS AND FINDINGS: We obtained weekly virology and underlying cause-of-death mortality time series for 2005-2009 for 20 countries covering ∼35% of the world population. We applied a multivariate linear regression model to estimate pandemic respiratory mortality in each collaborating country. We then used these results plus ten country indicators in a multiple imputation model to project the mortality burden in all world countries. Between 123,000 and 203,000 pandemic respiratory deaths were estimated globally for the last 9 mo of 2009. The majority (62%-85%) were attributed to persons under 65 y of age. We observed a striking regional heterogeneity, with almost 20-fold higher mortality in some countries in the Americas than in Europe. The model attributed 148,000-249,000 respiratory deaths to influenza in an average pre-pandemic season, with only 19% in persons <65 y. Limitations include lack of representation of low-income countries among single-country estimates and an inability to study subsequent pandemic waves (2010-2012). CONCLUSIONS: We estimate that 2009 global pandemic respiratory mortality was ∼10-fold higher than the World Health Organization's laboratory-confirmed mortality count. Although the pandemic mortality estimate was similar in magnitude to that of seasonal influenza, a marked shift toward mortality among persons <65 y of age occurred, so that many more life-years were lost. The burden varied greatly among countries, corroborating early reports of far greater pandemic severity in the Americas than in Australia, New Zealand, and Europe. A collaborative network to collect and analyze mortality and hospitalization surveillance data is needed to rapidly establish the severity of future pandemics. Please see later in the article for the Editors' Summary.

Asunto(s)

Causas de Muerte , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/mortalidad , Pandemias , Adolescente , Adulto , Distribución por Edad , Anciano , Américas/epidemiología , Australasia/epidemiología , Preescolar , Europa (Continente)/epidemiología , Femenino , Humanos , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Estaciones del Año , Organización Mundial de la Salud , Adulto Joven

RESUMEN

Both seasonal and pandemic influenza cause considerable morbidity and mortality globally. In addition, the ongoing threat of new, unpredictable influenza pandemics from emerging variant strains cannot be underestimated. Recently bioCSL (previously known as CSL Biotherapies) sponsored a symposium 'New Wisdom to Defy an Old Enemy' at the 4th Influenza Vaccines for the World Congress in Valencia, Spain. This symposium brought together a renowned faculty of experts to discuss lessons from past experience, novel influenza vaccine developments, and new methods to increase vaccine acceptance and coverage. Specific topics reviewed and discussed included new vaccine development efforts focused on improving efficacy via alternative administration routes, dose modifications, improved adjuvants, and the use of master donor viruses. Improved safety was also discussed, particularly the new finding of an excess of febrile reactions isolated to children who received the 2010 Southern Hemisphere (SH) trivalent inactivated influenza vaccine (TIV). Significant work has been done to both identify the cause and minimize the risk of febrile reactions in children. Other novel prophylactic and therapeutic advances were discussed including immunotherapy. Standard IVIg and hIVIg have been used in ferret studies and human case reports with promising results. New adjuvants, such as ISCOMATRIX™ adjuvant, were noted to provide single-dose, prolonged protection with seasonal vaccine after lethal H5N1 virus challenge in a ferret model of human influenza disease. The data suggest that adjuvanted seasonal influenza vaccines may provide broader protection than unadjuvanted vaccines. The use of an antigen-formulated vaccine to induce broad protection between pandemics that could bridge the gap between pandemic declaration and the production of a homologous vaccine was also discussed. Finally, despite the availability of effective vaccines, most current efforts to increase influenza vaccine coverage rates to higher levels (i.e., above 70-80%) have been ineffective in highly developed countries where the vaccine is used, hindered by the public's skepticism towards vaccines in general. New educational and social media methods to increase vaccine acceptance and coverage were discussed. While the first priority should be the development of improved influenza vaccines, a particular focus on the aging global population is critical. It is also important to draw lessons from other academic disciplines that can help to inform vaccine education programs, policy, and communication. By tailoring communications and patient education using an understanding of cognitive bias and the model of preferred cognitive styles, the likelihood of effecting desirable health decisions can be maximized, leading to improved vaccine coverage and control of influenza and other vaccine-preventable diseases.

Asunto(s)

Adyuvantes Inmunológicos/administración & dosificación , Inmunización Pasiva/métodos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Adyuvantes Inmunológicos/farmacología , Animales , Niño , Preescolar , Colesterol/administración & dosificación , Congresos como Asunto , Modelos Animales de Enfermedad , Combinación de Medicamentos , Hurones , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Subtipo H1N1 del Virus de la Influenza A , Subtipo H3N2 del Virus de la Influenza A , Subtipo H5N1 del Virus de la Influenza A , Influenza Pandémica, 1918-1919 , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/efectos adversos , Vacunas contra la Influenza/inmunología , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Gripe Humana/virología , Infecciones por Orthomyxoviridae/prevención & control , Pandemias , Aceptación de la Atención de Salud , Fosfolípidos/administración & dosificación , Saponinas/administración & dosificación , España , Vacunación/psicología , Vacunas de Productos Inactivados/efectos adversos

RESUMEN

We review experience in England of the swine flu pandemic between May 2009 and April 2010. The surveillance data from the Royal College of General Practitioners Weekly Returns Service and the linked virological data collected in the integrated program with the Health Protection Agency are used as a reference frame to consider issues emerging during the pandemic. Ten lessons are summarized. (1) Delay between illness onset in the first worldwide cases and virological diagnosis restricted opportunities for containment by regional prophylaxis. (2) Pandemic vaccines are unlikely to be available for effective prevention during the first wave of a pandemic. (3) Open, realistic and continuing communication with the public is important. (4) Surveillance programs should be continued through summer as well as winter. (5) Severity of illness should be incorporated in pandemic definition. (6) The reliability of diagnostic tests as used in routine clinical practice calls for further investigation. (7) Evidence from serological studies is not consistent with evidence based on health care requests made by sick persons and is thus of limited value in cost effectiveness studies. (8) Pregnancy is an important risk factor. (9) New strategies for administering vaccines need to be explored. (10) Acceptance by the public and by health professionals of influenza vaccination as the major plank on which the impact of influenza is controlled has still not been achieved.

Asunto(s)

Subtipo H1N1 del Virus de la Influenza A/inmunología , Gripe Humana/epidemiología , Pandemias/prevención & control , Características de la Residencia , Vigilancia de Guardia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/inmunología , Gripe Humana/prevención & control , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Embarazo , Factores de Riesgo , Vacunación , Adulto Joven

RESUMEN

Estimation of influenza vaccine effectiveness (VE) is complicated by various degrees of mismatch between circulating and vaccine strains each season. We carried out a cohort study to estimate VE of trivalent (TIV) and pandemic influenza vaccines (PIV) in preventing various respiratory outcomes among general practice (GP) patients in England and Wales between 2008 and 2010. Dates of consultations for influenza-like illness (ILI), acute respiratory tract infection (ARTI), lower respiratory tract infection (LRTI) and nasopharyngeal swabs were obtained from the patient-level electronic records of the 100 practices enrolled in a national GP network. Dates of vaccination with TIV and PIV were also extracted. Confounders including age, time period and consultation frequency were adjusted for through Poisson regression models. In the winter of 2008/9, adjusted VE of TIV in preventing ILI was 22.3% (95% CI 13.5%, 30.2%). During the 2009/10 winter VE for PIV in preventing ILI was 21.0% (5.3%, 34.0%). The VE for PIV in preventing PCR-confirmed influenza A/H1N1 (2009) was 63.7% (-6.1%, 87.6%). TIV during the period of influenza circulation of 2008/9 and PIV in the winter of 2009/10 were effective in preventing GP consultations for ILI. The cohort study design could be used each season to estimate VE; however, residual confounding by indication could still present issues, despite adjustment for propensity to consult.

Asunto(s)

Subtipo H1N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Pandemias , Infecciones del Sistema Respiratorio/epidemiología , Vacunación , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Medicina General , Humanos , Lactante , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/inmunología , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Nasofaringe/virología , Reacción en Cadena de la Polimerasa , Estaciones del Año , Gales/epidemiología

RESUMEN

BACKGROUND: In the northern hemisphere winter of 2003-04 antigenic variant strains (A/Fujian/411/02 -like) of influenza A H3N2 emerged. Circulation of these strains in the UK was accompanied by an unusually high number of laboratory confirmed influenza associated fatalities in children. This study was carried out to better understand risk factors associated with fatal cases of influenza in children. METHODOLOGY/PRINCIPAL FINDINGS: Case histories, autopsy reports and death registration certificates for seventeen fatal cases of laboratory confirmed influenza in children were analyzed. None had a recognized pre-existing risk factor for severe influenza and none had been vaccinated. Three cases had evidence of significant bacterial co-infection. Influenza strains recovered from fatal cases were antigenically similar to those circulating in the community. A comparison of protective antibody titres in age stratified cohort sera taken before and after winter 2003-04 showed that young children had the highest attack rate during this season (21% difference, 95% confidence interval from 0.09 to 0.33, p = 0.0009). Clinical incidences of influenza-like illness (ILI) in young age groups were shown to be highest only in the years when novel antigenic drift variants emerged. CONCLUSIONS/SIGNIFICANCE: This work presents a rare insight into fatal influenza H3N2 in healthy children. It confirms that circulating seasonal influenza A H3N2 strains can cause severe disease and death in children in the apparent absence of associated bacterial infection or predisposing risk factors. This adds to the body of evidence demonstrating the burden of severe illness due to seasonal influenza A in childhood.

Asunto(s)

Subtipo H3N2 del Virus de la Influenza A/metabolismo , Gripe Humana/mortalidad , Adolescente , Adulto , Anciano , Niño , Preescolar , Brotes de Enfermedades , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Subtipo H3N2 del Virus de la Influenza A/genética , Gripe Humana/epidemiología , Gripe Humana/inmunología , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Factores de Riesgo

Asunto(s)

Antivirales/farmacología , Subtipo H1N1 del Virus de la Influenza A/efectos de los fármacos , Gripe Humana/virología , Oseltamivir/farmacología , Animales , Planificación en Desastres , Brotes de Enfermedades , Farmacorresistencia Viral , Humanos , Subtipo H1N1 del Virus de la Influenza A/genética , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología

RESUMEN

Annual vaccination of all children 6-59 months of age is recommended in the United States but not in most of Europe. This paper reviews issues surrounding the epidemiology of influenza and vaccine effectiveness relevant to the determination of vaccination policy. Most clinical trials of vaccines (and treatments) that provide the evidence for current policy took place in the 1990s when rates of influenza-like illness (ILI) were twice those reported in recent years. The impact of influenza in the community is concealed by the variety of diagnoses appropriate to describing acute respiratory infections. Even in influenza virus active periods diagnoses of coryza, acute bronchitis, and otitis media made by general practitioners greatly exceed those of ILI. Respiratory syncytial virus presents particular problems because it often circulates at the same time as influenza. Thus, the diagnostic uncertainty and variety of respiratory pathogens causing similar illnesses are major confounders when estimating influenza vaccine effectiveness. Although meta-analyses have cast doubt on the wisdom of the universal vaccination of children, high-quality clinical trials have demonstrated efficacy against laboratory-confirmed infection. The distinction between this positive benefit and the wider issue of effectiveness against ILI in the community poses difficulties for determining policy. Mathematical models examining this issue are populated with data that are mostly estimated: therefore, the sensitivity analysis is critical and the conclusions are invariably accompanied by reservations. National policies based on demonstrated cost effectiveness are desirable, but these should not become a barrier to parents wishing to secure a benefit for their child or family, provided there is clear evidence of clinical efficacy.

Asunto(s)

Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Vacunación , Adolescente , Adulto , Anciano , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad

Asunto(s)

Medicina Familiar y Comunitaria , Morbilidad , Sistema de Registros , Humanos , Países Bajos , Clase Social

Asunto(s)

Resfriado Común/epidemiología , Resfriado Común/virología , Otitis Media/epidemiología , Otitis Media/virología , Adolescente , Niño , Preescolar , Resfriado Común/complicaciones , Inglaterra/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Estaciones del Año

RESUMEN

Respiratory infections are one of the leading causes of morbidity and mortality worldwide: influenza and respiratory syncytial virus (RSV) are the predominant pathogens responsible. Annual vaccination and the use of antiviral drugs provides both protection and treatment against influenza, particularly protecting those patients most at risk, including the elderly and individuals with chronic comorbidities. Currently, there are extremely limited options in the protection against RSV infection, making those at-risk patients vulnerable to serious disease, complications and death. This review focuses on recent trends in respiratory illness in the elderly, particularly focusing on the burden of influenza and RSV on hospitalizations and mortality. We discuss the potential benefit of influenza vaccination on these outcomes, including the recent controversial debate over the effectiveness of influenza vaccination.

Asunto(s)

Vacunas contra la Influenza , Gripe Humana/epidemiología , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Anciano , Femenino , Hospitalización , Humanos , Incidencia , Virus de la Influenza A , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/inmunología , Gripe Humana/mortalidad , Gripe Humana/prevención & control , Gripe Humana/virología , Masculino , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/mortalidad , Virus Sincitiales Respiratorios , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/mortalidad , Infecciones del Sistema Respiratorio/virología , Resultado del Tratamiento

RESUMEN

BACKGROUND: Hospitals experience winter surges in admissions due to respiratory infections. The roles of acute bronchitis and influenza-like illness (ILI) in the timing and severity of these surges are examined over the years 1990-91 to 2004-05. METHODS: Respiratory admissions of persons aged > or =65 years in England and Wales were analysed in relation to patients with ILI or acute bronchitis diagnosed by community-based general practitioners from a sentinel surveillance network. RESULTS: Acute bronchitis and ILI accounted for 46 and 7% of the variation in respiratory admissions, respectively: when admissions were lagged by 1 week, these estimates were 20 and 14%, respectively. Admissions peaked in weeks 52, 01 or 02 (late December to early January) in 14 of the 15 winters. Acute bronchitis peaked during weeks 01 or 02; ILI exhibited greater variability and peaks ranged from weeks 46 (mid-November) to 07 (mid-February). During winters where acute bronchitis and ILI peaked concurrently, surges on hospitals were most severe. CONCLUSIONS: During each winter acute bronchitis provides a consistent and major contribution to the winter admissions surge in the elderly. The variable incidence of ILI can increase the surge in admissions, especially when ILI and acute bronchitis peak together.

Asunto(s)

Infecciones del Sistema Respiratorio/epidemiología , Estaciones del Año , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Bronquitis/epidemiología , Inglaterra/epidemiología , Estudios Epidemiológicos , Femenino , Humanos , Incidencia , Masculino , Médicos de Familia , Virus Sincitiales Respiratorios , Vigilancia de Guardia , Factores de Tiempo , Gales/epidemiología

RESUMEN

This article summarizes personal reflections from the perspective of general practice on developments with regard to antibiotic resistance and the containment of antibiotic prescribing during the lifetime of the Specialist Advisory Committee on Antimicrobial Resistance in England. These reflections concern the entry of antibiotics into the food chain, recent extensions of prescribing responsibilities and developments towards improved surveillance and reduced antibiotic prescribing. A large gap remains between the scientific appreciation of the risks from antimicrobial resistance and effective means to measure it and thereby hopefully control it.

Asunto(s)

Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Utilización de Medicamentos/normas , Medicina Familiar y Comunitaria , Humanos , Reino Unido

RESUMEN

BACKGROUND: Reductions in the number of dispensed antibiotics and the incidence of respiratory infections presented to GPs and have been reported. Whether this trend applies to skin infections requires further investigation. AIM: To examine trends in the incidence of skin infections in relation to trends in dispensed prescriptions for flucloxacillin, topical fusidic acid, mupirocin, and corticosteroids with fusidic acid. DESIGN OF STUDY: Population-based analysis of patients presenting to GPs (1999-2005) contrasted with national prescribing data. SETTING: A sentinel practice network covering a population of 700,000 in England and Wales. METHOD: Quarterly incidence rates of skin infections and of impetigo reported over the years 1999-2005 were compared with quarterly data on dispensed prescriptions reported by the Prescription Pricing Authority for England. RESULTS: In children (aged 0-14 years) the incidence of skin infections decreased slightly between 1999 and 2003 and more sharply from 2004 to 2005. In adults (aged > or =15 years) incidence was reasonably constant from year to year. In every year examined, and in both age groups, there were autumnal incidence peaks. There were annual increases in dispensed prescriptions for flucloxacillin capsules, but there was little change in the use of flucloxacillin syrups and topical antibiotic prescriptions. All prescribing data sets showed increases in the third quarter: topical corticosteroids with fusidic acid were prescribed more frequently in summer than winter. CONCLUSION: In spite of slight reductions in the incidence of skin infections, flucloxacillin capsule-dispensed prescriptions have increased, suggesting that doctors have not limited their antibiotic prescribing behaviour for skin conditions.

Asunto(s)

Antibacterianos/uso terapéutico , Pautas de la Práctica en Medicina , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Preescolar , Inglaterra/epidemiología , Medicina Familiar y Comunitaria , Humanos , Incidencia , Lactante , Recién Nacido , Persona de Mediana Edad , Enfermedades Cutáneas Bacterianas/epidemiología , Gales/epidemiología

Asunto(s)

Infestaciones por Piojos/epidemiología , Adolescente , Animales , Niño , Preescolar , Inglaterra/epidemiología , Humanos , Incidencia , Prevalencia , Gales/epidemiología