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Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infección respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.
Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 20192022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.
Assuntos
Humanos , Pré-Escolar , Criança , Infecções Respiratórias/epidemiologia , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , Argentina/epidemiologia , Estudos Retrospectivos , Pandemias , Hospitalização , HospitaisRESUMO
Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019-2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.
Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infeccción respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.
Assuntos
COVID-19 , Influenza Humana , Infecções Respiratórias , Criança , Humanos , Lactente , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Estudos Retrospectivos , Argentina/epidemiologia , Pandemias , COVID-19/diagnóstico , COVID-19/epidemiologia , Hospitalização , Infecções Respiratórias/epidemiologia , HospitaisRESUMO
Abstract: The influenza-like illness (ILI) sentinel surveillance operates in Brazil to identify respiratory viruses of public health relevance circulating in the country and was first implemented in 2000. Recently, the COVID-19 pandemic reinforced the importance of early detection of the circulation of new viruses in Brazil. Therefore, an analysis of the design of the ILI sentinel surveillance is timely. To this end, we simulated a sentinel surveillance network, identifying the municipalities that would be part of the network according to the criteria defined in the design of the ILI sentinel surveillance and, based on data from tested cases of severe acute respiratory illness (SARI) from 2014 to 2019, we drew samples for each sentinel municipality per epidemiological week. The draw was performed 1,000 times, obtaining the median and 95% quantile interval (95%QI) of virus positivity by Federative Unit and epidemiological week. According to the ILI sentinel surveillance design criteria, sentinel units would be in 64 municipalities, distributed mainly in capitals and their metropolitan areas, recommending 690 weekly samples. The design showed good sensitivity (91.65% considering the 95%QI) for qualitatively detecting respiratory viruses, even those with low circulation. However, there was important uncertainty in the quantitative estimate of positivity, reaching at least 20% in 11.34% of estimates. The results presented here aim to assist in evaluating and updating the ILI sentinel surveillance design. Strategies to reduce uncertainty in positivity estimates need to be evaluated, as does the need for greater spatial coverage.
Resumen: La vigilancia centinela de la enfermedad tipo infuenza (ETI) funciona en Brasil para identificar los virus respiratorios de importancia para la salud pública que circulan en el país y comenzó a ser implementada en 2000. Recientemente, la pandemia de COVID-19 ha reforzado la importancia de la detección temprana de la circulación de nuevos virus en el territorio brasileño. Así, se hace oportuno un análisis del diseño de la vigilancia centinela de la ETI. Para ello, simulamos una red centinela identificando los municipios que formarían parte de la red según los criterios definidos en el diseño de la vigilancia centinela de la ETI y, a partir de los datos de casos testados de infección respiratoria aguda grave (IRAG) de 2014 a 2019, se extrajeron muestras para cada municipio centinela por semana epidemiológica. El sorteo se repitió 1.000 veces y se obtuvo la mediana y el intervalo cuantílico del 95% (IC95%) de la positividad por virus, por Unidad Federativa y semana epidemiológica. Según los criterios del diseño de la vigilancia centinela de la ETI, unidades centinelas estarían en 64 municipios, distribuidas principalmente en capitales y zonas metropolitanas de las capitales, preconizando 690 muestras semanales. El diseño presentó una buena sensibilidad (total de 91,65% considerando el IC95%) para la detección cualitativa de los virus respiratorios, incluso los de baja circulación. Sin embargo, hubo una importante incertidumbre en la estimación cuantitativa de la positividad, alcanzando al menos el 20% en el 11,34% de las estimaciones. Los resultados presentados aquí tienen como objetivo ayudar en la evaluación y actualización del diseño de la red centinela. Es necesario evaluar las estrategias para reducir la incertidumbre en las estimaciones de positividad, al igual que la necesidad de una mayor cobertura espacial.
Resumo: A vigilância sentinela de síndrome gripal atua no Brasil identificando os vírus respiratórios de importância para a saúde pública circulantes no país, e começou a ser implementada em 2000. Recentemente, a pandemia de COVID-19 reforçou a importância da detecção precoce de novos vírus em circulação no território brasileiro. Assim, se faz oportuna uma análise do desenho da vigilância sentinela de síndrome gripal. Para tal, simulamos uma rede sentinela, identificando os municípios que fariam parte da rede segundo os critérios definidos no desenho da vigilância sentinela de síndrome gripal, e, a partir dos dados de casos testados de síndrome respiratória aguda grave (SRAG) de 2014 a 2019, sorteamos amostras para cada município sentinela por semana epidemiológica. O sorteio foi repetido mil vezes, obtendo-se a mediana e intervalo quantílico de 95% (IQ95%) da positividade para cada vírus por Unidade Federativa e semana epidemiológica. Segundo os critérios do desenho da vigilância sentinela de síndrome gripal, unidades sentinelas estariam em 64 municípios, distribuídas principalmente em capitais e suas zonas metropolitanas, o que preconizou 690 amostras semanais. O desenho apresentou boa sensibilidade (total de 91,65%, considerando o IQ95%) para a detecção qualitativa dos vírus respiratórios, mesmo os de baixa circulação. Porém, houve importante incerteza na estimativa quantitativa de positividade, chegando a, pelo menos, 20% em 11,34% das estimativas. Os resultados aqui apresentados visam auxiliar a avaliação e a atualização do desenho da rede sentinela. Estratégias para reduzir a incerteza nas estimativas de positividade precisam ser avaliadas, assim como a necessidade de maior cobertura espacial.
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OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.
Assuntos
Infecções Bacterianas , Coinfecção , Vacinas contra Influenza , Influenza Humana , Infecções Bacterianas/complicações , Infecções Bacterianas/epidemiologia , Estudos de Coortes , Coinfecção/epidemiologia , Feminino , Humanos , Vacinas contra Influenza/efeitos adversos , Influenza Humana/complicações , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Unidades de Terapia Intensiva , Masculino , Estudos Prospectivos , Fatores de RiscoRESUMO
Influenza is a severe, vaccine-preventable disease. Vaccination programs across Latin American countries show contrasting coverage rates, from 29% in Paraguay to 89% in Brazil. This study explores how national influenza vaccination programs in the chosen South American countries address vaccine confidence and convenience, as well as complacency toward the disease. Barriers and facilitators to influenza vaccination programs in their relation to vaccine hesitancy were observed by documentary analysis and interviews with 38 national immunization program officers in high- (Brazil and Chile) and low-performing (Paraguay, Peru, and Uruguay) countries. Influenza vaccination policies, financing, purchasing, coordination, and accessibility are considered good or acceptable. National communication strategies focus on vaccine availability during campaigns. In Chile, Paraguay, and Uruguay, anti-vaccine propaganda was mentioned as a problem. Programming and implementation face human resource shortages across most countries. Statistical information, health information systems, and nominal risk-group records are available, with limitations in Peru and Paraguay. Health promotion, supervision, monitoring, and evaluation are perceived as opportunities to address confidence and complacency. Influenza vaccination programs identify and act on most barriers and facilitators affecting influenza vaccine hesitancy via supply-side strategies which mostly address vaccine convenience. Confidence and complacency are insufficiently addressed, except for Uruguay. Programs have the opportunity to develop integral supply and demand-side approaches.
La gripe es una enfermedad grave, prevenible mediante vacunas con sus correspondientes programas en países latinoamericanos, informando sobre tasas contrastadas de cobertura, desde el 29% en Paraguay al 89% en Brasil. Este artículo investiga cómo los programas nacionales contra la gripe en países seleccionados de Suramérica abordan la confianza en la vacuna y su conveniencia, así como también la complacencia hacia la enfermedad. Las barreras y facilitadores del programa de vacunación de la gripe, en su relación con la vacilación hacia la vacuna, se observaron mediante análisis documental y entrevistas a 38 a cargo de los programas nacionales de inmunización en países con alto (Brasil y Chile) y bajo desempeño (Paraguay, Perú y Uruguay). Políticas de vacunación contra la gripe, financiamiento, compras coordinación y accesibilidad fueron consideradas como buenas o aceptables. Las estrategias nacionales de comunicación se centran en la disponibilidad de la vacuna durante las campañas. En Chile, Paraguay y Uruguay la propaganda antivacunas fue mencionada como un problema. La planificación e implementación enfrentan escasez de recursos humanos en la mayoría de países a través de la mayoría de países. Los sistemas de información en salud, estadísticas y registros nominales por grupos de riesgo se encuentran disponibles con limitaciones en Perú y Paraguay. La promoción de la salud, supervisión, monitoreo y evaluación son percibidos como oportunidades para abordar la confianza y complacencia. Los programas de vacunación contra la gripe actúan principalmente sobre las barreras y facilitadores que afectan la vacilación a vacunarse mediante estrategias del lado de la demanda, las cuales en su mayor parte van dirigidas a contrarestar la conveniencia. La confianza y complacencia son insuficientemente abordadas en todos los países, excepto en Uruguay. Los programas tienen la oportunidad de desarrollar estrategias que aborden tanto el lado de la oferta como de la demanda.
A influenza é uma doença grave, imunoprevenível, para a qual os programas de vacinação nos países latino-americanos apresentam taxas de cobertura contrastantes, desde 29% no Paraguai até 89% no Brasil. O artigo explora de que maneira os programas nacionais de influenza em países selecionados da América do Sul lidam com a confiança e a conveniência da vacina, assim como, a acomodação em relação à doença. As barreiras e facilitadores dos programas de vacinação contra influenza foram observados em relação à hesitação vacinal, através de análise documental e entrevistas com 38 autoridades de programas nacionais de imunização em países com desempenho alto (Brasil e Chile) e baixo (Paraguai, Peru e Uruguai). As políticas de vacinação contra influenza, financiamento da compra de vacinas, coordenação e acessibilidade são consideradas boas ou aceitáveis. As estratégias nacionais de comunicação estão concentradas na disponibilidade durante campanhas. No Chile, Paraguai e Uruguay, a propaganda antivacina foi mencionada enquanto problema. A programação e a implementação enfrentam escassez de recursos humanos na maioria dos países. Dados estatísticos, sistemas de informação em saúde e registros nominais de grupos de risco estão disponíveis, com limitações no Peru e no Paraguai. A promoção da saúde, supervisão, monitoramento e avaliação foram percebidas como oportunidades para tratar da confiança e da acomodação. Os programas de vacinação contra influenza identificam e agem sobre a maioria das barreiras e facilitadores que afetam a hesitação vacinal através de estratégias do lado da oferta, tratando principalmente da conveniência da vacina. A confiança e a acomodação não são tratadas de maneira suficiente, com exceção notável do Uruguai. Os programas têm a oportunidade de desenvolver abordagens que integram os lados da oferta e da procura.
Assuntos
Humanos , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Brasil , Vacinação , Programas de ImunizaçãoRESUMO
OBJECTIVE: To determine whether the prior usage of the flu vaccine is a risk factor for bacterial co-infection in patients with severe influenza. DESIGN: This was a retrospective observational cohort study of subjects admitted to the ICU. A propensity score matching, and logistic regression adjusted for potential confounders were carried out to evaluate the association between prior influenza vaccination and bacterial co-infection. SETTINGS: 184 ICUs in Spain due to severe influenza. PATIENTS: Patients included in the Spanish prospective flu registry. INTERVENTIONS: Flu vaccine prior to the hospital admission. RESULTS: A total of 4175 subjects were included in the study. 489 (11.7%) received the flu vaccine prior to develop influenza infection. Prior vaccinated patients were older 71 [61-78], and predominantly male 65.4%, with at least one comorbid condition 88.5%. Prior vaccination was not associated with bacterial co-infection in the logistic regression model (OR: 1.017; 95%CI 0.803-1.288; p=0.885). After matching, the average treatment effect of prior influenza vaccine on bacterial co-infection was not statistically significant when assessed by propensity score matching (p=0.87), nearest neighbor matching (p=0.59) and inverse probability weighting (p=0.99). CONCLUSIONS: No association was identified between prior influenza vaccine and bacterial coinfection in patients admitted to the ICU due to severe influenza. Post influenza vaccination studies are necessary to continue evaluating the possible benefits.
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Resumen Desde 1982, cada año el Departamento de Inmunizaciones del Ministerio de Salud de Chile lleva a cabo la campaña de vacunación contra influenza junto con las Secretarías Regionales Ministeriales-SEREMI, Servicios de Salud y centros de atención primaria de salud. Con los objetivos de prevenir mortalidad y morbilidad grave en grupos de mayor riesgo y de preservar la integridad de los servicios de salud, hasta el 2020 las campañas de vacunación contra influenza serían las más grandes implementadas en Chile, para dar paso, el 2021, a la vacunación contra SARS-CoV-2. Obedeciendo a cambios demográficos y epidemiológicos locales y acogiendo los avances científicos sobre seguridad e inmunogenicidad de la vacuna, el incremento de las vacunas influenza disponibles en Chile forma parte de la planificación anual de la campaña. El 2020, sin embargo, la Campaña Influenza tuvo que ser re-planificada en curso como consecuencia de la incorporación de nuevos grupos a vacunar según dispuso la modificación de la alerta sanitaria por brote de SARS-CoV-2 del 6 de marzo de 2020. Así, de 6.799.800 de dosis, el Departamento de Inmunizaciones logró en menos de dos meses aumentar la disponibilidad a 8.480.325, y cumplir con el compromiso de garantizar el acceso de los grupos de riesgo al beneficio de la vacunación estatal gratuita.
Abstract In Chile, the Immunization Department of the Ministry of Health has carried out the seasonal influenza vaccination campaign annually since 1982 in collaboration with the national health services, regional health offices, and primary health care centres. With the aim of preventing deaths and serious morbidity in high-risk groups and preserving the integrity of health services, the seasonal influenza campaign had been the largest implemented in Chile until 2020, since in 2021 the vaccination campaign against SARS-CoV-2 is expected to become the largest ever implemented. In response to local demographic and epidemiological changes, and taking into account the new scientific evidence on the safety and immunogenicity of vaccines, the influenza vaccines available in Chile would increase annually as a result of campaign planning. In 2020, the influenza campaign had to be re-planned while in progress due to the addition of new high-risk groups to be vaccinated in accordance with the SARS-CoV-2 pandemic health alert modification of March 6th, 2020. Over the course of three weeks, the Immunization Department managed to increase the doses of available influenza vaccines from 6,799,800 previously agreed upon to 8,480,325 and thus serve high-risk groups, guaranteeing their access to state funded influenza vaccination.
Assuntos
Humanos , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Influenza Humana/epidemiologia , COVID-19 , Estações do Ano , Chile/epidemiologia , Saúde Pública , Vacinação em Massa , Programas de Imunização , Cobertura Vacinal , Pandemias , SARS-CoV-2RESUMO
OBJECTIVE: To test the hypotheses that emerging viruses are associated with neurological hospitalizations and that statistical models can be used to predict neurological sequelae from viral infections. METHODS: An ecological study was carried out to observe time trends in the number of hospitalizations with inflammatory polyneuropathy and Guillain-Barré syndrome (GBS) in the state of Rio de Janeiro from 1997 to 2017. Increases in GBS from month to month were assessed using a Farrington test. In addition, a cross-sectional study was conducted analyzing 50 adults hospitalized for inflammatory polyneuropathies from 2015 to 2017. The extent to which Zika virus symptoms explained GBS hospitalizations was evaluated using a calibration test. RESULTS: There were significant increases (Farrington test, P<0.001) in the incidence of GBS following the introduction of influenza A/H1N1 in 2009, dengue virus type 4 in 2013, and Zika virus in 2015. Of 50 patients hospitalized, 14 (28.0%) were diagnosed with arboviruses, 9 (18.0%) with other viruses, and the remainder with other causes of such neuropathies. Statistical models based on cases of emerging viruses accurately predicted neurological sequelae, such as GBS. CONCLUSION: The introduction of novel viruses increases the incidence of inflammatory neuropathies.
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Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/epidemiologia , Adulto , Doenças Autoimunes do Sistema Nervoso/virologia , Brasil/epidemiologia , Estudos Transversais , Monitoramento Epidemiológico , Feminino , Síndrome de Guillain-Barré/virologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Zika virus/imunologia , Infecção por Zika virus/virologiaRESUMO
O presente estudo tem o objetivo de descrever os pacientes hospitalizados por síndrome respiratória aguda grave (SRAG) em decorrência da COVID-19 (SRAG-COVID), no Brasil, quanto às suas características demográficas e comorbidades até a 21ª Semana Epidemiológica de 2020. Buscou-se comparar essas características com as dos hospitalizados por SRAG em decorrência da influenza em 2019/2020 (SRAG-FLU) e com a população geral brasileira. As frequências relativas das características demográficas, comorbidades e de gestantes/puérperas entre os pacientes hospitalizados por SRAG-COVID e SRAG-FLU foram obtidas por meio do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe), e as estimativas para a população geral brasileira foram obtidas por meio de projeções populacionais realizadas pelo Instituto Brasileiro de Geografia e Estatística, dados do Sistema de Informações sobre Nascidos Vivos e de pesquisas de âmbito nacional. Entre os hospitalizados por SRAG-COVID, observou-se uma elevada proporção, em relação ao perfil da população geral brasileira, de indivíduos do sexo masculino, idosos ou com 40 a 59 anos, com comorbidades (diabetes mellitus, doença cardiovascular, doença renal crônica e pneumopatias crônicas) e de gestantes/puérperas. Já entre os hospitalizados por SRAG-FLU, observou-se prevalências superiores às populacionais de indivíduos de 0 a 4 anos de idade ou idosos, de raça ou cor branca, com comorbidades (diabetes mellitus, doença renal crônica, asma e outras pneumopatias crônicas) e de gestantes/puérperas. Esses grupos podem estar evoluindo para casos mais graves da doença, de forma que estudos longitudinais na área são de extrema relevância para investigar esta hipótese e melhor subsidiar políticas públicas de saúde.
El objetivo del presente estudio es describir a los pacientes hospitalizados por infección respiratoria aguda grave (IRAG) a consecuencia de la COVID-19 (IRAG-COVID), en Brasil, respecto a sus características demográficas y comorbilidades hasta la 21ª Semana Epidemiológica de 2020. Se buscó comparar estas características con las de los hospitalizados por SRAS, a consecuencia de la influenza en 2019/2020 (IRAG-FLU) y con la población general brasileña. Las frecuencias relativas de las características demográficas, comorbilidades y de embarazadas/puérperas entre los pacientes hospitalizados por IRAG-COVID y IRAG-FLU se obtuvieron mediante el Sistema de Información de la Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe), y las estimaciones para la población general brasileña se consiguieron mediante proyecciones poblacionales realizadas por el Instituto Brasileño de Geografía e Estadística, datos del Sistema de Informaciones sobre Nascidos Vivos y de investigaciones de ámbito nacional. Entre los hospitalizados por IRAG-COVID, se observó una elevada proporción, respecto al perfil de la población general brasileña, de individuos del sexo masculino, ancianos o con 40 a 59 años, con comorbilidades (diabetes mellitus, enfermedad cardiovascular, enfermedad renal crónica y neumopatías crónicas) y de embarazadas/puérperas. Ya entre los hospitalizados por IRAG-FLU, se observaron prevalencias superiores a las poblacionales de individuos de 0 a 4 años de edad o ancianos, de raza o color blanco, con comorbilidades (diabetes mellitus, enfermedad renal crónica, asma y otras neumopatías crónicas) y de embarazadas/puérperas. Estos grupos pueden estar evolucionando hacia casos más graves de la enfermedad, por ello, los estudios longitudinales en esta área son de extrema relevancia para investigar esta hipótesis y apoyar mejor las políticas públicas de salud.
The study aims to describe patients hospitalized for severe acute respiratory illness (SARI) due to COVID-19 (SARI-COVID) in Brazil according to demographic characteristics and comorbidities up to the 21st Epidemiological Week of 2020. The study aimed to compare these characteristics with those of patients hospitalized for SARI due to influenza in 2019/2020 (SARI-FLU) and with the Brazilian general population. The proportions of demographic characteristics, comorbidities, and pregnant and postpartum women among patients hospitalized for SARI-COVID and SARI-FLU were obtained from the SIVEP-Gripe database, and the estimates for the Brazilian population were obtained from the population projections performed by Brazilian Institute of Geography and Statistics, Information System on Live Birth data, and nationwide surveys. Compared to the Brazilian population, patients hospitalized for SARI-COVID showed a higher proportion of males, elderly individuals and those aged 40 to 59 years, comorbidities (diabetes mellitus, cardiovascular disease, chronic kidney disease, and chronic lung diseases), and pregnant/postpartum women. Compared to the general population, Brazilians hospitalized for SARI-FLU showed higher prevalence rates of ages 0 to 4 years or over 60 years, white race/color, comorbidities (diabetes, chronic kidney disease, asthma, and other chronic lung diseases), and pregnant/postpartum women. The data suggest that these groups are evolving to more serious forms of the disease, so that longitudinal studies are extremely relevant for investigating this hypothesis and supporting appropriate public health policies.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Idoso , Adulto Jovem , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/virologia , Influenza Humana/epidemiologia , Pneumonia Viral/complicações , Brasil/epidemiologia , Comorbidade , Demografia , Prevalência , Infecções por Coronavirus/complicações , Síndrome Respiratória Aguda Grave/epidemiologia , Influenza Humana/complicações , Pandemias , Betacoronavirus , SARS-CoV-2 , COVID-19 , Hospitalização , Pessoa de Meia-IdadeRESUMO
Resumo: A dificuldade de alcançar coberturas ideais para a vacina contra influenza no Brasil e a crescente onda do movimento antivacina no mundo apontam a necessidade de aprofundar a compreensão dos determinantes individuais de adesão a essa vacina. O Modelo de Crenças em Saúde, um modelo teórico que objetiva explicar e predizer o comportamento em relação à saúde, sugere que crenças individuais influenciam a adoção de comportamentos relacionados a essa área. Este trabalho teve como objetivo a adaptação transcultural de um instrumento para avaliar os preditores de aceitação da vacina da influenza em adultos no Brasil. Realizaram-se a tradução, a retrotradução, a validade de face e um inquérito para validade de construto. Também foram analisados os fatores associados à adesão à vacina da influenza em 2017. Um instrumento, originalmente com sete domínios, foi identificado e selecionado. Na análise fatorial, quatro dos sete construtos do modelo teórico foram validados: Suscetibilidade, Barreiras, Estímulos para a ação e Motivação para a saúde. No inquérito das 396 pessoas, 59,3% relataram vacinação contra influenza na última campanha de 2017. Sexo feminino, idade > 50 anos, gestante, vacina na rede privada, vacinação contra a hepatite B e influenza antes de 2017 mostraram-se como fatores associados à vacinação em 2017. No modelo logístico final, a percepção de Barreiras apresentou-se como um forte Estímulo para não vacinação, ao passo que Estímulos para a ação atuou aumentando a chance de vacinação.
Resumen: La dificultad de alcanzar coberturas ideales para la vacuna contra la gripe en Brasil y la creciente ola del movimiento antivacunas en el mundo apunta la necesidad de profundizar la comprensión de los determinantes individuales de adhesión a esa vacuna. El Modelo de Creencias en Salud, un modelo teórico que tiene como objetivo explicar y predecir el comportamiento en relación con la salud, sugiere que las creencias individuales influencian la adopción de comportamientos relacionados con esa área. El objetivo de este trabajo es la adaptación transcultural de un instrumento para evaluar los predictores de aceptación de la vacuna de la gripe en adultos en Brasil. Se realizó la traducción, retrotraducción, validez de la presentación, así como una encuesta para la validez del constructo. También se analizaron los factores asociados con la adhesión a la vacuna de la gripe en 2017. Un instrumento, originalmente con siete dominios, fue identificado y seleccionado. En el análisis factorial, cuatro de los siete constructos del modelo teórico fueron evaluados: Susceptibilidad, Barreras, Estímulos para la acción y Motivación para la salud. En el cuestionario a las 396 personas, 59,3% informaron haber sido vacunadas contra la gripe en la última campaña de 2017. Sexo femenino, edad > 50 años, embarazada, vacunada en la red privada, vacunación contra la hepatitis B y gripe antes de 2017 se mostraron como factores asociados a la vacunación en 2017. En el modelo logístico final, la percepción de Barreras se presentó como un fuerte Estímulo para la no vacunación, al paso que Estímulos para la acción actuó aumentando la oportunidad de vacunación.
Abstract: The difficulty in achieving ideal coverage rates with the influenza vaccine in Brazil and the growing wave of antivaccine movements in the world point to the need for a more in-depth understanding of the individual determinants of to this vaccine uptake. The Health Belief Model, a theoretical model that aims to explain and predict health-related behaviors, suggests that individual beliefs influence the adoption of health-related behaviors. The objective of this study was a cross-cultural adaptation of an instrument to assess predictors of influenza vaccine uptake in Brazilian adults. The authors conducted translation, back-translation, face validity, and a survey for construct validity. They also analyzed the factors associated with influenza vaccine uptake in 2017. An instrument originally with seven domains was identified and selected. In the factor analysis, four of the model's seven constructs were validated: Susceptibility, Barriers, Cues to action, and Self-efficacy. In the survey with 396 persons, 59.3% reported having received the influenza vaccine in the last campaign in 2017. Female sex, age > 50 years, pregnancy, vaccination in private healthcare services, hepatitis B vaccination, and influenza vaccination prior to 2017 were associated with vaccination in 2017. In the final logistic regression model, perceived Barriers appeared as a strong factor for non-vaccination, while Cues to action increased the odds of vaccination.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Portugal , Brasil , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Inquéritos e Questionários , Vacinação , Pessoa de Meia-IdadeRESUMO
Resumo A Síndrome Respiratória Aguda Grave (SRAG) deve ser notificada e investigada. O objetivo do estudo foi analisar o perfil epidemiológico e fatores associados à internação e óbitos por SRAG notificados em Goiás. Estudo de coorte retrospectiva, com dados das fichas de investigação do Sistema de Informação de Agravos de Notificação Influenza Web. Métodos de análise multivariada foram realizados para verificar a associação entre variáveis de exposição com os desfechos internação em UTI e óbito. Entre 2013 e 2018 foram notificados 4.832 casos de SRAG em Goiás. O principal diagnóstico etiológico foi influenza A (22,3%) com o subtipo A (H1N1pdm09) predominante, seguido pelo Vírus Sincicial Respiratório. 34,6% dos pacientes necessitaram de internação em UTI e 19% evoluíram para o óbito. Maior tempo de início do tratamento com antiviral foi associado à maior chance de internação em UTI, enquanto a não vacinação prévia contra a influenza, maior tempo para início do antiviral e idade mais avançada foram associados à maior chance de óbito. O estudo mostrou uma elevada frequência de doenças respiratórias provocadas pelo vírus Influenza no estado de Goiás e que a gravidade da síndrome, caracterizada pela internação em UTI e óbitos, está associada com o tempo de início do tratamento com o antiviral, o status vacinal e a idade do paciente.
Abstract Severe Acute Respiratory Infection (SARI) is a notifiable syndrome that must be investigated. This study aimed to analyze the epidemiological profile and factors associated with SARI-related hospitalization and deaths reported in Goiás. Retrospective cohort study, with data from the investigation files of the Notifiable Diseases Information System's Influenza Web. Multivariate analysis methods were employed to verify the association between exposure variables with the outcomes of ICU admission and death. A total of 4,832 SARI cases were reported in Goiás from 2013 to 2018. The primary etiological diagnosis was Influenza A (22.3%) with the predominant subtype A (H1N1pdm09), followed by the Respiratory Syncytial Virus. A total of 34.6% of the patients required ICU admission, and 19% died. A longer time to start treatment with antivirals was associated with a higher likelihood to have an ICU admission, while a previous non-vaccination against Influenza, longer time to start treatment, and older age were associated with a higher likelihood to suffer death. The study showed a high frequency of respiratory diseases caused by the Influenza virus in Goiás and that the severity of the syndrome, characterized by ICU admission and deaths, is associated with the start of antiviral treatment vaccine status, and patient's age.
Assuntos
Humanos , Idoso , Infecções Respiratórias , Influenza Humana/epidemiologia , Índice de Gravidade de Doença , Brasil/epidemiologia , Estudos Retrospectivos , HospitalizaçãoRESUMO
Abstract This article aims to identify the prevalence and factors associated with influenza vaccination in pregnant women. This is a cross-sectional study conducted in a municipality in the southernmost region of Brazil, which included all women giving birth in 2016. The outcome was having received the vaccine against influenza during pregnancy. Sociodemographic, behavioral and prenatal care characteristics and morbidities were analyzed. The analysis included sample description, the prevalence of vaccination for each independent variable and a multivariate analysis. Two thousand six hundred ninety-four pregnant women were interviewed, of which 53.9% reported having been vaccinated. Factors associated with increased prevalence of vaccination were mother's higher schooling, prenatal care, tetanus vaccination and prenatal care performed in a public service. On the other hand, prenatal care onset after the first quarter reduced the prevalence of vaccination. The results point to the need to reinforce the importance of vaccination against influenza among pregnant women and among health professionals, regardless of the severity of the current epidemiological setting.
Resumo O objetivo deste artigo é identificar a prevalência da imunização contra a gripe em mulheres grávidas e seus fatores associados. Estudo transversal realizado em um município no extremo sul do Brasil, que incluiu todas as mulheres que deram à luz no ano de 2016. O desfecho foi ter recebido a vacina contra a gripe durante a gravidez. Características sociodemográficas, comportamentais, do pré-natal e morbidades foram analisadas como fatores associados à vacinação. A análise constou de descrição da amostra, prevalência da vacinação para cada uma das variáveis independentes e análise multivariada. Foram entrevistadas 2.694 parturientes, das quais 53,9% informaram ter recebido a vacina. Os fatores associados a uma maior prevalência de imunização foram: maior escolaridade materna, realização do pré-natal, ter realizado a vacina antitetânica e fazer o pré-natal em um serviço público. Por outro lado, o início do pré-natal após o primeiro trimestre reduziu a prevalência de imunização. Os resultados apontam para a necessidade de reforçar a importância da imunização contra a Influenza entre mulheres grávidas e entre profissionais da saúde, independentemente da gravidade do atual cenário epidemiológico.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Complicações Infecciosas na Gravidez/prevenção & controle , Vacinas contra Influenza/administração & dosagem , Vacinação/estatística & dados numéricos , Gestantes , Influenza Humana/prevenção & controle , Cuidado Pré-Natal , Brasil , Toxoide Tetânico/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Análise Multivariada , EscolaridadeRESUMO
INTRODUCTION: Influenza epidemics are of higher risk at the extremes of life and in people with comorbidities. Effective -vaccination prevents the occurrence of serious cases and decreases mortality. OBJECTIVE: To describe deaths from influenza with a history of timely vaccination, from the 2010 to the 2018 season in Mexico. METHOD: Cross-sectional, descriptive study where the Influenza Epidemiological Surveillance System database was used. RESULTS: From 2010 to 2018, 65 vaccinated individuals died from influenza, from which 55% of cases (n = 36) were due to type A (H1N1), 51% (n = 33) were females, median age was 57 years, 21 % (n = 14) did not meet the operational definition of influenza-like illness or severe acute respiratory infection, 83% (n = 54) had at least one comorbidity, with the most common being diabetes mellitus and hypertension (32% each); 55% (n = 36) of deaths received antiviral treatment and only 8% (n = 5) had no comorbidities and received treatment with oseltamivir. CONCLUSIONS: Deaths from influenza with timely vaccination represent a very low percentage of the totality. Vaccination against influenza has been a specific prevention strategy that decreases disease burden.
INTRODUCCIÓN: Las epidemias de influenza son de mayor riesgo en los extremos de la vida y en personas con comorbilidades. La vacunación efectiva previene la aparición de casos graves y disminuye la mortalidad. OBJETIVO: Describir las defunciones por influenza en México con antecedente de vacunación oportuna, de 2010 a 2018. MÉTODO: Estudio transversal descriptivo en el que se utilizó la base de datos del Sistema de Vigilancia Epidemiológica de Influenza. RESULTADOS: De 2010 a 2018 fallecieron por influenza 65 personas con vacunación, 55 % (n = 36) de las cuales por tipo A (H1N1), 51 % (n = 33) del sexo femenino, la mediana de edad fue de 57 años, 21 % (n = 14) no cumplía la definición operacional de enfermedad tipo influenza o infección respiratoria aguda grave, 83 % (n = 54) tenía al menos una comorbilidad; las comorbilidades más frecuentes fueron diabetes mellitus e hipertensión arterial (32 % cada una); 55 % (n = 36) recibió tratamiento antiviral y solo 8 % (n = 5) no presentaba comorbilidades y tenía tratamiento con oseltamivir. CONCLUSIONES: Las defunciones por influenza con vacunación oportuna representan un porcentaje muy bajo del total. La vacunación contra influenza ha sido una estrategia de prevención específica que disminuye la carga de la enfermedad.
Assuntos
Influenza Humana/mortalidade , Antivirais/uso terapêutico , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/administração & dosagem , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Distribuição por Sexo , Vacinação/mortalidadeRESUMO
Introduction: Influenza epidemics are of higher risk at the extremes of life and in people with comorbidities. Effective vaccination prevents the occurrence of serious cases and decreases mortality. Objective: To describe deaths from influenza with a history of timely vaccination, from the 2010 to the 2018 season in Mexico. Method: Cross-sectional, descriptive study where the Influenza Epidemiological Surveillance System database was used. Results: From 2010 to 2018, 65 vaccinated individuals died from influenza, from which 55% of cases (n = 36) were due to type A (H1N1), 51% (n = 33) were females, median age was 57 years, 21 % (n = 14) did not meet the operational definition of influenza-like illness or severe acute respiratory infection, 83% (n = 54) had at least one comorbidity, with the most common being diabetes mellitus and hypertension (32% each); 55% (n = 36) of deaths received antiviral treatment and only 8% (n = 5) had no comorbidities and received treatment with oseltamivir. Conclusions: Deaths from influenza with timely vaccination represent a very low percentage of the totality. Vaccination against influenza has been a specific prevention strategy that decreases disease burden.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Vacinas contra Influenza/administração & dosagem , Imunização/mortalidade , Influenza Humana/mortalidade , Antivirais/uso terapêutico , Fatores de Tempo , Comorbidade , Vigilância da População , Estudos Transversais , Imunização/estatística & dados numéricos , Influenza Humana/virologia , Vírus da Influenza A Subtipo H1N1 , México/epidemiologiaRESUMO
Objective: To describe the characteristics of patients with influenza A subtype H3N2 requiring ventilatory support during the 2017 outbreak, as well as the evolution of the disease and clinical results. Materials and Methods: Retrospective cohort. We included all patients admitted to the Emergency Department with confirmed diagnosis of H3N2 during June 2017, requiring invasive or noninvasive mechanical respiratory assistance, high-flow nasal cannula treatment or continuous airway pressure. Results: 34 patients were included; 52.9% men, mean age 81 years (Standard Deviation [SD] 10). Main comorbidities of patients on admission were: 73.5% hypertension, 44.1% chronic obstructive pulmonary disease and 76.5% congestive heart failure. The mean Charlson Index score was 6 (SD 2), the APACHE II median (Acute Physiology and Chronic Health Evaluation II) was 17 (IQR 14-20) and the SOFA median (Sequential Organ Failure Assessment) on day 1 was 5 (IQR 3-7). On admission, 23 patients required noninvasive ventilation, 5 continuous positive airway pressure, 4 invasive mechanical ventilation and 2 high-flow nasal cannula therapy. The rate of noninvasive ventilation failure was 47.8% (95% CI [confidence interval] 26.8-69.4) and finally 38.2% of patients were intubated and mechanically ventilated. Hospital mortality was 52.9% (95% CI 35.1-70.2). Conclusions: A high mortality rate was observed among elderly patients with comorbidities during the H3N2 outbreak. Most patients underwent a noninvasive ventilation trial on admission, however a high percentage failed. The initial condition could have been interpreted as acute chronic obstructive pulmonary disease or congestive heart failure.
Assuntos
Humanos , Influenza Aviária , Doença Pulmonar Obstrutiva Crônica , Ventilação não Invasiva , Insuficiência CardíacaRESUMO
RESUMEN Con el objetivo de analizar las creencias y actitudes de trabajadores sanitarios y estudiantes de enfermería de Las Palmas de Gran Canaria en España ante una pandemia por gripe, se aplicó una encuesta durante marzo-mayo del 2017. Un alto porcentaje duda que exista una vacuna que les proteja ante una pandemia por gripe aunque los trabajadores muestran mayor seguridad con respecto al acceso a una vacuna que los estudiantes, los trabajadores sanitarios manifestaron una mayor responsabilidad ante su trabajo que los estudiantes, así un 46,7% estaría de acuerdo en sancionar al que se negase a ir a trabajar, debido a que existe un alto porcentaje lo anteponen a su responsabilidad para sí y su familia. En conclusión, se sugiere la promoción de iniciativas encaminadas a reducir el absentismo, identificando aquellos factores que lo facilitarían y tener preparado un plan de contingencia ante una pandemia por gripe.
ABSTRACT A survey was carried out during March-May 2017 to analyze the beliefs and attitudes of health workers and nursing students in the face of an influenza pandemic in Las Palmas de Gran Canaria, Spain. A high percentage doubted that there is a vaccine to protect them against an influenza pandemic, although workers showed greater certainty than students concerning access to a vaccine. Health workers showed themselves as more responsible for their work than students; i.e., 46.7% would be in favor of penalizing anyone who refused to go to work because there is a high percentage that put work before their responsibility toward themselves and their families. In conclusion, this study suggests promoting initiatives for reducing absenteeism, identifying those factors that would facilitate it, and having a contingency plan prepared in the event of an influenza pandemic.
Assuntos
Feminino , Humanos , Masculino , Estudantes de Enfermagem/psicologia , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Pessoal de Saúde/psicologia , Cultura , Influenza Humana/epidemiologia , Pandemias , Espanha/epidemiologia , Estudos Transversais , AutorrelatoRESUMO
BACKGROUND: Experimental data show that type I interferon has a key role in innate immune response against influenza infection. OBJECTIVE: We compared nasal levels of interferon-α2 and ß among inpatients and outpatients with influenza. STUDY DESIGN: Children younger than 5 years of age with influenza-like illness seeking care at the emergency department within the first 72 h of disease onset were prospectively included. Clinical and demographic data and secretions through nasal wash were obtained. Influenza infection was assessed through reverse-transcription polymerase chain reaction and nasal levels of interferon-α2 and ß were measured by enzyme-linked immunosorbent assay. All patients followed until the end of the disease. RESULTS: One hundred patients were included, of which 24 had confirmed influenza infection, and 5 of them were hospitalized. Subtypes A (H3N2) and B were confirmed in 10 and 14 patients, respectively. Seventy-six patients without influenza, including 48% of outpatients, were recruited as controls. All hospitalized patients were significantly younger regardless of influenza status (age <6 months in 59% vs. 23.2%, p < 0.001). All other data were similar among the groups. Comparing median levels of interferon-α2 among children with influenza, levels were significantly higher in outpatients than in hospitalized patients and were 263.2 pg/mL (25-75 interquartile range: 58.3-634) and detectable in only one patient (90 pg/mL), respectively. The levels of interferon-α2 in controls and those of interferon-ß in all groups were not detected. CONCLUSIONS: Higher levels of interferon-α2 in patients with less severe influenza reinforce experimental evidence about the protective role of interferon-α2 against influenza infection.
Assuntos
Imunidade Inata , Influenza Humana/imunologia , Interferon Tipo I/análise , Nariz/imunologia , Infecções Respiratórias/imunologia , Secreções Corporais/virologia , Pré-Escolar , Estudos de Coortes , Feminino , Hospitalização , Humanos , Lactente , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza A Subtipo H3N2/imunologia , Pacientes Internados/estatística & dados numéricos , Interferon Tipo I/imunologia , Interferon alfa-2/análise , Interferon alfa-2/imunologia , Interferon beta/análise , Interferon beta/imunologia , Masculino , Nariz/virologia , Pacientes Ambulatoriais/estatística & dados numéricos , Infecções Respiratórias/virologiaRESUMO
INTRODUCTION: Influenza epidemics are of higher risk at the extremes of life and in people with comorbidities. Effective vaccination prevents the occurrence of serious cases and decreases mortality. OBJECTIVE: To describe deaths from influenza with a history of timely vaccination, from the 2010 to the 2018 season in Mexico. METHOD: Cross-sectional, descriptive study where the Influenza Epidemiological Surveillance System database was used. RESULTS: From 2010 to 2018, 65 vaccinated individuals died from influenza, from which 55% of cases (n = 36) were due to type A (H1N1), 51% (n = 33) were females, median age was 57 years, 21 % (n = 14) did not meet the operational definition of influenza-like illness or severe acute respiratory infection, 83% (n = 54) had at least one comorbidity, with the most common being diabetes mellitus and hypertension (32% each); 55% (n = 36) of deaths received antiviral treatment and only 8% (n = 5) had no comorbidities and received treatment with oseltamivir. CONCLUSIONS: Deaths from influenza with timely vaccination represent a very low percentage of the totality. Vaccination against influenza has been a specific prevention strategy that decreases disease burden.
Assuntos
Imunização/mortalidade , Vacinas contra Influenza/administração & dosagem , Influenza Humana/mortalidade , Antivirais/uso terapêutico , Comorbidade , Estudos Transversais , Feminino , Humanos , Imunização/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/virologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Fatores de TempoRESUMO
The "Spanish" flu pandemic, which occurred a century ago, is considered the most devastating in human history. An estimated one third of world population fell ill with flu and more than 2.5% of them died. The course of the epidemic had two main waves (1918 and 1919) and showed an unusual W-shaped morbidity/mortality distribution. Death was not a direct outcome of flu itself but rather a consequence of secondary bacterial bronchopneumonia, for which antibiotics had not yet been discovered. Pre-existing pulmonary tuberculosis was also accountable for increased flu death rates during the pandemic. As it happened in Europe, in Argentina the epidemic had two main waves, with ample variation in mortality by region. Available treatment at the time included diet, throat antiseptic rinses, low doses of quinine valerianate, salicylates, codeine as a cough suppressant, and camphor oil. Primitive anti-pneumococcal vaccines and immune sera were also applied. Upon the disclosure of the whole RNA sequence of the 1918 influenza virus genome, by means of reverse genetics it was possible to assemble viral particles resembling those of the deadly pandemic. The reconstituted virus proved to be extraordinarily virulent for mice. Current seasonal flu vaccines help to reduce, but not to abolish, the risk of another pandemic. The ongoing development of "universal" vaccines against influenza conferring reliable and long-lasting immunity may prevent its global spread in the future.
Assuntos
Influenza Humana/história , Pandemias/história , Argentina/epidemiologia , Surtos de Doenças/história , Europa (Continente)/epidemiologia , História do Século XX , Humanos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vacinas contra Influenza , Influenza Humana/mortalidade , Influenza Humana/virologiaRESUMO
La pandemia de gripe "española", de la que se cumplen 100 años, es considerada la más devastadora de la historia. Se estima que afectó a un tercio de la población mundial, y más del 2.5% de los enfermos murieron. Esta pandemia se presentó en dos oleadas principales, en 1918 y 1919, y la morbimortalidad por edades tuvo una curva en W. En general, la muerte no ocurría como consecuencia directa de la gripe, sino por bronconeumonías bacterianas, para las que se carecía de tratamiento. Hubo, además, una mayor mortalidad en enfermos con tuberculosis preexistente con respecto al resto de los afectados de influenza. En Argentina la epidemia también se presentó en dos oleadas principales, con amplias variaciones en la mortalidad por regiones. El tratamiento disponible incluía dieta, antisepsia de garganta, valerianato de quinina, salicilato, codeína para la tos y aceite alcanforado. También se aplicaban primitivas vacunas y sueros anti-neumococos. Con la disponibilidad de la secuencia de ARN completa del genoma del virus de la influenza 1918 ha sido posible ensamblar, mediante genética inversa, partículas virales semejantes a las de la pandemia mortal. El virus reconstituido demostró ser extraordinariamente virulento para ratones. En la actualidad, la vacunación contra la gripe estacional reduce el riesgo de otra pandemia, pero por el momento no puede eliminarlo. El desarrollo de vacunas "universales" contra la gripe, que confieran inmunidad confiable y duradera, podrá evitar en el futuro su propagación mundial.
The "Spanish" flu pandemic, which occurred a century ago, is considered the most devastating in human history. An estimated one third of world population fell ill with flu and more than 2.5% of them died. The course of the epidemic had two main waves (1918 and 1919) and showed an unusual W-shaped morbidity/mortality distribution. Death was not a direct outcome of flu itself but rather a consequence of secondary bacterial bronchopneumonia, for which antibiotics had not yet been discovered. Pre-existing pulmonary tuberculosis was also accountable for increased flu death rates during the pandemic. As it happened in Europe, in Argentina the epidemic had two main waves, with ample variation in mortality by region. Available treatment at the time included diet, throat antiseptic rinses, low doses of quinine valerianate, salicylates, codeine as a cough suppressant, and camphor oil. Primitive anti-pneumococcal vaccines and immune sera were also applied. Upon the disclosure of the whole RNA sequence of the 1918 influenza virus genome, by means of reverse genetics it was possible to assemble viral particles resembling those of the deadly pandemic. The reconstituted virus proved to be extraordinarily virulent for mice. Current seasonal flu vaccines help to reduce, but not to abolish, the risk of another pandemic. The ongoing development of "universal" vaccines against influenza conferring reliable and long-lasting immunity may prevent its global spread in the future.