Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010-2017

We conducted a retrospective cohort study to assess the effect of influenza virus type and subtype on disease severity among hospitalized influenza patients in Spain. We analyzed the cases of 8,985 laboratory-confirmed case-patients hospitalized for severe influenza by using data from a national surveillance system for the period 2010-2017. Hospitalized patients with influenza A(H1N1)pdm09 virus were significantly younger, more frequently had class III obesity, and had a higher risk for pneumonia or acute respiratory distress syndrome than patients infected with influenza A(H3N2) or B (p<0.05). Hospitalized patients with influenza A(H1N1)pdm09 also had a higher risk for intensive care unit admission, death, or both than patients with influenza A(H3N2) or B, independent of other factors. Determining the patterns of influenza-associated severity and how they might differ by virus type and subtype can help guide planning and implementation of adequate control and preventive measures during influenza epidemics.S

Falta de implementacion de actividades de promocion, prevencion y control de la hipertension arterial en diferentes localidades de colombia: ipiales, chinchina, florencia, pasto, santander de quilichao

En este trabajo nos propusimos realizar un estudio sobre la ausencia de actividades tendientes a la promoción, prevención y control de una enfermedad crónica, asintomática y de fácil detección, como lo es la Hipertensión Arterial, pero que puede convertirse en grave y mortal si no es tratada a tiempo o, como sucede con la mayoría de las personas encuestadas en la presente investigación, si no se sigue la prescripción médica. Encuestamos a 100 personas de ambos sexos (51 mujeres y 49 hombres) en Ipiales, Chinchiná, Florencia, Pasto y Santander de Quilichao (20 por cada ciudad), con edades que oscilan entre los 20 y los 90 años. Nuestro trabajo empieza haciendo un recorrido histórico de la enfermedad, sus fundamentos teóricos y los antecedentes del tema. Sigue con el recuento de las estrategias metodológicas utilizadas para la recopilación de la información, luego el análisis de los datos y la interpretación de los resultados que nos condujeron a las conclusiones y recomendaciones finales. La principal conclusión a la que llegamos es que la falta de adherencia terapéutica es la causa más importante por la cual se dificulta alcanzar la prevención de la hipertensión arterial y que lo más pertinente es que el personal de salud busque concientizar a la comunidad, por medio de conferencias, charlas o volantes, sobre los daños irreversibles producidos por esta enfermedad. Nuestro estudio termina relacionando los planes territoriales de salud de las ciudades seleccionadas para llevar a cabo la investigación y la encuesta empleada para la recolección de los datos.In this work, we undertook a study on the lack of activities for the promotion, prevention and control of chronic disease, asymptomatic and easy detection, such as arterial hypertension, but it can become severe and fatal if not treated in time or, as with the majority of respondents in this investigation, if it does not follow the prescription. We surveyed 100 people of both sexes (51 women and 49 men) in Ipiales, Chinchiná, Florencia, Pasto and Santander de Quilichao (20 from each city), aged between 20 and 90 years. Our work begins by a historical overview of the disease, its theoretical and background of the subject. Keep the count of the approaches used for the collection of information, then the data analysis and interpretation of the results that led us to the conclusions and recommendations. The main conclusion we draw is that the lack of adherence is the most important which is difficult to achieve the prevention of hypertension and that the most relevant is that health personnel look sensitize the community through conferences, lectures or flyers, on the irreversible damage caused by this disease. Our study ends linking territorial health plans of the cities selected to carry out the research and the survey used to collect data

Predominance of influenza A(H3N2) virus genetic subclade 3C.2a1 during an early 2016/17 influenza season in Europe - Contribution of surveillance data from World Health Organization (WHO) European Region to the WHO vaccine composition consultation for northern hemisphere 2017/18

Erratum to "Predominance of influenza A(H3N2) virus genetic subclade 3C.2a1 during an early 2016/17 influenza season in Europe - Contribution of surveillance data from World Health Organization (WHO) European region to the WHO vaccine composition consultation for northern hemisphere 2017/18". Vaccine. 2018 May 3;36(19):2740-2741. doi: 10.1016/j.vaccine.2017.12.039. PMID: 29274700.During the European 2016/17 influenza season, A(H3N2) viruses have predominated and the majority clustered in genetic subclade 3C.2a1. Genetic analyses showed that circulating viruses have undergone considerable genetic diversification of the haemagglutinin gene from the current vaccine virus A/Hong Kong/4801/2014 (clade 3C.2a), but the antigenic data that is limited by the challenges with the antigenic characterisation of currently circulating A(H3N2) viruses, showed no clear evidence of antigenic change. The recommended A(H3N2) vaccine component for the northern hemisphere 2017/18 influenza season remained unchanged. However, early and mid-season vaccine effectiveness (VE) estimates were suggestive of reduced VE against A(H3N2) viruses.S

Gravedad de la epidemia gripal 2017-18 en España

[ES] Siguiendo las recomendaciones de la Organización Mundial de la Salud (OMS), España ha adaptado su guía PISA (por las siglas en inglés de Pandemic Influenza Severity Assessment) para evaluar la gravedad de cualquier epidemia de gripe, estacional o pandémica, a partir de la información de vigilancia de gripe disponible. Dicha gravedad se establece en función de tres indicadores: la transmisibilidad del virus circulante, la gravedad clínica de la enfermedad que produce y su impacto en la población. En este manuscrito se aplican los indicadores y parámetros PISA utilizados en España con la información obtenida en el Sistema de Vigilancia de Gripe en España (SVGE) y del sistema de monitorización de la mortalidad diaria (MoMo y EuroMOMO), con el objetivo de evaluar la gravedad de la gripe durante la temporada 2017-18 en España. La transmisibilidad de la epidemia gripal de la temporada 2017-18 alcanzó un nivel moderado/ alto para todas las edades en la semana de máxima actividad gripal (3/2018), y se caracterizó particularmente por una alta transmisibilidad en mayores de 64 años. En cuanto a la gravedad clínica, la epidemia gripal 2017-18, según el grado de admisión en UCI entre los casos graves hospitalizados confirmados de gripe (CGHCG), presentó un nivel bajo para todas las edades, adultos jóvenes y mayores de 64 años. En menores de 15 años el porcentaje de admisión en UCI alcanzó niveles altos respecto a los valores observados en temporadas previas. En términos de letalidad entre los CGHCG, se estimó que en la temporada 2017-18 se alcanzó un nivel alto de gravedad clínica en todas las edades y mayores de 64 años. En adultos jóvenes de 15-64 años la letalidad se estabilizó en un nivel bajo en el pico de la epidemia gripal y en menores de 15 años se consideró baja respecto a los valores observados en temporadas previas. En cuanto al impacto, la temporada 2017-18 presentó un impacto muy alto en términos de tasas de hospitalización de CGHCG en todas las edades, a expensas fundamentalmente de las hospitalizaciones por gripe en el grupo de mayores de 64 años. En este grupo de edad se observaron las tasas más altas de hospitalización desde la temporada 2013-14. En términos de excesos de mortalidad por todas las causas, la epidemia alcanzó un impacto alto en todas las edades, a expensas fundamentalmente de la mortalidad observada en el grupo de mayores de 64 años, siendo, en menores de 15 años y adultos jóvenes, el impacto nulo.En definitiva, la guía PISA permite la estimación de una serie de indicadores y parámetros para evaluar la gravedad de una epidemia o posible pandemia de gripe. La actividad realizada en el marco del proyecto PISA es un proceso dinámico en continua revisión, susceptible de mejora a medida que se desarrolla y aplica a las diferentes temporadas de gripe. [EN] Following World Health Organization (WHO) recommendations, Spain has adapted its PISA guide (for Pandemic Influenza Severity Assessment) to assess the severity in seasonal epidemics and pandemics, based on available influenza surveillance information. This severity is defined in terms of three indicators: the transmissibility of the circulating virus, the seriousness or clinical severity of the disease it produces and its impact on the population. In this manuscript the PISA indicators and parameters used in Spain are applied with the information obtained in the Spanish Influenza Surveillance System and the daily mortality monitoring system (MoMo and EuroMOMO), with the objective of evaluating the severity of the influenza during the 2017-18 season in Spain. The transmissibility indicator in the 2017-18 influenza season reached a moderate / high level for all ages in the peak week (week 03/2018), and was particularly high in people over 64 years. Regarding seriousness, the 2017-18 influenza epidemic, according to the cumulative percentage of ICU admissions among severe hospitalized confirmed influenza cases (SHCIC), presented a low level for all ages, young adults and those over 64 years. In children under 15, the cumulative percentage of ICU admissions reached high levels compared to the values observed in previous seasons. In terms of lethality among the SHCIC, it was estimated that the 2017-18 season presented a high level of clinical severity at all ages and over 64 years. In young adults aged 15-64, lethality stabilized at a low level at the peak of the flu epidemic. In children under 15 years, the lethality was estimated low compared to the values observed in previous seasons. Regarding the impact, the 2017-18 influenza season presented a very high impact in terms of SHCIC rates at all ages, mainly due to hospitalizations in the group over 64 years. In this age group, the highest hospitalization rates were observed this season, since the 2013-14 season. In terms of excess mortality from all causes, the epidemic reached a high impact at all ages group, mainly due to the mortality observed in the group over 64 years. In children under 15 years and young adults, the impact according to excess mortality from all causes was low. In short, the PISA guide allows the estimation of indicators and parameters to assess the severity in seasonal epidemics and possible pandemics. The activity carried out within the framework of the PISA project is a dynamic process in continuous revision, susceptible to improvement as it develops and applies to the different influenza seasons.N

Dominant influenza A(H3N2) and B/Yamagata virus circulation in EU/EEA, 2016/17 and 2017/18 seasons, respectively

We use surveillance data to describe influenza A and B virus circulation over two consecutive seasons with excess all-cause mortality in Europe, especially in people aged 60 years and older. Influenza A(H3N2) virus dominated in 2016/17 and B/Yamagata in 2017/18. The latter season was prolonged with positivity rates above 50% among sentinel detections for at least 12 weeks. With a current west-east geographical spread, high influenza activity might still be expected in eastern Europe.S

Current practices for respiratory syncytial virus surveillance across the EU/EEA Member States, 2017

Background: Respiratory syncytial virus (RSV) is a major contributor to lower respiratory tract infections worldwide and several vaccine candidates are currently in development. Following vaccine introduction, reliable RSV surveillance should enable monitoring of vaccination impact. Data on the RSV disease burden in the European Union and European Economic Area (EU/EEA) are sparse. Aim: The aim of this study was to gather knowledge on current practices of national RSV surveillance in the EU/EEA. Methods: National Coordinators and National Focal Points for Influenza (epidemiologists and virologists) from the EU/EEA countries (n = 31) were invited to participate in an online survey in August and September 2017. The questionnaire covered questions on epidemiological and laboratory aspects of RSV surveillance. Results: All EU/EEA countries except Liechtenstein replied to the survey. Eighteen countries reported to have a sentinel surveillance system, 26 countries a non-sentinel surveillance system and three countries to have neither. RSV data collection was mostly done within the context of influenza surveillance. A wide range of diagnostic and characterisation assays was used for the detection of RSV. Discussion: The majority of EU/EEA countries have some surveillance for RSV in place. The prevailing integration of RSV surveillance into the existing influenza sentinel surveillance system may lead to under-reporting of RSV. The documented variations in existing RSV surveillance systems and their outputs indicate that there is scope for developing guidelines on establishing comparable methods and outcomes for RSV surveillance across the EU/EEA, to ensure the availability of a consistent evidence base for assessing future vaccination programmes.S

Informe de situación: Actividad gripal en la temporada 2018-19 Evaluación de riesgo hasta semana 03/2019

[ES] La epidemia gripal 2018-19 se ha iniciado en España en la semana 01/2019, tres semanas más tarde que en las dos temporadas previas, pero en el rango de las temporadas post-pandémicas previas. La incidencia de gripe se asocia de forma casi exclusiva a la circulación de virus de la gripe tipo A. Aunque la proporción entre subtipos A(H1N1)pdm09 y A(H3N2) es similar, la tendencia de las últimas semanas indica un aumento en la proporción del primero. Los datos de vigilancia en hospitales señalan una distribución similar por tipo/subtipo de virus. Si bien el grupo de mayores de 65 años es el mayoritario (53%), este porcentaje es inferior al que se puede observar en aquellas temporadas en las que predomina A(H3N2) y se parece más a aquellas temporadas en las que predominó A(H1N1)pdm09. Hasta el momento, la epidemia gripal 2018-19 presenta un nivel bajo de transmisibilidad en todos los grupos de edad. El impacto ocasionado en la población española se estima medio, en términos de tasa de hospitalización y bajo en términos de excesos de mortalidad por todas las causas. Ambos indicadores, así como la gravedad clínica de la enfermedad, se seguirán evaluando en las semanas próximas de la epidemia gripal. Las estimaciones preliminares de EV antigripal de esta temporada en Canadá señalan un valor de EV frente a A(H1N1)pdm09 por encima del 70%, en consonancia con datos preliminares de la red Europea I-MOVE. La EV antigripal frente a A(H3N2) es subóptima hasta el momento. Sin embargo, se han estimado valores moderados de EV antigripal frente a todos los virus A en grupos recomendados de vacunación, lo que refuerza la recomendación oficial de vacunación antigripal en estos grupos de riesgo de complicaciones por gripe. En definitiva, las características de la epidemia 2018-19 hasta el momento se mueven en un patrón intermedio entre las temporadas de A(H1N1)pdm09 y las de A(H3N2), de forma que según derive la circulación mayoritaria de uno u otro virus, cabe esperar que predominen unas u otras características. [EN] Influenza activity in Spain started this 2018-19 season in week 01/2019, three weeks later than in the previous two seasons, but in the range of the previous post-pandemic seasons. So far, the influenza season 2018-19 is characterized by the predominant circulation of type A. Although both A(H1N1) pdm09 and A(H3N2) subtypes are co-circulating in similar proportions, the trend of the last weeks indicates an increase in the proportion of the first. Surveillance data in hospitals indicate a similar distribution by type/subtype. Although 53% were adults 65 years of age and older, this percentage is lower than that observed in seasons associated with A(H3N2) predominance, and more similar to those seasons in which A(H1N1)pdm09 predominated. So far, the influenza season 2018-19 has a low level of transmissibility in all age groups. The impact caused in the Spanish population is estimated as “medium”, in terms of hospitalization rates, and “low” in terms of all causes excess mortality. Both indicators, as well as the clinical severity of the disease, will continue to be evaluated in the next few weeks of the flu epidemic. Preliminary estimates of the effectiveness of influenza vaccine this season in Canada indicate good vaccine effectiveness (VE) (above 70%), in line with preliminary data from the European I-MOVE network. The VE against influenza A(H3N2) viruses is suboptimal so far. However, moderate values of VE have been estimated against all A viruses in recommended groups of vaccination, which reinforces the official recommendation of influenza vaccination in these risk groups of complications due to influenza. In short, the characteristics of the influenza season 2018-19 so far move in an intermediate pattern between the A(H1N1)pdm09 seasons and those with A(H3N2) predominance. It is expected that some or other characteristics will prevail depending on the predominance of the circulation of one or the other virus.N

Vigilancia de la gripe en España Temporada 2015-2016 (desde la semana 40/2015 hasta la semana 20/2016)

[ES] La actividad gripal en España en la temporada 2015-16 fue baja y asociada a una circulación mayoritaria de virus de la gripe A(H1N1)pdm09, con una creciente contribución de virus de la gripe B a medida que ha ido avanzando la temporada. La epidemia gripal se inició de forma tardía, presentando posteriormente una onda epidémica atípica, con una meseta de incidencia de gripe estable durante varias semanas consecutivas y una duración total en el rango de las 10 temporadas previas. Los menores de 15 años fueron el grupo de edad más afectado, con mayores tasas de incidencia acumulada en el grupo de 0-4 años. Se notificaron 12 brotes confirmados de gripe en siete CCAA. El 92% de los brotes se asoció a virus tipo A (siete A(H1N1)pdm09, 3 ANS y uno A(H3N2)) todos ellos en centros sanitarios, geriátricos o instituciones de larga estancia. De las 2.716 detecciones centinela identificadas a lo largo de la temporada, el 66% fueron virus de la gripe A, 98% de A(H1N1)pdm09, entre los subtipados. A nivel global se puede distinguir una primera onda de circulación de virus A(H1N1)pdm09 y posteriormente otra con circulación de virus B. En las redes centinela con picos de intensidad gripal más tempranos se ha observado una mayor contribución de virus A(H1N1)pdm09, mientras que en aquellas con periodos epidémicos más tardíos se observó una mayor contribución de virus B. La caracterización genética de los virus circulantes esta temporada indicó que todos aquellos virus A(H1N1) caracterizados eran semejantes a A/SouthAfrica/3626/2013, todos los virus A(H3N2) eran semejantes a A/HongKong/4801/2014 y la práctica totalidad (96%) de virus de la gripe B eran semejantes a B/Brisbane/60/2008 (linaje Victoria). Se notificaron 3.101 casos graves hospitalizados confirmados de gripe (CGHCG) en 19 CCAA, de los que 1.071 (35%) fueron admitidos en UCI y 352 (11,4%) fallecieron. La mayor proporción de casos se concentró en los mayores de 64 años (40%), seguido del grupo de 45-64 años (33%). Las mayores tasas de hospitalización se observaron en los mayores de 64 años y en el grupo de 0 a 4 años. En el 85% de los casos se confirmó el virus de la gripe tipo A, siendo el 98% de los subtipados (H1N1)pdm09. El 75% de los CGHCG presentó algún factor de riesgo de complicaciones de gripe. El 64,5% de los pacientes pertenecientes a grupos donde estaba recomendada la vacunación, no habían recibido la vacuna antigripal de esta temporada. Las defunciones en casos graves hospitalizados confirmados de gripe se concentraron fundamentalmente en los mayores de 64 años (59%) y el 88% de los casos fatales presentó algún factor de riesgo de complicaciones. El 59% de los pacientes recomendados de vacunación no habían recibido la vacuna antigripal de esta temporada. La letalidad observada en términos de defunciones entre CGHCG fue inferior a la temporada previa, y similar a las anteriores. El sistema MOMO (Monitorización de la mortalidad diaria) estimó un exceso de mortalidad por todas las causas en las semanas 9, 11, 13 y 14/2016 que se concentró en el grupo de 15 a 64 años. Excesos similares se han informado en varios países europeos. [EN] Influenza activity in Spain during the 2015-16 season was low and dominated by influenza A(H1N1)pdm09 virus circulation, with an increasing contribution from B virus as the season progressed. Influenza epidemic had a late time presentation, showing an atypical epidemic wave afterwards, with a stable incidence plateau for several consecutive weeks. The total duration was in the range of the previous 10 seasons. Children under 15 years old have been the most affected with higher rates of cumulative incidence in 0-4 age group. Twelve laboratory-confirmed influenza outbreaks were reported in seven autonomous regions (AR), 92% of them associated with type A virus (seven A(H1N1)pdm09, 3 A not subtyped and one A (H3N2), all in health centers, nursing homes or long-stay institutions. Of the 2,716 specimens from sentinel sources tested positive for influenza virus throughout the season, 66% were influenza A virus, with A(H1N1)pdm09 representing 98% of those subtyped. Globally, a first wave associated with A(H1N1)pdm09 can be distinguished, and then another associated with B virus. In those sentinel networks with early intensity peak, a greater contribution of virus A (H1N1) pdm09 has been observed, while those with later epidemic periods where associated with greater contribution of B virus. All A(H1N1)pdm09 virus genetically characterized have been similar to A/ SouthAfrica/3626/2013, all A(H3N2) were similar to A/HongKong/4801/2014 and almost all (96%) of influenza B viruses were similar to B/Brisban /60/2008 (Victoria lineage). A total of 3,101 severe hospitalized laboratory-confirmed influenza cases (SHCIC) were reported in 19 AR, of which 1,071 (35%) were admitted to ICU and 352 (11.4%) died. The highest percentage of SHCIC occurred over 64 years (40%), followed by the 45-64 age group (33%). The highest hospitalization rates were observed over 64 years and in the group of 0-4 years. The 85% of SHCIC were associated with influenza A virus, and the vast majority of the subtyped A viruses (98%) were A(H1N1)pdm09. Seventy-five percent had underlying conditions and 64.5% had not received a seasonal influenza vaccine. Most of the deaths of SHCIC (59%) were in adults over 64 years old. Eighty-eight percent had underlying conditions and 59% of patients with recommended vaccination condition had not received a seasonal influenza vaccine. MOMO system (Monitoring daily mortality) estimated an excess mortality from all causes in weeks 9, 11, 13 and 14/2016 which focused on the group of 15-64 years. Similar excesses have been reported in several European countrie

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain

Background: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. Methods: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. Results: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. Conclusions: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).The data of the study was originally collectedas part of the following projects run by the European Centre for Disease Prevention and Control:“Establishing Severe Acute Respiratory Infections (SARI) surveillance and performing hospital-based COVID-19 transmission studies”, “Developing an infrastructure and performing vaccine effectiveness studies for COVID-19 vaccines in the EU/EEA”, and the “Vaccine Effectiveness, Burden and Impact Studies(VEBIS) of COVID-19 and Influenza".S