Retrospective Investigation of an Influenza A/H1N1pdm Outbreak in an Italian Military Ship Cruising in the Mediterranean Sea, May-September 2009

BACKGROUND: Clinical surveillance may have underestimated the real extent of the spread of the new strain of influenza A/H1N1, which surfaced in April 2009 originating the first influenza pandemic of the 21(st) century. Here we report a serological investigation on an influenza A/H1N1pdm outbreak in an Italian military ship while cruising in the Mediterranean Sea (May 24-September 6, 2009). METHODS: The contemporary presence of HAI and CF antibodies was used to retrospectively estimate the extent of influenza A/H1N1pdm spread across the crew members (median age: 29 years). FINDINGS: During the cruise, 2 crew members fulfilled the surveillance case definition for influenza, but only one was laboratory confirmed by influenza A/H1N1pdm-specific RT-PCR; 52 reported acute respiratory illness (ARI) episodes, and 183 reported no ARI episodes. Overall, among the 211 crew member for whom a valid serological result was available, 39.3% tested seropositive for influenza A/H1N1pdm. The proportion of seropositives was significantly associated with more crowded living quarters and tended to be higher in those aged <40 and in those reporting ARI or suspected/confirmed influenza A/H1N1pdm compared to the asymptomatic individuals. No association was found with previous seasonal influenza vaccination. CONCLUSIONS: These findings underline the risk for rapid spread of novel strains of influenza A in confined environment, such as military ships, where crowding, rigorous working environment, physiologic stress occur. The high proportion of asymptomatic infections in this ship-borne outbreak supports the concept that serological surveillance in such semi-closed communities is essential to appreciate the real extent of influenza A/H1N1pdm spread and can constitute, since the early stage of a pandemic, an useful model to predict the public health impact of pandemic influenza and to establish proportionate and effective countermeasures

Results of influenza A/H1N1pdm serology in 211 crew members of the Italian military ship Scirocco.

<p>Results of influenza A/H1N1pdm serology in 211 crew members of the Italian military ship Scirocco.</p

Results of influenza A/H1N1pdm serology in 211 crew members of the Italian military ship Scirocco, according to respiratory illness reported during the cruise.

<p>Results of influenza A/H1N1pdm serology in 211 crew members of the Italian military ship Scirocco, according to respiratory illness reported during the cruise.</p

Distribution of acute respiratory illness (ARI) and suspected A/H1N1pdm cases, according to the time of symptoms onset and to the results of Influenza A/H1N1pdm-specific serological tests.

<p><u>Black bars</u>: seropositives; <u>gray bars</u>: seronegatives.</p

Proportion of serum samples with contemporary HAI and CF titers ≥1∶10 in 4 control groups.

<p><b>Group 1: T0 and T1:</b> paired acute and convalescent serum samples from patients with A/H1N1pdm infection confirmed by RT-PCR.</p><p><b>Group 2:</b> serum samples submitted to our laboratory for HIV antibody screening and resulted HIV-negative in September 2008, from males matching the age group represented in the study population.</p><p><b>Group 3:</b> serum samples submitted to our laboratory for HIV antibody screening and resulted HIV-negative in September 2009, from males matching the age group represented in the study population.</p><p><b>Group 4:</b> serum samples submitted to our laboratory for HIV antibody screening and resulted HIV-negative, 2 months after the pandemic influenza peak in Italy (February 2010).</p

Distribution of cases according to the time of symptoms onset.

<p><u>Black bar</u>: acute respiratory illness (ARI) episodes; <u>gray bars</u>: episodes fulfilling suspected A/H1N1pdm case definition. The arrows indicate the arrival to the stopover port. Location of docking sites: Beirut, Lebanon; Lymassol, Cyprus; Mersin, Turkey.</p

Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor