Predicting Pneumonia and Influenza Mortality from Morbidity Data

BACKGROUND: Few European countries conduct reactive surveillance of influenza mortality, whereas most monitor morbidity. METHODOLOGY/PRINCIPAL FINDINGS: We developed a simple model based on Poisson seasonal regression to predict excess cases of pneumonia and influenza mortality during influenza epidemics, based on influenza morbidity data and the dominant types/subtypes of circulating viruses. Epidemics were classified in three levels of mortality burden (“high”, “moderate” and “low”). The model was fitted on 14 influenza seasons and was validated on six subsequent influenza seasons. Five out of the six seasons in the validation set were correctly classified. The average absolute difference between observed and predicted mortality was 2.8 per 100,000 (18% of the average excess mortality) and Spearman's rank correlation coefficient was 0.89 (P = 0.05). CONCLUSIONS/SIGNIFICANCE: The method described here can be used to estimate the influenza mortality burden in countries where specific pneumonia and influenza mortality surveillance data are not available

Online detection and quantification of epidemics

<p>Abstract</p> <p>Background</p> <p>Time series data are increasingly available in health care, especially for the purpose of disease surveillance. The analysis of such data has long used periodic regression models to detect outbreaks and estimate epidemic burdens. However, implementation of the method may be difficult due to lack of statistical expertise. No dedicated tool is available to perform and guide analyses.</p> <p>Results</p> <p>We developed an online computer application allowing analysis of epidemiologic time series. The system is available online at <url>http://www.u707.jussieu.fr/periodic_regression/</url>. The data is assumed to consist of a periodic baseline level and irregularly occurring epidemics. The program allows estimating the periodic baseline level and associated upper forecast limit. The latter defines a threshold for epidemic detection. The burden of an epidemic is defined as the cumulated signal in excess of the baseline estimate. The user is guided through the necessary choices for analysis. We illustrate the usage of the online epidemic analysis tool with two examples: the retrospective detection and quantification of excess pneumonia and influenza (P&I) mortality, and the prospective surveillance of gastrointestinal disease (diarrhoea).</p> <p>Conclusion</p> <p>The online application allows easy detection of special events in an epidemiologic time series and quantification of excess mortality/morbidity as a change from baseline. It should be a valuable tool for field and public health practitioners.</p

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Pneumopathies au retour de voyages

BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La réévaluation de la pandémie grippale de 1918

Cette thèse est une tentative de synthèse des paramètres épidémiologiques de cette pandémie. Nous avons réévalué la mortalité dans 14 pays européens pendant la pandémie de 1918, à l aide d un support informatique en ligne. Nous avons estimé l excès de mortalité en Europe pendant la pandémie de 1918 à 2,64 millions de décès (1,1% de la population européenne). Il était trouvé un gradient Nord Sud de l excès de mortalité, les pays du sud expérimentant un excès de mortalité plus élevé que les pays du Nord. Il existait une importante synchronie entre les différents pays, ceci plaidant contre une origine européenne de la pandémie. Dans la seconde partie de ce travail, nous avons réalisé une synthèse des études apportant des données originales pour l estimation de l intervalle de génération et du nombre de reproduction au cours des pandémies grippales. Nous avons estimé l intervalle sériel moyen à partir de 8 études en foyer entre 2,8 et 3,3 jours au cours des années pandémiques. Nous avons estimé le nombre de reproduction à 1,6 (1,5 1,7) pendant la pandémie de 1918. Des intervalles de génération courts sont donc caractéristiques de la grippe, conduisant à un nombre de reproduction, estimé à partir de l analyse du taux de croissance épidémique, inférieur à 2.PARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Making the best of data derived from a daily practice in clinical legal medicine for research and practice – the example of Spe3dLab

Forensic science suffers from a lack of studies with high-quality design, such as randomized controlled trials (RCT). Evidence in forensic science may be of insufficient quality, which is a major concern. Results from RCT are criticized for providing artificial results that are not useful in real life and unfit for individualized prescription. Various sources of collected data (e.g. data collected in routine practice) could be exploited for distinct goals. Obstacles remain before such data can be practically accessed and used, including technical issues. We present an easy-to-use software dedicated to innovative data analyses for practitioners and researchers. We provide 2 examples in forensics. Spe3dLab has been developed by 3 French teams: a bioinformatics laboratory (LaTIM), a private partner (Tekliko) and a department of forensic medicine (Jean Verdier Hospital). It was designed to be open source, relying on documented and maintained libraries, query-oriented and capable of handling the entire data process from capture to export of best predictive models for their integration in information systems. Spe3dLab was used for 2 specific forensics applications: i) the search for multiple causal factors and ii) the best predictive model of the functional impairment (total incapacity to work, TIW) of assault survivors. 2,892 patients were included over a 6-month period. Time to evaluation was the only direct cause identified for TIW, and victim category was an indirect cause. The specificity and sensitivity of the predictive model were 99.9% and 90%, respectively. Spe3dLab is a quick and efficient tool for accessing observational, routinely collected data and performing innovative analyses. Analyses can be exported for validation and routine use by practitioners, e.g., for computer-aided evaluation of complex problems. It can provide a fully integrated solution for individualized medicine

Prevention and management of coronavirus disease 2019 (COVID-19) in prison: Feedback from an experience in a French remand center

International audienceNo abstract availabl

Impact of atazanavir-based HAART regimen on the carotid intima-media thickness of HIV-infected persons: a comparative prospective cohort.

International audienceOBJECTIVE: With the advent of highly active antiretroviral therapy regimens, it is crucial to consider their long-term benefits to risk ratios among HIV-infected persons. The impact of protease inhibitors on the cardiovascular risk is controversial. DESIGN: This observational cohort was designed to investigate the cardiovascular impact of boosted atazanavir (ATV/r), a protease inhibitor that does not provide major dyslipidemia or insulin resistance. SETTING: This study was carried out at the University Hospital of Brest (France). PATIENTS: Among the 229 HIV-infected persons of the cohort, 33 cases treated by ATV/r-containing regimen since less than 6 months were compared to 99 age-matched and sex-matched ATV/r naive controls. INTERVENTION: None. MAIN OUTCOME MEASURE: The main outcome measure was carotid intima-media thickness (cIMT) at the baseline, 6, 12, and 18 months. RESULTS: Although the cIMT was not different at inclusion (0.633 ± 0.05 vs. 0.666 ± 0.09, P = 0.07), the cIMT course significantly decreased (P = 0.018) in cases at 18 months. The differences remained significant even after adjustment on the variables that differed between cases and controls (P < 0.1) at inclusion (high-density lipoprotein cholesterol, cardiovascular family history) and the cumulated and current exposure to the nucleosidic reverse transcriptase inhibitor, nonnucleosidic reverse transcriptase inhibitor, and protease inhibitor class. CONCLUSION: Despite similar HIV and cardiovascular characteristics at baseline, cIMT decreased after 6 months of follow-up among the patients exposed to ATV/r, even after adjustment for the exposure to the three antiretroviral classes. Considering the shortcomings of this study, especially the absence of randomization and the heterogeneity of the control group, the benefit of ATV/r treatment in patients with high cardiovascular should be confirmed by randomized trials

Infection pulmonaire a Mycobacterium abscessus sensu lato chez des patients exempts de mucoviscidose.

International audienceInfection with Mycobacterium abscessus sensu lato is uncommon in patients without cystic fibrosis. We are interested in these patients and have collected cases in Finistère between 2007 and 2011. Four patients met the infection criteria recommended by the American Thoracic Society in 2007. Among them, all had Aspergillus spp. in sputum, 3 had gastroesophageal reflux and two had the criteria for allergic bronchopulmonary aspergillosis. We identified Mycobacterium massiliense in the single patient in our series whose therapeutic outcome was successful. By comparing these data with those in the literature, we believe that the search for allergic bronchopulmonary aspergillosis and gastroesophageal reflux is necessary in these patients and that species identification is essential for prognosis