Self-reported prevalence of warts in children and GP consultation

Objective: Respiratory infections are a frequent causes of medical attendance. Influenza viruses increases this phenomena. The aim of this study was to prospectively identify GPs’ increased work in terms of visits and time. Methods: Over a period of five months 5 GPs recorded sex, age, number and place of visits, telephone consultations of the patients visited for acute respiratory disease (ARD)which included acute respiratory infections (ARI), influenza (FLU) and Influenza-like illness (ILI). Upper respiratory tract infections (URTI) were classified as sinusitis, rhinitis, otitis, tonsillitis, pharyngitis, laryngitis, Lower respiratory tract infections (LRTI) were classified as tracheitis, bronchitis, pneumonia, bronchopneumonia, acute episodes of chronic obstructive pulmonary disease (COPD) and asthma. FLU and ILI were considered two different entities on the basis of symptoms. Results: Acute respiratory disease increase of 22 patients attending every GP's office monthly (from 176 to 198 total visits). 6542 patients were observed. The incidence of ARD was 33.5% (2191: 1091 female and 1100 males). URTI affected 944 patients, LRTI 739, FLU 328 and ILI 180. The increase in home visits grew from 10 to 36. Each home visit took from 15 to 45 minutes. In a high number of cases (236), home visits were necessary for sick-leave certificates. FLU (54%) and LRTI (37.5%) required more attention, and they were the primary causes for visits. Telephone consultations took place for all ILI or FLU of minor severity and in young people.

Conclusion: During the winter there is an increased work-load for GPs due to the diffusion of influenza virus and respiratory tract diseases. “Burn out syndrome” is increasing among the GPs. Territorial GPs’ action is highly efficacious. Patients self-certification should be evaluated. Vaccine therapy could be more effective if done on a larger population. More research is needed.     

Establishing thresholds for influenza surveillance in Victoria

Objective: We aimed to review the proportion of influenza-like illness (ILI) that could be attributed to influenza infection over five consecutive influenza seasons in Victoria, to compare ILI activity with hospital admissions for influenza, and to develop thresholds that would indicate when ILI activity may coincide with increases in influenza hospitalisations.
Methods: Combined nose/throat swabs from patients with ILI selected from sentinel general practices were tested for influenza and other respiratory viruses at the Victorian Infectious Diseases Reference Laboratory. The proportion of ILI attributed to laboratory-confirmed influenza was evaluated for five consecutive surveillance seasons, from 1998 to 2002. The seasonal patterns of ILI and laboratory-confirmed influenza were compared for 2000–02. ILI surveillance from sentinel general practices between 1997 and 2000 was compared with hospital admissions for influenza extracted from the Victorian Admitted Episodes Dataset between 1994 and 2000.
Results: Approximately 41% of all ILI cases from sentinel general practices were confirmed to have an influenza infection between 1998 and 2002. The seasonal pattern of ILI and confirmed influenza among patients selected from sentinel general practices was very similar over three influenza seasons. The trends for ILI rates in sentinel general practices appeared to correlate remarkably well with those of hospital admissions for influenza. Thresholds for ILI were defined as: baseline <0.25 ILI cases/100 patients/week; normal seasonal activity 0.25–1.5; above normal seasonal activity >1.5–3.5; and epidemic activity above 3.5.
Conclusion: ILI rates from sentinel general practices correspond with hospital admissions coded as influenza and allow the use of threshold levels to describe seasonal influenza activity.     

Influenza surveillance in Victoria, 2006

The Victorian influenza season in 2006 remained within normal seasonal activity thresholds and was relatively mild compared with recent years. The season peaked in mid-August, with influenza-like illness (ILI) rates from general practitioner sentinel surveillance and the Melbourne Medical Locum Service (MMLS), and cases of laboratory-confirmed influenza notified to the Department of Human Services, reaching their zeniths within one week of each other. A total of 74 general practitioners (GPs) participated in the sentinel surveillance in 2006, reporting a total of 136,732 consultations during the surveillance period from May to September inclusive. Participating GPs reported a total of 765 patients with an ILI; an average ILI rate of 5.6 cases per 1,000 consultations. The average ILI rate from the MMLS in the same period was 8.5 cases per 1,000 call-outs. Eighty-two per cent of laboratory-confirmed influenza notifications during the surveillance period were type A; the remainder were type B. Typing indicated circulation of two predominant strains during the season: A/Wisconsin/67/2005(H3N2)-like virus and B/Malaysia/2506/2004-like virus. The influenza vaccine for 2006 contained A/New Caledonia/20/ 99(H1N1)-like virus, A/California/7/2004(H3N2)-like virus and B/Malaysia/2506/2004-like virus.     

Consultations for Influenza-Like Illness in Primary Care in The Netherlands: A Regression Approach

ObjectivesTo estimate the general practitioner (GP) consultation rate attributable to influenza in The Netherlands.MethodsRegression analysis was performed on the weekly numbers of influenza-like illness (ILI) GP consultations and laboratory reports for influenza virus types A and B and 8 other pathogens over the period 2003–2014 (11 influenza seasons; week 40–20 of the following year).ResultsIn an average influenza season, 27% and 11% of ILI GP consultations were attributed to infection by influenza virus types A and B, respectively. Influenza is therefore responsible for approximately 107 000 GP consultations (651/100 000) each year in The Netherlands. GP consultation rates associated with influenza infection were highest in children under 5 years of age, at 667 of 100 000 for influenza A and 258 of 100 000 for influenza B. Influenza virus infection was found to be the predominant cause of ILI-related GP visits in all age groups except children under 5, in which respiratory syncytial virus (RSV) infection was found to be the main contributor.ConclusionsThe burden of influenza in terms of GP consultations is considerable. Overall, influenza is the main contributor to ILI. Although ILI symptoms in children under 5 years of age are most often associated with RSV infection, the majority of visits related to influenza occur among children under 5 years of age.     

Comparability of different methods for estimating influenza infection rates over a single epidemic wave

Estimation of influenza infection rates is important for determination of the extent of epidemic spread and for calculation of severity indicators. The authors compared estimated infection rates from paired and cross-sectional serologic surveys, rates of influenza like illness (ILI) obtained from sentinel general practitioners (GPs), and ILI samples that tested positive for influenza using data from similar periods collected during the 2009 H1N1 epidemic in Singapore. The authors performed sensitivity analyses to assess the robustness of estimates to input parameter uncertainties, and they determined sample sizes required for differing levels of precision. Estimates from paired seroconversion were 17% (95% Bayesian credible interval (BCI): 14, 20), higher than those from cross-sectional serology (12%, 95% BCI: 9, 17). Adjusted ILI estimates were 15% (95% BCI: 10, 25), and estimates computed from ILI and laboratory data were 12% (95% BCI: 8, 18). Serologic estimates were least sensitive to the risk of input parameter misspecification. ILI-based estimates were more sensitive to parameter misspecification, though this was lessened by incorporation of laboratory data. Obtaining a 5-percentage-point spread for the 95% confidence interval in infection rates would require more than 1,000 participants per serologic study, a sentinel network of 90 GPs, or 50 GPs when combined with laboratory samples. The various types of estimates will provide comparable findings if accurate input parameters can be obtained.     

Public health responses to influenza in care homes: a questionnaire-based study of local Health Protection Units

BACKGROUND: Influenza virus infection poses a major threat to the elderly people in residential care. We sought to describe the extent to which local public health services in England were positioned to detect and respond effectively to influenza-like illness (ILI) in nursing homes. METHODS: A questionnaire-based survey was conducted in all 34 Health Protection Units (HPUs) regarding the 2004-05 influenza season. RESULTS: Of the 20 responses, half reported 24 outbreaks of ILI in care homes. The mean resident population attack rate was 41% (range 15-79) with 31 deaths. Staff ILI occurred in 23 of 24 outbreaks. Seven of 20 HPUs stated that a local policy for the management of ILI in nursing homes was in place, with only four specifying the use of neuraminidase inhibitors (NI) for treatment of cases and prophylaxis of residents. In the outbreaks reported, NIs were used for treatment and prophylaxis, respectively, in only 46 and 54% of instances. CONCLUSIONS: Given the availability of effective interventions for treatment and prophylaxis, there is potential to prevent substantial morbidity and mortality from influenza in at-risk populations. This study suggests that challenges remain in the effective response to influenza outbreaks in care homes and that there are wide variations in practice at local level.     

Vaccine effectiveness in preventing influenza hospitalizations in Navarre, Spain, 2010-2011: cohort and case-control study

We evaluated the 2010-2011 seasonal influenza vaccine effectiveness in preventing hospitalizations. Using healthcare databases we defined the target population for vaccination in Navarre, Spain, consisting of 217,320 people with major chronic conditions or aged 60 years and older. All hospitalized patients with influenza-like illness (ILI) were swabbed for influenza testing. A total of 269 patients with ILI were hospitalized and 61 of them were found positive for influenza virus: 58 for A(H1N1)2009 and 3 for B virus. The incidence rates of hospitalization with laboratory-confirmed influenza were compared by vaccination status. In the Cox regression model adjusted for sex, age, children in the household, urban/rural residence, comorbidity, pandemic vaccination, pneumococcal vaccination, outpatient visits and hospitalization in the previous year, the seasonal vaccine effectiveness was 58% (95% CI: 16-79%). The nested test-negative case-control analysis gave an adjusted estimate of 59% (95% CI: 4-83%). These results suggest a moderate effect of the 2010-2011 seasonal influenza vaccine in preventing hospitalization in a risk population. The close estimates obtained in the cohort and the test-negative case-control analyses suggest good control of biases.     

台州市2018/2019年度社区老年人接种流感疫苗的保护效果

目的评估台州市2018/2019年度社区老年人接种三价灭活流感疫苗(TIV)的保护效果(VE)。方法运用前瞻性队列研究设计,招募接种和未接种TIV的≥60岁社区老年人随访6个月,观察流感样疾病(ILI)、因ILI就诊、因ILI或肺炎住院、因呼吸或循环系统疾病住院4种临床结局,计算TIV的VE。结果 TIV接种组、未接种组分别纳入研究对象1 048名、1 025名。接种TIV后1-3月预防4种临床结局的VE(95%CI)分别为-25.1(-80.4-13.2)%、-33.1(-99.2-11.1)%、35.8(-124.9-81.7)%和-12.6(-229.2-61.5)%;接种TIV后4-6月分别为25.5(-7.5-48.4)%、35.1(3.0-56.5)%、1.4(-249.1-72.1)%和-11.5(-240.9-63.5)%;接种TIV后1-6月分别为5.9(-24.2-28.7)%、11.6(-18.9-34.3)%、21.7(-99.2-69.2)%和-13.9(-155.5-49.2)%。结论台州市2018/2019年度社区老年人接种TIV对预防ILI病例发病、就诊和相关住院具有一定的保护效果。     

北京市老年人群流行性感冒疫苗免疫效果及成本效益评价

目的评价老年人群接种流行性感冒(流感)疫苗的效果和效益。方法选取北京市朝阳区和宣武区590名接种过流感疫苗,且年龄>60岁的老年人群为接种组,在社区中随机选择与接种组年龄、性别、健康状况等相匹配的602名未接种流感疫苗者为对照组。采用流行病学试验方法,在基线调查的基础上,分别于流感疫苗接种(基线调查)后的第1、3和6个月对试验组和对照组进行随访调查。结果接种组流感样疾病的发病率和就诊率均低于对照组,接种后第1、3和6个月内流感疫苗对流感样疾病的保护率分别为52.38%、36.84%和37.89%;接种流感疫苗减少流感样疾病就诊率分别为45.16%、50.54%和50.54%。接种组患感冒、其他呼吸系统疾病和慢性病的发病率和就诊率低于对照组,接种流感疫苗对感冒、其他呼吸道疾病和其他慢性疾病的保护率分别为49.54%、64.54%和38.82%。老年人群接种流感疫苗后第3和6个月内所获得的效益成本比为4.97∶1和4.98∶1。结论老年人群接种流感疫苗能有效地预防流感样疾病的发生,降低流感相关慢性疾病的发病率和复发率,且能够获得较高的成本效益。     

2015-2019年度合肥市流感样症状病例流行病学的特征分析

  目的  掌握合肥市2015-2019年度流行性感冒(简称流感)活动水平及流行动态,为今后流感防控提供科学依据。  方法  从“中国流感监测信息系统”收集2015-2019年度合肥市哨点医院每日流感样病例(influenza like illness,ILI)数据以及相应的病原学检测结果,分析其流行情况。  结果  2015-2019年度,合肥市3家哨点医院监测ILI累计183 789例,占门/急诊人数的5.06%。ILI发病率有明显的季节性,发病高峰主要在每年的11月至次年4月,各年度ILI发病率差异有统计学意义(χ2 =484.793,P＜0.001)。实验室共接收样本17 442份,检测结果阳性4 925份,占28.24%,高阳性率集中在12月至次年4月,不同月份阳性率差异有统计学意义(χ2 =2 567.306,P＜0.001)。从分型上看,主要为Victoria型和季H3型。ILI发病率和病原学阳性率之间呈正相关(r=0.491,P=0.021)。  结论  2015-2019年度合肥市流感活动呈现冬季和夏季2个高峰,不同流感病毒亚型混合流行。     

Higher than expected seasonal influenza activity in Victoria, 2007

In 2007, the Victorian influenza season exceeded normal seasonal activity thresholds. The average rate of influenza-like illness (ILI) reported by general practitioners (GPs) participating in sentinel surveillance was 9.0 cases per 1,000 consultations, peaking at 22 cases per 1,000 consultations in mid-August. The average ILI rate reported by the Melbourne Medical Locum Service (MMLS) was 11.5 per 1,000 consultations over the season. The MMLS ILI rate peaked at 30 per 1,000 consultations at the same time as peak rates were reported by GPs, with a secondary peak observed three weeks later (22 cases per 1,000 consultations). Influenza cases notified to the Victorian Department of Human Services peaked in mid-August with a secondary peak of influenza A in early September. Of the influenza positive swabs collected by GPs and among those collected throughout the state, 92% were type A and 8% were type B. The most common strains identified in Victoria in the 2007 influenza season were A/ Brisbane/10/2007-like followed by A/Solomon Islands/3/2006-like. While neither virus strain was specifically included in the 2007 Australian influenza vaccine, reasonable cross protection was afforded by the strains in the vaccine.     

Surveillance of influenza in Apulia, Italy, 1999-2000, 2000-2001, 2001-2002, and 2002-2003 seasons

BACKGROUND: The objective of this study was to evaluate, within the Italian National Influenza Epidemiological and Virological Surveillance, the rate of vaccination coverage, the incidence of Influenza Like-Illness (ILI), the incidence of Acute Respiratory Illness (ARI), and to identify the virus strains circulating in Apulia from 1999 to 2003. METHODS: Vaccination coverage rates were calculated based on the number of doses administered to individuals > 65 years of age. Every week, sentinel physicians reported ILI and ARI cases having occurred among their patients. Voluntary general practitioners (GPs) and paediatricians (Ps) collected oropharyngeal swab samples from patients suspected with ILI. Influenza viruses were isolated and identified by cell culture (MDCK cells) and RT-PCR. Virological surveillance was carried out by the ISS, in collaboration with a network of peripheral laboratories. RESULTS: In Apulia, vaccination coverage progressively increased to 68.6% during the 2002-2003 season. The analysis of ILI cases showed higher incidence rates during the 1999-2000 and 2002-2003 seasons. ARI rates appeared to have a more constant trend. ILI and ARI incidence rates were higher in the 0-14 year age group. CONCLUSION: The increase in vaccination coverage rates and implementation of the network of clinical, and epidemiological and virological surveillance are fundamental for the control and prevention of influenza.     

北京市普通人群甲型H1N1流感病毒血清抗体阳性影响因素的病例对照研究

目的探讨影响北京市普通人群血清甲型H1N1流感病毒抗体阳性的因素。方法按1∶1配对的病例对照研究设计,采用问卷调查方法,收集65例血清甲型H1N1流感病毒抗体阳性病例和65例阴性对照者的人口统计学特征、疫苗接种史,卫生习惯等信息。结果单因素分析显示,疫苗接种史、旅游史、调查前曾出现流感样症状、周围有确诊的甲型H1N1流感患者、调查前曾去医院发热门诊、勤洗手习惯等与血清甲型H1N1流感病毒抗体阳性有关。多因素条件Logistic回归分析结果表明,甲型H1N1流感病毒疫苗接种史（OR=4.82,95%CI：1.23-19.91）、调查前1月内曾出现过流感样症状（OR=2.53,95%CI：1.01-6.25）,勤洗手习惯（OR=0.21,95%CI：0.06-0.74）等3个因素与血清甲型H1N1流感病毒抗体阳性有关。结论甲型H1N1流感疫苗接种史、旅游史、曾出现流感样症状、曾与确诊的甲型H1N1流感患者接触、勤洗手习惯等与血清甲型H1N1流感病毒抗体阳性有关。提示应当继续推行甲型H1N1流感疫苗的接种,加强手卫生等一般措施是预防甲型H1N1流感的重要手段。     

Comparison of the pandemic H1N1 2009 experience in the Southern Hemisphere with pandemic expectations

Objective: To describe the epidemiological characteristics of the 2009 H1N1 pandemic virus (pH1N1) over the 2009 and 2010 influenza seasons in Australia and New Zealand (NZ) and compare them with expectations based on previous pandemics. Methods: Laboratory‐confirmed influenza and influenza‐like illness (ILI) data were collected from established general practitioner sentinel surveillance schemes in NZ, Victoria and Western Australia (WA) throughout the 2009 and 2010 winter influenza seasons. Respiratory swabs from a sample of ILI patients were tested for influenza type and subtype. ILI rates and laboratory‐confirmed influenza data were analysed by age group and over time. Morbidity, mortality and reproductive number data were collated from the published literature. Results: Peak ILI rates and the percentage of influenza‐positive swabs from ILI patients from all sentinel surveillance schemes were considerably lower in 2010 than 2009. Compared to the population, cases of ILI were over‐represented in the young. While the age distributions in NZ and WA remained consistent, ILI cases were significantly younger in Victoria in 2009 compared to 2010. In Victoria, laboratory‐confirmed pH1N1 comprised up to 97% of influenza‐positive swabs in 2009 but only 56–87% in 2010. Mortality and hospitalisations were lower in 2010. The effective reproduction number (R) for pH1N1 was estimated to be 1.2–1.5 in NZ and WA, similar to estimated R values for seasonal influenza. Data from the surveillance systems indicated differences in the epidemiology of pH1N1 compared to expectations based on previous pandemics. In particular, there was no evidence of a second pandemic wave associated with increased mortality, and complete influenza strain replacement did not occur. Implications: Pandemic planning needs to accommodate the potential for influenza viruses to produce pandemics of various infectiousness and degrees of severity.     

Correlates of general practitioners’ recommendations to patients regarding vaccination for the 2009–2010 pandemic influenza (A/H1N1) in France: Implications for future vaccination campaigns

Background

General practitioners’ (GPs) recommendations to their patients regarding influenza vaccination is a key determinant of patient uptake of influenza vaccination.

Objectives

To study factors associated with GPs’ recommendations regarding pandemic vaccination (pvaccination) to adults ≤65 years of age (hereafter referred to as adults) at risk and not at risk of severe complications of the 2009–2010 A/H1N1 influenza.

Patients/Methods

National cross-sectional survey of 1431 French GPs. Pvaccination recommendations by GPs to adults were studied according to three categories: recommended pvaccination to at-risk adults only; recommended pvaccination to all adults; recommended against pvaccination or did not provide any advice to any adult.

Results

GPs were more likely to recommend pvaccination to at-risk than not-at-risk adults (73.4% vs 40.1%, p < 0.01). GPs who consulted official sources of information rather than news media during the pandemic were more likely to recommend pvaccination to at-risk adults only (OR = 1.78; CI 95% = 1.27–2.48) and to all adults (OR = 2.03; CI 95% = 1.42–2.92) than other GPs. GPs’ unfavorable perceptions of the risk/efficacy balance of the pandemic vaccine (pvaccine) together with their perceptions of the low severity of the disease were negatively associated with recommending pvaccination. Hospitalization of GPs’ patients because of the influenza was specifically associated with pvaccine recommendation to all adults (OR = 2.81; CI 95% = 1.98–3.99) but not with pvaccine recommendation to at-risk adults only.

Conclusion

In the pandemic context, GPs’ perceptions of disease severity and the risk/efficacy balance of the pvaccine were the major determinants of French GPs recommending pvaccination or not. To increase the general public's acceptability of vaccination policies, GPs should be adequately informed about the course of the epidemics and the safety of the vaccine.     

Use of a Real-Time Syndromic Surveillance System to Improve Influenza Like Illness Screening and Documentation in Emergency Departments during the H1N1 Pandemic

Objective

Screening for Influenza Like Illness (ILI) is an important infection control activity within emergency departments (ED). When ILI screening is routinely completed in the ED it becomes clinically useful in isolating potentially infectious persons and protecting others from exposure to disease. When routinely collected, ILI screening in an electronic clinical application, with real time reporting, can be useful in Public Health surveillance activities and can support resource allocation decisions e.g. increasing decontamination cleaning. However, the reliability of documentation is unproven. Efforts to support the adoption of ILI screening documentation in a computer application, without mandatory field support, can lead to long term success and increased adherence.

Methods

We evaluated the impact of efforts to improve ILI screening documentation adherence in an electronic ED information system (EDIS) during wave 2 of the September–November 2009 H1N1 pandemic. ILI screening documentation rates were calculated across the 8 sites in Edmonton Zone of Alberta Health Services and subsequently correlated to interventions. Five interventions were evaluated: real-time verbal reminders (one-to-one nurse reminders), delayed email reminders (with the ILI screening documentation rates), meetings (strategize to improve documentation rate), media (visual media broadcasts) and clinic awareness (opening and operation of the influenza assessment clinic). A logistic regression model was used to derive odds ratios (OR) and 95% confidence intervals (CI) for correlation between the interventions and the screening rate change.

Results

The ILI screening not-documented (N/D) rate on September 27, 2009, was 75% (N/D = 781; ED visits = 1039). By November 25, the N/D rate had fallen to 11% and remained below 20% into July 2010. October 18, 2009 marked the first day that the daily positive (POS) ILI screen rate was at or above 10% of patient visits with a rate of 12% (POS = 139; ED visits = 1164). The POS rate sustained values >10% until November 25(peaking at 40% on October 28, 2009) reflecting influenza activity and informing public health and other decision makers. When all site screening rates were aggregated and compared to the intervention variables – e-mail reminders (OR = 2.176; 95% CI: 2.078–2.279), meetings (OR = 2.286; 95% CI: 2.089–2.501), media (OR = 4.894; 95% CI: 4.219–5.677), clinic awareness (OR = 1.145; 95% CI: 0.998–1.313) were positively associated with increased adherence. Where one-to-one reminders to document ILI screening were provided at one site, the ILI documentation increased (OR = 2.663; 95% CI: 2.260–3.138). E-mail reminders (OR = 0.852; 95% CI: 0.732–0.992) and meetings (OR = 0.696; 95% CI: 0.505–0.960) had less influence on ILI documentation when the single site was analyzed.

Conclusions

A variety of interventions successfully improved ILI screening documentation. The greatest impact was associated with e-mail reminders for recording ILI screening results, meetings on how to improve adherence and media broadcasts associated with the circulating pandemic influenza. The strongest reported effect size was seen in one site following one-to-one nurse reminders to record the ILI screening results. These results suggest that ILI documentation adherence can be successfully increased using a variety of interventions. Implementing and monitoring the effect of the interventions was made possible by the syndromic surveillance system, which at the same time, contributed to improved data used for infection prevention and control and public health purposes.     

中国2001～2003年流行性感冒流行特征分析

目的 分析中国2001～2003年流行性感冒(流感)流行特征。方法 收集2001～2003年全国流感监测网流感样病例(ILI)监测资料,流感病毒分离与鉴定结果以及爆发疫情信息进行分析。结果 2001～2003年,中国北方地区流感流行高峰为12月或次年1月,南方地区则为4、5、7、8月和11、12月。北方、南方地区ILI就诊百分比基线值分别为13.68％、13.08％。ILI的年龄构成与流感流行季节类型有关。流感爆发疫情以5月份最多(32％),一般在6月前后流感疫情毒株类型发生改变。结论 中国南、北方流感流行特征有所不同。南方地区可能存在春季流行高峰,尚需进一步监测和分析。南方地区4～6月期间流感爆发的毒株类型变化值得关注。     

2013-2017年无锡市流感年流感流行特征分析及预警值探讨

目的 分析近5年无锡市扩大流感监测后流行性感冒的流行特征,探索无锡市流感流行预警阈值。方法 对2013-2017年流感年无锡市4家流感监测哨点医院流感样病例(ILI)和病原学监测资料及网络上暴发疫情资料进行描述性统计分析。采用流感病毒最高阳性检出率的30%作为流行判断标准,以确立预警基线。结果 2013-2017年流感年无锡流感流行高峰在1、4、8、12月,70%～90%ILI为15岁以下年龄组人群,ILI的年龄构成与流感流行季节类型有关。无锡地区ILI就诊百分比基线值为5.43%,其灵敏度达到50.52%。暴发疫情发生时间主要集中在12月、次年1月和3月(76.92%),83.33%的疫情发生在中小学,B型Yamagata是引起冬春季暴发疫情的主要病原。结论 无锡地区存在冬春、夏季流感流行高峰,采用历史基线5年的核酸阳性率高值30%作为流感流行的标准计算相应的ILI预警基线值能起到流感暴发疫情早期预警的效果。     

2011-2017年苏州市区5岁以下儿童流感相关门诊就诊率的估计

  目的  估计2011-2017年苏州市区5岁以下儿童流感相关流感样病例（influenza-like illness，ILI）就诊率。  方法  2011年10月~2017年3月，在苏州大学附属儿童医院门急诊室开展对5岁以下儿童ILI病例的监测。收集咽拭子标本并采用实时定量逆转录-聚合酶链反应进行流感病毒检测。同时基于卫生服务利用数据及人口学数据，估计苏州市区5岁以下儿童流感相关ILI就诊数和就诊率。  结果  2011-2017年苏州市区约有45 930例次5岁以下流感相关ILI病例，其中因流感病毒A/H1N1感染就诊的ILI病例7 490例，A/H3N2就诊数为17 843例，B就诊数为20 597例。研究期间，苏州市区5岁以下儿童流感相关ILI病例的就诊率为6.4/100人年，其中2011-2012年流感相关ILI就诊率最高，达20.5/100人年，2012-2013年最低，为2.4/100人年。  结论  苏州市区5岁以下的儿童流感相关ILI就诊数和就诊率较高，疾病负担较大。     

Evaluation of Diagnostic and Therapeutic Approaches for Suspected Influenza A(H1N1)pdm09 Infection, 2009-2010

To assess adherence to real-time changes in guidelines for influenza diagnosis and use of oseltamivir during the 2009 influenza A(H1N1) pandemic, we reviewed medical records of patients with confirmed or suspected influenza-like illness (ILI) and those with no viral testing in a large Los Angeles (California, USA) hospital. Of 882 tested patients, 178 had results positive for influenza; 136 of the remaining patients received oseltamivir despite negative or no results. Oseltamivir use was consistent with national recommendations in >90%. Of inpatients, children were less likely than adults to have ILI at testing and to receive oseltamivir if ILI was found. Of outpatients, children were more likely to have positive test results; 20% tested did not have ILI or other influenza signs and symptoms. Twenty-five of 96 test-positive patients and 13 of 19 with lower respiratory tract disease were, inappropriately, not treated. Variations between practice and national recommendations could inform clinical education in future influenza seasons.