TY - JOUR AU - Morvan, Esra AU - Parra, Joanna AU - Roy, Gerard AU - Jeannel, Dominique PY - 2017/05/02 Y2 - 2024/03/28 TI - Surveillance system of severe influenza cases admitted to the regional ICU,2009-2015 JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Population Health Analysis of Patient-Centered, Health System Outcomes DO - 10.5210/ojphi.v9i1.7768 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7768 SP - AB - <div style="left: 79.8182px; top: 248.996px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.08117);" data-canvas-width="56.563006734006734">Objective</div><div style="left: 93.1234px; top: 262.249px; font-size: 12.564px; font-family: serif; transform: scaleX(0.986507);" data-canvas-width="335.2809287878787">The study aimed at: i) analyses the regional characteristics and risk</div><div style="left: 79.8182px; top: 277.025px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01258);" data-canvas-width="349.40911649831656">factors of severe influenza, taking into account dominant circulating</div><div style="left: 79.8182px; top: 291.8px; font-size: 12.564px; font-family: serif; transform: scaleX(0.961492);" data-canvas-width="349.9669569023567">virus(es) ii) estimate the regional completeness of the surveillance</div><div style="left: 79.8182px; top: 306.575px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00115);" data-canvas-width="38.04371043771043">system.</div><div style="left: 79.8182px; top: 334.707px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.11744);" data-canvas-width="73.28565488215487">Introduction</div><div style="left: 93.1234px; top: 347.961px; font-size: 12.564px; font-family: serif; transform: scaleX(0.992416);" data-canvas-width="337.5537515151517">Every year, circulating influenza viruses generate a significant</div><div style="left: 79.8182px; top: 362.736px; font-size: 12.564px; font-family: serif; transform: scaleX(0.965713);" data-canvas-width="350.29613299663305">number of deaths. During the 2009 pandemic influenza A(H1N1),</div><div style="left: 79.8182px; top: 377.511px; font-size: 12.564px; font-family: serif; transform: scaleX(0.975313);" data-canvas-width="350.2672358585858">a national non mandatory surveillance system of severe influenza</div><div style="left: 79.8182px; top: 392.286px; font-size: 12.564px; font-family: serif; transform: scaleX(0.965635);" data-canvas-width="350.57379680134676">cases admitted to intensive care units(ICU) was set up in France.</div><div style="left: 79.8182px; top: 407.062px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01238);" data-canvas-width="349.3563478114478">This surveillance is regionally driven by the regional offices (CIRE)</div><div style="left: 79.8182px; top: 421.837px; font-size: 12.564px; font-family: serif; transform: scaleX(0.968262);" data-canvas-width="350.39790117845126">of Santé publique France, the French Public Health Agency. This</div><div style="left: 79.8182px; top: 436.612px; font-size: 12.564px; font-family: serif; transform: scaleX(0.978031);" data-canvas-width="350.55872003366994">report provides epidemiologic analysis of the recorded data since</div><div style="left: 79.8182px; top: 451.387px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00548);" data-canvas-width="349.0359664983165">the implementation of surveillance in the Centre-Val de Loire region</div><div style="left: 79.8182px; top: 466.163px; font-size: 12.564px; font-family: serif; transform: scaleX(0.955761);" data-canvas-width="350.0473663299662">over seasons 2009-10 to 2015-16 in regard of influenza epidemics</div><div style="left: 79.8182px; top: 480.938px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00095);" data-canvas-width="51.298702020202015">dynamics.</div><div style="left: 79.8182px; top: 509.07px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.0727);" data-canvas-width="51.65049326599326">Methods</div><div style="left: 93.1234px; top: 522.324px; font-size: 12.564px; font-family: serif; transform: scaleX(0.978318);" data-canvas-width="337.4054966329968">Surveillance was carried out each year from October to April.</div><div style="left: 79.8182px; top: 537.099px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0445);" data-canvas-width="352.4671875420874">Descriptive and analytic analyses were conducted to compare</div><div style="left: 79.8182px; top: 551.874px; font-size: 12.564px; font-family: serif; transform: scaleX(1.03886);" data-canvas-width="350.1302885521883">population characteristics, pre-existing risk factors and the clinical</div><div style="left: 79.8182px; top: 566.649px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0729);" data-canvas-width="353.11046296296297">data according to influenza season and dominant circulating</div><div style="left: 79.8182px; top: 581.424px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02523);" data-canvas-width="349.86141952861914">influenza virus(es). Logistic regressions were performed to identify</div><div style="left: 79.8182px; top: 596.2px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00813);" data-canvas-width="349.2847331649831">factors associated with an increased risk of acute respiratory distress</div><div style="left: 79.8182px; top: 610.975px; font-size: 12.564px; font-family: serif; transform: scaleX(0.974154);" data-canvas-width="350.0461099326599">syndrome (ARDS) or death. Two capture-recapture analyses were</div><div style="left: 79.8182px; top: 625.75px; font-size: 12.564px; font-family: serif; transform: scaleX(1.03401);" data-canvas-width="349.9795208754209">performed to establish the completeness of the surveillance system</div><div style="left: 79.8182px; top: 640.525px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02079);" data-canvas-width="349.48575673400677">in the region. The first one was realized on all cases, using two data</div><div style="left: 79.8182px; top: 655.301px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0035);" data-canvas-width="349.116375925926">sources (hospital records/surveillance data) and the second one, only</div><div style="left: 79.8182px; top: 670.076px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01505);" data-canvas-width="349.5824993265992">on deaths, using three data sources(additional source: medical death</div><div style="left: 79.8182px; top: 684.851px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01286);" data-canvas-width="62.44294612794613">certificates).</div><div style="left: 79.8182px; top: 712.983px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.08437);" data-canvas-width="45.38107070707071">Results</div><div style="left: 93.1234px; top: 726.237px; font-size: 12.564px; font-family: serif; transform: scaleX(0.971172);" data-canvas-width="337.0939101010102">From 2009-10 to 2015-16, the outbreak of influenza epidemics</div><div style="left: 79.8182px; top: 741.012px; font-size: 12.564px; font-family: serif; transform: scaleX(0.975563);" data-canvas-width="350.79617912457934">was started more and more late. The number of severe influenza</div><div style="left: 79.8182px; top: 755.787px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00194);" data-canvas-width="348.9266599326599">cases reported in the Loire Valley varied from 19 in 2010-11 to 75 in</div><div style="left: 79.8182px; top: 770.563px; font-size: 12.564px; font-family: serif; transform: scaleX(0.993922);" data-canvas-width="348.75076430976407">2014-15. Overall, the most affected population was adults, from 41%</div><div style="left: 79.8182px; top: 785.338px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00083);" data-canvas-width="348.98947979797964">in 2011-12 to 83% in 2009-10. However seniors (more than 65 years</div><div style="left: 79.8182px; top: 800.113px; font-size: 12.564px; font-family: serif; transform: scaleX(0.992468);" data-canvas-width="348.7532771043771">old) represented an important part of patients during three epidemics:</div><div style="left: 79.8182px; top: 814.888px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01739);" data-canvas-width="351.6279141414141">50% in 2011-12 and around 45% during the two last seasons;</div><div style="left: 79.8182px; top: 829.664px; font-size: 12.564px; font-family: serif; transform: scaleX(1.03156);" data-canvas-width="350.0071616161616">during these epidemics, men, (60%-68%), were more affected than</div><div style="left: 79.8182px; top: 844.439px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02413);" data-canvas-width="349.87775269360264">women. Patients’ pre-existing risk factors were mainly: being older</div><div style="left: 79.8182px; top: 859.214px; font-size: 12.564px; font-family: serif; transform: scaleX(0.960415);" data-canvas-width="350.50343855218836">than 65 years old and suffering of cardiac or pulmonary diseases.</div><div style="left: 79.8182px; top: 873.989px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02169);" data-canvas-width="349.7571385521885">The comparison by dominant viruses over the seasons revealed that</div><div style="left: 79.8182px; top: 888.764px; font-size: 12.564px; font-family: serif; transform: scaleX(0.980637);" data-canvas-width="350.5122333333332">when A(H1N1) virus prevailed, severe influenza occurred mainly</div><div style="left: 79.8182px; top: 903.54px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02891);" data-canvas-width="349.7960868686869">in adults patients with any type of pre-existing risk factors whereas</div><div style="left: 79.8182px; top: 918.315px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00451);" data-canvas-width="349.1854777777778">when A(H3N2) virus prevailed, seniors with pre-existing pulmonary</div><div style="left: 79.8182px; top: 933.09px; font-size: 12.564px; font-family: serif; transform: scaleX(1.03356);" data-canvas-width="351.94578265993266">disease were the most affected. More than a third of patients</div><div style="left: 79.8182px; top: 947.865px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00437);" data-canvas-width="349.11763232323227">declared an ARDS. The overall observed lethality was close to 16%.</div><div style="left: 79.8182px; top: 962.641px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02645);" data-canvas-width="349.6252168350168">ARDS occurred more frequently in patients who were middle-aged</div><div style="left: 79.8182px; top: 977.416px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0163);" data-canvas-width="351.59022222222217">(45-64 years), immunocompromised or infected with A(H1N1).</div><div style="left: 79.8182px; top: 992.191px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01718);" data-canvas-width="349.57119175084165">Pre-existing pulmonary disease was a protective factor. Risk factors</div><div style="left: 79.8182px; top: 1006.97px; font-size: 12.564px; font-family: serif; transform: scaleX(0.97551);" data-canvas-width="348.54974074074056">associated with death were being older than 65 years, male and having</div><div style="left: 79.8182px; top: 1021.74px; font-size: 12.564px; font-family: serif; transform: scaleX(0.987494);" data-canvas-width="348.70050841750816">declared an ARDS. The completeness of this surveillance system was</div><div style="left: 79.8182px; top: 1036.52px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01603);" data-canvas-width="349.549832996633">estimated by capture-recapture methods at 59% for severe influenza</div><div style="left: 79.8182px; top: 1051.29px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00065);" data-canvas-width="154.90122390572395">cases and 40% for death cases.</div><div style="left: 452.303px; top: 248.996px; font-size: 12.564px; font-family: sans-serif; transform: scaleX(1.10256);" data-canvas-width="75.39640235690236">Conclusions</div><div style="left: 465.608px; top: 262.249px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01155);" data-canvas-width="336.0360235690236">The epidemiology of severe influenza and epidemics dynamics in</div><div style="left: 452.303px; top: 277.025px; font-size: 12.564px; font-family: serif; transform: scaleX(1.03682);" data-canvas-width="349.85890673400615">the Centre-Val de Loire follow the national trends. Every season is</div><div style="left: 452.303px; top: 291.8px; font-size: 12.564px; font-family: serif; transform: scaleX(0.960247);" data-canvas-width="350.21823636363655">characterized by the same dominant virus at national and regional</div><div style="left: 452.303px; top: 306.575px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01288);" data-canvas-width="351.4683516835012">levels in intensive care units. Influenza epidemics 2009-10 and</div><div style="left: 452.303px; top: 321.35px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02201);" data-canvas-width="351.79124579124584">2014-15 were particularly long and severe, the first dominated</div><div style="left: 452.303px; top: 336.126px; font-size: 12.564px; font-family: serif; transform: scaleX(1.01538);" data-canvas-width="351.7284259259259">by the A(H1N1)pdm09 virus and the second by the A(H3N2).</div><div style="left: 452.303px; top: 350.901px; font-size: 12.564px; font-family: serif; transform: scaleX(0.963703);" data-canvas-width="350.2898510101009">Our study has demonstrated that the populations at risk of severe</div><div style="left: 452.303px; top: 365.676px; font-size: 12.564px; font-family: serif; transform: scaleX(0.996439);" data-canvas-width="351.0122794612794">influenza differ according to the circulating virus(es). According</div><div style="left: 452.303px; top: 380.451px; font-size: 12.564px; font-family: serif; transform: scaleX(0.989851);" data-canvas-width="350.9846387205384">to the obtained estimations, the completeness of the surveillance</div><div style="left: 452.303px; top: 395.226px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0261);" data-canvas-width="349.881521885522">system, based on voluntary report by physicians, can be considered</div><div style="left: 452.303px; top: 410.002px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0071);" data-canvas-width="349.1113503367003">as satisfactory. Regarding influenza deaths relatively low percentage</div><div style="left: 452.303px; top: 424.777px; font-size: 12.564px; font-family: serif; transform: scaleX(1.0429);" data-canvas-width="349.7709589225588">of completeness may be explained by the fact that two sources are</div><div style="left: 452.303px; top: 439.552px; font-size: 12.564px; font-family: serif; transform: scaleX(1.00035);" data-canvas-width="350.9243316498316">hospital based whereas the third one, medical death certificates,</div><div style="left: 452.303px; top: 454.327px; font-size: 12.564px; font-family: serif; transform: scaleX(1.02022);" data-canvas-width="349.6113964646465">includes all influenzadeaths with no information on the death place.</div><div style="left: 452.303px; top: 469.103px; font-size: 12.564px; font-family: serif; transform: scaleX(0.983984);" data-canvas-width="348.55979191919187">Many patients were not vaccinated or their status was unknown. Most</div><div style="left: 452.303px; top: 483.878px; font-size: 12.564px; font-family: serif; transform: scaleX(0.965954);" data-canvas-width="350.27100505050527">cases admitted to ICU presented pre-existing risk factors included</div><div style="left: 452.303px; top: 498.653px; font-size: 12.564px; font-family: serif; transform: scaleX(0.985241);" data-canvas-width="350.74592323232304">in eligibility criteria in influenza vaccination policies. This study</div><div style="left: 452.303px; top: 513.428px; font-size: 12.564px; font-family: serif; transform: scaleX(0.982581);" data-canvas-width="345.9502547138046">outlines the importance of vaccination as the first prevention measure.</div> ER -