flu
[Mortality from acute respiratory infections and influenza (1976-1980)]

[Article in Spanish]

Morales Suarez-Varela MM, Llopis Gonzalez A, Sanz Aliaga SA, Sancho Izquierdo E.

Unidad de Salud Publica, Higiene y Sanidad Ambiental, Facultad de Farmacia, Universitat de Valencia.

Acute respiratory infections (ARI) and influenza (flu) are extremely common illnesses, which make up the main causes of medical consultation and absence from work. OBJECTIVE. To discover the level of mortality because of ARI and flu in the Health Areas within the Community of Valencia; to analyse their possible relationship with socio-economic factors and also to identify higher-risk groups according to age and sex. DESIGN. Retrospective study. SITE. The Community of Valencia. PATIENTS OR OTHER PARTICIPANTS. Mortality data across the Community were obtained from the mortality statistics published by the Generalitat (Government) of Valencia during the five-year period of 1976 to 1980. MAIN MEASUREMENTS AND RESULTS. The results establish that Health Areas 4, 6, 7, 9-12 and 18 present less mortality because of ARI and flu. These are the better areas, socio-economically speaking, although the data are without statistical significance. A spectacular increase in mortality in the age-group of those over 70 was observed, with no great differences found between the sexes. CONCLUSIONS. Given that the main interventions to prevent these diseases are based on vaccination, it would be useful to carry out vaccination programmes with greater thoroughness in those areas identified as of high risk.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1525307&dopt=Abstract flu, flu medicine, tamiflu



flu
Do knowledge and attitudes about influenza and its immunization affect the likelihood of obtaining immunization?

Gene J, Espinola A, Cabezas C, Boix C, Comin E, Martin A, Sanz E.

Family and Community Medicine Training Program, Barcelona Primary Health Care Center, Spain.

A telephone survey was conducted on 190 patients in Barcelona, Spain, at high-risk for influenza to evaluate the relationship between their knowledge and attitudes toward influenza and influenza immunization and whether they received the immunization. A discriminant function correlates (r = 0.86) with the immunization behavior and predicts the behavior before flu immunization in 84% of cases if we know the previous immunization behavior and adequately classifies the behavior in 82% if we don't know it (r = 0.75). Modifiable factors that predict immunization are self-identification as high-risk, belief that the immunization will not cause discomfort, intention to be immunized, and physician assigned. Those not immunized had a prevalent feeling that the shot is not effective, that they are not susceptible to the illness, and that the health center does not offer satisfactory organization to provide immunization. Furthermore, they felt that they had received controversial information through the mass media. We therefore believe that health education activities regarding influenza immunization should be specifically directed to increasing awareness of those who belong to a high-risk group, as well as to emphasizing susceptibility to the illness and the innocuousness of the immunization.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1549948&dopt=Abstract flu, flu medicine, tamiflu



flu
Epidemiology and the law: courts and confidence intervals.

Christoffel T, Teret SP.

School of Public Health, University of Illinois, Chicago 60680.

Beginning with the swine flu litigation of the early 1980s, epidemiological evidence has played an increasingly prominent role in helping the nation's courts deal with alleged causal connections between plaintiffs' diseases or other harm and exposure to specific noxious agents (such as asbestos, toxic waste, radiation, and pharmaceuticals). Judicial reliance on epidemiology has high-lighted the contrast between the nature of scientific proof and of legal proof. Epidemiologists need to recognize and understand the growing involvement of their profession in complex tort litigation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1746668&dopt=Abstract flu, flu medicine, tamiflu



flu
Improving influenza vaccination rates for high-risk inpatients.

Nichol KL.

Section of General Internal Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota 55417.

PURPOSE: In 1987, the Minneapolis Veterans Affairs Medical Center implemented an ongoing, multifaceted influenza vaccination program that targeted all high-risk outpatients followed at the medical center. While the program achieved and sustained vaccination rates of 60% or more for high-risk outpatients, vaccination rates for high-risk inpatients continued to be 25% or less. Beginning with the 1989-1990 immunization season, the "flu shot" program was extended to include all high-risk inpatients. Both the outpatient and inpatient components of the Minneapolis Flu Shot Program emphasized administrative and organizational elements. The program's goal was to achieve vaccination rates of at least 60% for both high-risk outpatients and inpatients. This study assesses the effectiveness of the inpatient program among elderly patients hospitalized on the medical service during the immunization season. PATIENTS AND METHODS: To estimate patient risk characteristics and vaccination rates, 50% of elderly patients who were discharged from the medical service during the immunization season were surveyed using a validated postcard questionnaire. Their responses were compared with the responses of elderly patients to the annual outpatient survey conducted to assess the "flu shot" program. RESULTS: Overall, 78.6% of elderly respondents discharged from the medical service during the immunization season were vaccinated. Vaccination rates within various high-risk subgroups all exceeded 70%. None of these vaccination rates for inpatient groups differed significantly from the rates for corresponding outpatients. CONCLUSION: An outpatient "flu shot" program that emphasizes administrative and organizational elements can be successfully expanded to high-risk inpatients. The vaccination rates attained with such a program may not only achieve but exceed the national health objective for influenza vaccination.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1750427&dopt=Abstract flu, flu medicine, tamiflu



flu
Evolution of pig influenza viruses.

Schultz U, Fitch WM, Ludwig S, Mandler J, Scholtissek C.

Institut fur Virologie, Justus-Liebig Universitat Giessen, Federal Republic of Germany.

There is evidence that the nucleoprotein (NP) gene of the classical swine virus (A/Swine/1976/31) clusters with the early human strains at the nucleotide sequence level, while at the level of the amino acid sequence, as defined by consensus amino acids and in functional tests, its NP is clearly "avian like." Therefore it was suggested that the Sw/31 NP had been recently under strong selection pressure, possibly caused by reassortment with other avian influenza genes, whose gene products have to cooperate intimately with NP (Gammelin et al., 1989. Virology 170, 71-80). This suggestion has been investigated by sequencing the genes of internal and nonstructural proteins of Sw/31. The data on these sequences and on the phylogenetic trees are not in accordance with that suggestion: all these genes cluster with the early human strains at the nucleotide level while, at the level of the amino acid sequence, most of them are more closely related to the avian strains, thus resembling NP in this respect. This indicates that these genes rather evolved concomitantly with the NP gene. Our data are in agreement with the suggestion that, at about the time of the Spanish Flu (1918/19), a human influenza A (H1N1) virus entered the pig population. Furthermore, it is known that the NP of the human influenza A viruses--in contrast to that of the avian and swine strains--has been under strong selection pressure to change (Gammelin et al., 1990. Mol. Biol. Evol. 7, 194-200. Gorman et al., 1990a. J. Virol. 64, 1487-1497). Thus, after transfer of a human strain into pigs, the selection pressure might be released, enabling the NP and the other genes of the swine virus to evolve back to the optimal avian sequences, especially at the functionally important consensus positions. The swine influenza viruses circulating since 1979 in Northern Europe--represented by A/Swine/Germany/2/81 (H1N1)--have all genes, so far examined, derived from an avian influenza virus pool and are different from the classical swine viruses.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2053297&dopt=Abstract flu, flu medicine, tamiflu



flu
Influenza vaccination coverage level at a cystic fibrosis center.

Marshall BC, Henshaw C, Evans DA, Bleyl K, Alder S, Liou TG.

Intermountain Cystic Fibrosis Center, Salt Lake City, Utah, USA. bruce.marshall hsc.utah.edu

BACKGROUND: Influenza causes substantial morbidity and mortality, particularly in vulnerable populations. Annual vaccination is the most effective means to prevent or attenuate this illness. The vaccine is recommended for patients with cystic fibrosis (CF) older than 6 months, but the degree of adherence with this recommendation is unknown. OBJECTIVES: To determine 1) the vaccination coverage level for the 1997-1998 influenza season in a population of CF patients, and 2) the factors associated with nonadherence with vaccination. DESIGN: Retrospective chart review, a mailed survey, and telephone interviews. SETTING: Intermountain CF Center. This center, accredited by the CF Foundation, delivers health care to affected individuals throughout the Intermountain West. Care of children and adults is based at Primary Children's Medical Center and the University of Utah Hospital, respectively. The adjacent hospitals are comprehensive, tertiary care medical centers on the University of Utah campus in Salt Lake City. Approximately one third of the center's patient population lives in southern Idaho. There are 2 affiliate centers in Idaho, one based in Pocatello/Idaho Falls and the other in Boise. PATIENTS: All patients over 6 months of age on the center's roster. RESULTS: We found documentation of influenza vaccination status in the medical records of 99 patients; 98 who received the vaccine and 1 who did not because of an allergy to egg products. Through the mailed surveys and telephone interviews, we collected data on 236 additional patients. Thus, we report data on 335 (92.5%) of 362 patients on the center's roster. A total of 256 (76.4%) of 335 patients received the influenza vaccine before the 1997-1998 flu season, including 181 (79.4%) of 228 children (<18 years of age) and 75 (70.1%) of 107 adult patients (</=18 years of age). We also analyzed the data assigning all patients to their major site of care, either the Salt Lake parent center or one of the Idaho affiliates. We found no difference in the vaccination rate when comparing parent center to affiliates: 179 (78.2%) of 229 patients at the parent center were vaccinated versus 77 (72.6%) of 106 patients at the affiliates. For the 79 patients who did not obtain the influenza vaccine, the major reasons were: "forgot," "too healthy," "too busy," "worried about the side effects," or "too sick at the time." The unvaccinated group had fewer clinic visits, fewer CF-related hospitalizations, and lived further from the care center than the vaccinated group. To further explore the association between contact with the center and vaccination status, we categorized patients into those who were evaluated in the outpatient clinic and/or hospitalized in 1997 and those who were not. We found that 80.8% of the 281 patients who actually received care at the center during 1997 were vaccinated as compared with only 59.5% of the 42 patients who did not receive care during that year. The timing of clinic visits also appears to be a critical factor. We found that 87.1% of patients who had a visit during the fourth quarter of the year had the vaccination as compared with 64.9% of patients who did not have a fourth quarter visit. A fourth quarter visit remained highly associated with vaccination in a logistic regression analysis, whereas number of clinic visits did not. CONCLUSIONS: The vaccination coverage level in this vulnerable population is higher than other high-risk groups of comparable age. Nonetheless, there is room for improvement. Strategies aimed at increasing patient contact with the CF center, particularly during the fourth quarter of the calendar year, may result in improved vaccination rates. Additional data encompassing a cross-section of CF centers would be helpful in ensuring that influenza vaccination is receiving adequate attention in this patient population. Systematic monitoring of influenza vaccination rates at a national level should be considered as a means of encouraging compliance with this important preventive measure. cystic fibrosis, influenza, vaccination, health care delivery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11986486&dopt=Abstract flu, flu medicine, tamiflu