Niños hospitalizados con influenza en un hospital pediátrico de Argentina durante 2019-2022: ¿qué ha cambiado luego de la pandemia por COVID-19? / Children with influenza admitted at a children's hospital in Argentina in the 2019­2022 period: What has changed after the COVID-19 pandemic?

Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infección respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.

Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019­2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.

Coletânea de Respostas Rápidas-Turma 1: programa educacional em vigilância em saúde no enfrentamento da COVID-19 e de outras doenças virais VigiEpidemia / Collection of Rapid Responses-Class 1: educational program in health surveillance in coping with COVID-19 and other viral diseases VigiEpidemia

Coletânea dedicada aos estudos das respostas rápidas do Programa Educacional em Vigilância em Saúde no enfrentamento da COVID-19 e outras Doenças Virais (VigiEpidemia). Esse tema é de extrema relevância e atualidade em nosso contexto da saúde global e na resposta as emergências em saúde pública (ESP) de forma geral. As ESP, que englobam surtos e epidemias, desastres e desassistência à população, representam desafios complexos que exigem respostas ágeis e eficazes por parte das autoridades sanitárias, profissionais da saúde e comunidades como um todo. Até o momento, a pandemia de COVID-19 foi a maior ESP do Século XXI. Ela serviu como um lembrete doloroso da vulnerabilidade da humanidade diante da ameaça de doenças virais. Esta ESP, que teve resposta catastrófica em diversos momentos, evidenciou a importância do investimento em preparação, vigilância e resposta, destacando a necessidade de sistemas de vigilância robustos, colaboração internacional, Inteligência epidemiológica e comunicação transparente para mitigar o impacto devastador das doenças infecciosas na sociedade. As lições aprendidas com a pandemia de COVID-19 são vastas e multifacetadas. A importância da pesquisa, da educação em saúde e do desenvolvimento de vacinas foi evidenciada como uma prioridade crucial na proteção da saúde pública mundial. O investimento em pesquisas e em cursos para formação de profissionais que possam estar atentos as mudanças nos padrões e comportamentos das doenças infecciosas, além de atuar na resposta rápida quando necessário, é fundamental para estarmos preparados para as futuras pandemias. A vacinação, por exemplo, sempre foi uma das ferramentas mais poderosas para evitar surtos e epidemias e, durante a pandemia de COVID-19, ajudou a controlar os óbitos pela doença e possibilitou que voltássemos a ter uma vida normal. Além da vacina contra COVID-19, as vacinas de influenza e dengue também são exemplos notáveis de avanços científicos que desempenham um papel fundamental na prevenção de futuras ESP. Ao explorar os diversos aspectos da resposta, monitoramento e controle de surtos, epidemias e pandemias, esta coletânea visa fornecer uma compreensão abrangente dos desafios enfrentados, das melhores práticas e das estratégias eficazes para mitigar os impactos adversos desses eventos. Espera-se que este trabalho não apenas informe e eduque, mas também inspire ações concretas para fortalecer a recuperação e resiliência dos sistemas de saúde e proteger o bem-estar das comunidades mais vulneráveis do nosso pais.

A collection dedicated to the study of rapid responses by the Educational Program in Health Surveillance in addressing COVID-19 and other Viral Diseases (VigiEpidemia). This theme is of utmost relevance and timeliness in our context of global health and in responding to public health emergencies (PHE) in general. PHEs, which encompass outbreaks and epidemics, disasters, and neglect of the population, represent complex challenges that require swift and effective responses from health authorities, healthcare professionals, and communities as a whole. To date, the COVID-19 pandemic has been the largest PHE of the 21st century. It served as a painful reminder of humanity's vulnerability in the face of viral disease threats. This PHE, which had catastrophic responses at various times, highlighted the importance of investing in preparedness, surveillance, and response, underscoring the need for robust surveillance systems, international collaboration, epidemiological intelligence, and transparent communication to mitigate the devastating impact of infectious diseases on society. The lessons learned from the COVID-19 pandemic are vast and multifaceted. The importance of research, health education, and vaccine development was highlighted as a crucial priority in protecting global public health. Investing in research and training courses to prepare professionals who can be attentive to changes in the patterns and behaviors of infectious diseases and act quickly when needed is essential to be prepared for future pandemics. Vaccination, for example, has always been one of the most powerful tools to prevent outbreaks and epidemics, and during the COVID-19 pandemic, it helped control disease-related deaths and allowed us to return to a normal life. In addition to the COVID-19 vaccine, influenza and dengue vaccines are also notable examples of scientific advancements that play a key role in preventing future PHEs. By exploring the various aspects of response, monitoring, and control of outbreaks, epidemics, and pandemics, this collection aims to provide a comprehensive understanding of the challenges faced, best practices, and effective strategies to mitigate the adverse impacts of these events. It is hoped that this work will not only inform and educate but also inspire concrete actions to strengthen the recovery and resilience of health systems and protect the well-being of the most vulnerable communities in our country.

"Valha-nos a Providência!": festas e ritos católicos em tempos epidêmicos, Salvador-BA, Brasil, 1918-1919 / "God for us!": Catholic festivals and rites in times of epidemics, Salvador-BA, Brasil, 1918-1919

Resumo O artigo analisa as reações dos católicos vinculados às associações leigas na cidade do Salvador, no período da gripe espanhola (1918) e da varíola (1919). Os jornais foram as principais fontes utilizadas para a identificação das festas e dos ritos, tanto dos praticados para pedir a intercessão dos santos quanto daqueles que foram suspensos em função da necessidade de isolamento social. Apesar de ambas as doenças serem transmissíveis e do curto espaço de tempo entre as duas epidemias, a análise das fontes evidenciou diferentes reações dos fiéis quanto às medidas de proteção e busca da cura.

Abstract This article analyzes the reactions of Catholics linked to lay associations in the city of Salvador, in the period of the Spanish flu (1918) and smallpox (1919). Newspapers were the main sources used to identify the festivals and rites, both those practiced to ask for the intercession of the saints, and those that were suspended due to the need for social isolation. In spite of both diseases being transmissible and the short interval between the two epidemics, the analysis of the sources showed different reactions from the faithful regarding the measures of protection and the search for a cure.

Teleconsulta de enfermagem: desenvolvimento de plataforma para atendimento de casos de Covid-19 / Nursing teleconsultation: development of a platform for Covid-19 case management / Telecosulta en enfermería: desarrollo de una plataforma para el manejo de casos de Covid-19

Objetivo: Desenvolver uma plataforma virtual de Teleconsulta para atendimento a casos suspeitos de Síndromes Gripais e infecção por COVID-19. Metodologia: Trata-se de um estudo de natureza aplicada, com desenvolvimento de produção tecnológica e inovadora, prospectivo, ecológico, descritivo, de série temporal. A população do estudo foi formada por qualquer pessoa sintomática para Síndromes Gripais por COVID-19, suspeitos ou confirmados, de qualquer local do Brasil. Este estudo foi realizado em duas etapas, a saber: Etapa I: Desenvolvimento da Aplicação para Plataforma de Teleconsulta. Etapa II: atendimento por meio de Teleconsulta de Casos suspeitos de COVID-19 e Sindromes Gripais. A metodologia utilizada para o desenvolvimento da aplicação proposta foi a modelagem por prototipação evolucionária. Resultados: Foram realizados 209 atendimentos na Plataforma de Teleconsulta, sendo 151 (70%) do sexo feminino e 65 (30%) do sexo masculino, com prevalência de idade variando de 20 a 29 anos (41%). Quanto ao risco de infecção por COVID-19, 42 (20%) tinham alto risco, 75 (36%) médio risco e 92 (44%) baixo risco. Os sintomas mais prevalentes foram: secreção nasal ou espirros (53%), dores no corpo (49%), dor de cabeça (47%), dor de garganta (46%), tosse seca (35%), Febre (31%), falta de ar (25%) e diarreia (23%). Inicialmente o teleatendimento foi composto por teletriagem com classificação de risco com base na sintomatologia dos pacientes que foram codificados com pontuações conforme a gravidade do sintoma para formas graves de COVID-19. A classificação de risco categorizou os pacientes em risco baixo (1 a 9 pontos), risco médio (10 a 19 pontos) e risco alto (20 a 36 pontos). Em seguida, a teleconsulta foi agendada conforme disponibilidade do paciente por meio do método SBAR para comunicação efetiva e ao término do atendimento um plano de cuidados com Sistematização da Assistência de Enfermagem ­ SAE era encaminhado ao paciente por meio de WhatsApp ou e-mail. Conclusão: A plataforma de teleconsulta possibilitou a triagem dos pacientes, reduziu as visitas desnecessárias às unidades de emergência, permitiu a avaliação e monitoramento dos casos, bem como o acompanhamento de pacientes ambulatoriais que não necessitam de avaliação presencial.

Objective: To develop a virtual Teleconsultation platform for care of suspected cases of influenza syndromes and infection by COVID-19. Methodology: This is a study of applied nature, with development of technological and innovative production, prospective, ecological, descriptive, time series. The study population was made up of any person symptomatic for COVID-19 influenza syndromes, suspected or confirmed, from any location in Brazil. This study was conducted in two stages, namely: Stage I: Development of the Application for Teleconsultation Platform. Stage II: care through Teleconsultation of suspected cases of COVID-19 and influenza syndromes. The methodology used to develop the proposed application was evolutionary prototyping modeling. Results: There were 209 consultations in the Teleconsultation Platform, 151 (70%) were female and 65 (30%) were male, with prevalence of age ranging from 20 to 29 years (41%). As for the risk of infection by COVID-19, 42 (20%) had high risk, 75 (36%) medium risk and 92 (44%) low risk. The most prevalent symptoms were: nasal discharge or sneezing (53%), body aches (49%), headache (47%), sore throat (46%), dry cough (35%), fever (31%), shortness of breath (25%), and diarrhea (23%). Initially, the telecare was composed of teletry with risk classification based on the symptomatology of the patients who were coded with scores according to symptom severity for severe forms of COVID-19. The risk classification categorized patients into low risk (1 to 9 points), medium risk (10 to 19 points), and high risk (20 to 36 points). Then, the teleconsultation was scheduled according to the patient's availability through the SBAR method for effective communication and at the end of the service a care plan with Nursing Assistance Systematization - SAE was forwarded to the patient through WhatsApp or e-mail. Conclusion: Teleconsultation platform enabled patient triage, reduced unnecessary visits to emergency units, allowed the evaluation and monitoring of cases, as well as the follow- up of outpatients who do not need face-to-face evaluation.

Objetivo: Desarrollar una plataforma de Teleconsulta virtual para atender casos sospechosos de síndromes gripales e infección por COVID-19. Metodología: Se trata de un estudio aplicado, con desarrollo de producción tecnológica e innovadora, prospectivo, ecológico, descriptivo, con serie de tiempo. La población de estudio estuvo formada por cualquier persona sintomática de síndromes gripales por COVID-19, sospechada o confirmada, de cualquier localidad de Brasil. Este estudio se realizó en dos etapas, a saber: Etapa I: Desarrollo de Aplicaciones para la Plataforma de Teleconsulta. Etapa II: atención mediante teleconsulta de casos sospechosos de COVID-19 y síndromes gripales. La metodología utilizada para el desarrollo de la aplicación propuesta fue el modelado por prototipo evolutivo. Resultados: Se realizaron 209 consultas en la Plataforma de Teleconsulta, 151 (70%) del sexo femenino y 65 (30%) del masculino, con prevalencia de edades entre 20 a 29 años (41%). En cuanto al riesgo de infección por COVID-19, 42 (20%) fueron de alto riesgo, 75 (36%) de riesgo medio y 92 (44%) de bajo riesgo. Los síntomas más prevalentes fueron: secreción nasal o estornudos (53%), dolor de cuerpo (49%), dolor de cabeza (47%), dolor de garganta (46%), tos seca (35%), fiebre (31%), falta de aliento (25%) y diarrea (23%). Inicialmente, la teleasistencia consistía en teleselección con clasificación de riesgo en función de la sintomatología de los pacientes a los que se codificaba con puntuaciones según la gravedad del síntoma para formas graves de COVID-19. La clasificación de riesgo clasificó a los pacientes en riesgo bajo (1 a 9 puntos), riesgo medio (10 a 19 puntos) y riesgo alto (20 a 36 puntos). Luego, se programó la teleconsulta de acuerdo a la disponibilidad del paciente a través del método SBAR para una comunicación efectiva y al final de la atención se remitió al paciente un plan de cuidados con Sistematización de Atención de Enfermería - SAE vía WhatsApp o correo electrónico. Conclusión: La plataforma de teleconsulta posibilitó el triaje de pacientes, redujo las visitas innecesarias a las unidades de emergencia, permitió la evaluación y seguimiento de casos, así como el seguimiento de pacientes ambulatorios que no requieren evaluación presencial.

Miositis aguda asociada a infección por virus influenza. Serie de casos en un hospital pediátrico / Acute myositis associated with influenza infection. Case series in a pediatric hospital

La miositis aguda benigna asociada a influenza es una complicación esporádica. En Argentina, en el año 2022, hubo un aumento temprano de la circulación de influenza y del número total de las notificaciones, con la aparición de miositis secundarias. Serie clínica retrospectiva de nueve pacientes pediátricos que consultaron por dolor e impotencia funcional de extremidades inferiores, y enzimas musculares elevadas, en el hospital Pedro de Elizalde de la Ciudad Autónoma de Buenos Aires, entre agosto y octubre del 2022. En todos se detectó infección por virus influenza y se recuperaron sin secuelas. La miositis aguda benigna es una entidad infrecuente en la infancia, cuyo diagnóstico es predominantemente clínico y de recuperación ad integrum. Debe ser sospechada en pacientes con clínica compatible en contexto de alta circulación viral. La vigilancia epidemiológica aporta herramientas para identificar los virus circulantes y sus posibles complicaciones.

Benign acute myositis associated with influenza is a sporadic complication. In Argentina, in 2022, there was an early increase in influenza circulation and the total number of notifications, with the appearance of secondary myositis. Retrospective clinical series of nine pediatric patients who consulted for pain and functional impotence of the lower extremities, and elevated muscle enzymes, at the Pedro de Elizalde hospital in the Autonomous City of Buenos Aires, between August and October 2022. In all of them, infection by influenza virus and recovered without sequelae. Benign acute myositis is a rare entity in childhood, whose diagnosis is predominantly clinical and recovery ad integrum. It should be suspected in patients with compatible symptoms in a context of high viral circulation. Epidemiological surveillance provides tools to identify circulating viruses and their possible complications.

Influenza aviar H5N1. ¿Debemos preocuparnos? / Avian influenza H5N1. Should we worry?

Desde la segunda mitad de 2022 se ha reportado un aumento de casos de influenza en aves migratorias en Latinoamérica. Los virus influenza A y B son los principales agentes asociados a influenza estacional epidémica en humanos. Los virus influenza A circulan no solo en humanos sino también en animales, incluyendo aves migratorias. El intercambio de segmentos de ARN genómico entre dos virus del mismo tipo aumenta la diversidad de los subtipos circulantes e incluso puede facilitar la generación de progenie viral potencialmente pandémica. La naturaleza zoonótica del virus influenza A puede generar infecciones en humanos con virus de origen animal. El virus influenza A de origen aviar ha ocasionado transmisiones en humanos, incluyendo casos graves y muertes, siendo la influenza A H5N1 la más destacada. Es importante tomar medidas de prevención y control en caso de aumento de casos de influenza en aves migratorias para prevenir posibles pandemias en Chile y el mundo.

Since the second half of 2022, an increase in influenza cases in migratory birds has been reported in Latin America. Influenza A and B viruses are the main agents associated with seasonal epidemic influenza in humans. Influenza A viruses circulate not only in humans but also in animals, including migratory birds. The exchange of genomic RNA segments among two viruses increases the diversity of circulating subtypes and may even facilitate the generation of potentially pandemic viral progeny. The zoonotic nature of influenza A virus can generate infections in humans with animal-origin viruses. Avian-origin influenza A virus has caused transmissions in humans, including severe cases and deaths, with influenza A H5N1 being the most prominent. It is important to take preventive and control measures in case of an increase in influenza cases in migratory birds to prevent possible pandemics in Chile and the world.

Nota Técnica N. 3/2023 - SES/GVEDT: Nota técnica de Síndrome Gripal (SG) e Síndrome Respiratória Aguda Grave (SRAG) pelo vírus influenza / Technical Note N. 3/2023 - SES/GVEDT: Technical Note on Influenza Syndrome (SG) and Severe Acute Respiratory Syndrome (SARS) due to the influenza virus

A vigilância d influenza no Brasil é composta pela vigilância sentinela de Síndrome Gripal (SG), Síndrome Respiratória Grave (SRAG) em pacientes hospitalizados ou óbitos e em surtos de SG em instituições e de longa permanência. As unidade sentinelas de Síndrome Gripal têm como objetivo monitorar a circulação dos vírus respiratórios com ênfase em influenza e Sars-CoV-2, identificar as variações sazonais por faixa etária, prover cepas virais para formulação de vacinas de influenza, vigilância genômica do coronavírus, e identificar situações inusitadas

Influenza surveillance in Brazil is composed of sentinel surveillance of Influenza Syndrome (SG), Severe Respiratory Syndrome (SARS) in hospitalized or deceased patients and in SG outbreaks in institutions and long-term care facilities. The flu syndrome sentinel units aim to monitor the circulation of respiratory viruses with emphasis on influenza and Sars-CoV-2, identify seasonal variations by age group, provide viral strains for the formulation of influenza vaccines, genomic surveillance of the coronavirus, and identify unusual situations

Vacunación antigripal en personal de salud que trabaja con niños en un prestador privado de salud: años 2019 y 2020 / Flu vaccine administered to health care personnel working with children at a private health provider (2019-2020) / Vacina contra influenza administrada a profissionais de saúde que trabalham com crianças numa operadora de saúde privada (2019-2020)

Introducción: la infección por el virus de la gripe genera morbimortalidad. El personal de salud es uno de los grupos prioritarios para ser vacunado. Objetivo: conocer cobertura vacunal contra la gripe del personal de salud que trabaja con niños en CASMU en 2019 y 2020, y las razones por las que se vacunaron o no. Material y método: estudio observacional, descriptivo, transversal. Recolección de datos en 2020 a través de un cuestionario anónimo. Se registraron las siguientes variables: edad, lugar de trabajo (urgencias, internación o policlínica), función, riesgo de enfermedad grave, aplicación o no de vacuna en 2019 y en 2020, y motivos de vacunación o de no vacunación. Resultados: completaron la encuesta 204 trabajadores. En 2019, se vacunó el 73 % y, en 2020, el 77,5 % (p >0,05). El personal de salud de urgencias de Montevideo presentó mayor vacunación (en 2019, el 90,7 %; en 2020, el 93 %), seguido por el personal de salud de urgencias de Ciudad de la Costa e internación. Según la ocupación, para los médicos se registró una vacunación mayor al 95 % (2019 y 2020); para las licenciadas y auxiliares de enfermería, el 68,6 % en 2019 y el 75,7 % en 2020; para el personal no clínico, el 33 % en 2019 y el 41 % en 2020. El aumento de vacunados en 2020 no fue significativo en ninguna de las ocupaciones. El 21 % de los encuestados presentaba riesgo de enfermedad grave; el 65 % de estos se vacunó en 2019 y el 74,4 % en 2020. La totalidad de las embarazadas de la muestra se vacunó. Motivos más frecuentes mencionados de vacunación (2019 y 2020): prevención (50,5 %) y ser personal de salud (36 %). El de quienes no se vacunaron fue "Nunca enfermo" (19 %). Quienes no se administraron la vacuna en 2019, pero sí en 2020, mencionaron más frecuentemente la pandemia como motivo. Conclusión: en CASMU, el porcentaje de trabajadores de la salud en contacto con niños que se adhirió a la vacunación antigripal en 2019 y 2020 fue mayor al 70 %. No se registró aumento significativo por la pandemia. Se debe mejorar la cobertura en policlínicas y del personal de salud no médico, en particular del personal de salud con factores de riesgo de enfermedad grave.

Introduction: the influenza virus infection causes morbidity and mortality. Health care personnel (HCP) is one of the priority groups to be vaccinated. Objective: to learn about HCP's vaccination coverage against influenza of those workers working with children at CASMU in 2019 and 2020, and the reasons why they received vaccination or did not. Material and Methods: observational, descriptive, crosssectional study. Data collection in 2020: anon ymous survey. Variables: age, place of work (emer gency, hospital or clinic), function, risk of serious illness, vaccination received (or not received) in 2019 and 2020 and reasons. Results: 204 workers completed the survey; influenza vaccination: 73% in 2019 and 77.5% in 2020 (p>0.05). Montevideo's Emergency Department presented the highest level of vaccination and hospitalization (2019-90.7%; 2020-93%) followed by the Ciudad de la Costa's Emergency Department. By occupational level: doctors: vaccination> 95% (2019 and 2020); graduates and nursing assistants: 2019-68.6%; 2020- 75.7%; administrative, kitchen, cleaning and gate house staff: 2019-33%, 2020-41%. The increase in vaccinated personnel in 2020 was not significant for any of the occupations. 21% of those surveyed had a risk of serious illness; 65% were vaccinated in 2019 and 74.4% in 2020. All the sampled pregnant women were vaccinated. The most frequent reasons mentioned for vaccination (2019 and 2020): "prevention" (50.5%), being PS (36%). Those who were not vaccinated stated that were "never ill" (19%). Those who had not received the vaccine in 2019, but received in 2020, mostly mentioned the "pandemic" as a reason. Conclusion: in CASMU, the percentage of health workers in contact with children who adhered to the flu vaccination in 2019 and 2020 was higher than 70%. There was no significant increase after to the pandemic. Coverage in polyclinics and nonmedical HCP, in particular those HCP with risk factors for serious diseases, should be improved.

Introdução: a infecção pelo vírus influenza gera morbimortalidade. O pessoal de saúde (PS) é um dos grupos prioritários a ser vacinado. Objetivo: conhecer a cobertura vacinal contra influenza do PS que atende crianças no CASMU em 2019 e 2020, e os motivos pelos quais foram vacinados ou não. Material e Métodos: estudo observacional, descritivo e transversal. Coleta de dados em 2020: questionário anônimo. Variáveis: idade, local de trabalho (emergência, internação ou policlínica), função, anos de trabalho, risco de doença grave, aplicação ou não da vacinação em 2019 e 2020 e motivos. Resultados: 204 trabalhadores responderam à pesquisa; vacinação contra influenza: 73% em 2019 e 77,5% em 2020 (p> 0,05). O pronto socorro de Montevidéu apresentou o maior nível de vacinação (2019-90,7%; 2020-93%) seguido pelo pronto socorro de Ciudad de la Costa e internação. Ocupação: médicos: vacinação> 95% (2019 e 2020); graduados e auxiliares de enfermagem: 2019-68,6%; 2020-75,7%; Pessoal administrativo, cozinha, limpeza e porteiros: 2019-33%, 2020-41%. O aumento de vacinados em 2020 não foi significativo em nenhuma das ocupações. 21% dos entrevistados corriam risco de doenças graves; 65% deles foram vacinados em 2019 e 74,4% em 2020. Todas as gestantes da amostra foram vacinadas. Motivos mais citados para a vacinação (2019 e 2020): "prevenção" (50,5%), sendo PS (36%). Aqueles que não foram vacinados disseram que eles "nunca ficavam doentes" (19%). Os que não receberam a vacina em 2019, mas sim em 2020, citaram com mais frequência a "pandemia" como motivo. Conclusão: no CASMU, a percentagem de profissionais de saúde em contato com crianças que aderiram à vacinação contra gripe em 2019 e 2020 foi superior a 70%. Não houve aumento significativo após a pandemia. A cobertura em policlínicas e profissionais de saúde não médicos e, em particular, profissionais de saúde com fatores de risco para doenças graves, deve ser melhorada.

Ethical considerations on placebo-controlled vaccine trials in pregnant women / Consideraciones éticas sobre los ensayos de vacunas controlados con placebo en mujeres embarazadas / Considerações éticas sobre estudos de vacina controlada com placebo em gestantes

Abstract Placebo use in clinical trials, whenever a proven effective treatment exists, is one of the most debated topics in contemporary research ethics. This article addresses the ethical framework for placebo use in clinical trials assessing vaccine efficacy in pregnant women. Vaccine trial participants are healthy at the outset and some must be infected during the study to demonstrate the product's efficacy, meaning that placebo-treated participants are under risk of serious and irreversible harm. If effective vaccines exist, such risk precludes placebo use. This interdiction should be extended to any clinical trial of vaccine efficacy in pregnant women, because a demonstration of clinical efficacy in nonpregnant individuals and comparable immunogenic responses in pregnant women are predictors of efficacy in pregnancy as well. Moreover, product effectiveness in real-world use scenarios can be ascertained by observational studies conducted after its inclusion in vaccination campaigns.

Resumen El uso de placebo en ensayos clínicos es uno de los principales temas debatidos sobre la ética en investigación contemporánea cuando existe un tratamiento eficaz probado. Este artículo aborda la ética en el uso de placebo en ensayos clínicos sobre la eficacia de vacuna en mujeres embarazadas. Las participantes en los ensayos de vacunas estaban sanas al inicio del estudio, y algunas fueron vacunadas durante el estudio para demostrar la eficacia del producto. Las participantes tratadas con placebo corren el riesgo de sufrir daños graves e irreversibles. Si existen vacunas efectivas, este riesgo impide el uso de placebo. Este impedimento debe extenderse a cualquier ensayo clínico de eficacia de vacuna en embarazadas, pues la eficacia clínica demostrada en mujeres no embarazadas y las respuestas inmunogénicas comparables con las embarazadas son predictores de eficacia en el embarazo. Además, la efectividad del producto se constata en estudios observacionales realizados tras las campañas de vacunación.

Resumo O uso de placebo em ensaios clínicos, quando um tratamento comprovadamente eficaz existe, é um dos principais tópicos debatidos na ética em pesquisa contemporânea. Este artigo aborda o quadro ético para o uso de placebo em ensaios clínicos que avaliam a eficácia de vacina em gestantes. Participantes em ensaios de vacina são saudáveis no início e alguns devem ser inoculados durante o estudo para demonstrar a eficácia do produto. Ou seja, participantes tratados com placebo estão sob risco de danos graves e irreversíveis. Se existirem vacinas eficazes, esse risco impede o uso de placebo. Essa interdição deve ser estendida a qualquer ensaio clínico de eficácia de vacina em gestantes, pois a demonstração de eficácia clínica em não gestantes e as respostas imunogênicas comparáveis em gestantes também são preditoras de eficácia na gravidez. Ademais, a eficácia do produto em cenários reais de uso pode ser verificada por estudos observacionais realizados após sua inclusão em campanhas de vacinação.

Technical guidelines for seasonal influenza vaccination in China (2023-2024) / 中华流行病学杂志

Influenza is an acute respiratory infectious disease that is caused by the influenza virus, which seriously affects human health. The influenza virus has frequent antigenic drifts that can facilitate escape from pre-existing population immunity and lead to the rapid spread and annual seasonal epidemics. Influenza outbreaks occur in crowded settings, such as schools, kindergartens, and nursing homes. Seasonal influenza epidemics can cause 3-5 million severe cases and 290 000-650 000 respiratory disease-related deaths worldwide every year. Pregnant women, infants, adults aged 60 years and older, and individuals with comorbidities or underlying medical conditions are at the highest risk of severe illness and death from influenza. China has experienced a influenza epidemic season dominated by A (H1N1) pdm09 subtype from mid-February to the end of April 2023, and the intensity was slightly higher than the epidemic year before the COVID-19. We may face the risk of interaction or co-circulation of respiratory infectious diseases such as COVID-19 and influenza during the coming season. Annual influenza vaccination is an effective way to prevent influenza, reduce influenza-related severe illness and death, and reduce the harm caused by influenza-related diseases and the use of medical resources. The currently approved influenza vaccines in China include trivalent inactivated influenza vaccine (IIV3), quadrivalent inactivated influenza vaccine (IIV4), and trivalent live attenuated influenza vaccine (LAIV3). IIV3 and IIV4 are produced as a split virus vaccine and subunit vaccine; LAIV3 is a live, attenuated virus vaccine. The influenza vaccine is a non-immunization program vaccine, which means that residents are voluntarily vaccinated. China CDC has issued "Technical guidelines for seasonal influenza vaccination in China" every year from 2018 to 2022. Over the past year, new research evidence has been published at home and abroad, and new influenza vaccines have been approved for marketing in China. To better guide the prevention and control of influenza and vaccination in China, the National Immunization Advisory Committee (NIAC) Technical Working Group (TWG), Influenza Vaccination TWG updated and revised the 2022-2023 technical guidelines with the latest research progress into the "Technical guidelines for seasonal influenza vaccination in China (2023-2024)." The new version has updated five key areas: (1) new research evidence－especially research conducted in China-has been added, including new estimates of the burden of influenza disease, assessments of influenza vaccine effectiveness and safety, and analyses of the cost-effectiveness of influenza vaccination; (2) policies and measures for influenza prevention and control were issued by the National Health Commission of the People's Republic of China and National Disease Control and Prevention Administrationy over the past year; (3) influenza vaccines approved for marketing in China this year; (4) composition of trivalent and quadrivalent influenza vaccines for the 2023-2024 northern hemisphere influenza season; and (5) recommendations for influenza vaccination during the 2023-2024 influenza season. The 2023-2024 guidelines recommend that all people aged 6 months and above who have no contraindications should get the influenza vaccination. For adults aged ≥18 years, co-administration of inactivated SARS-CoV-2 and influenza vaccines in separate arms is acceptable regarding immunogenicity and reactogenicity. For people under 18 years of age, there should be at least 14 days between influenza vaccination and COVID-19 vaccination. The guidelines express no preference for influenza vaccine type or manufacturer-any approved, age-appropriate influenza vaccines can be used. Combining the influenza epidemic tendency and the prevention and control strategy of multiple diseases, the technical guidelines recommend priority vaccination of the following high-risk groups during the upcoming 2023-2024 influenza season to minimize harm from influenza: (1) healthcare workers, including clinical doctors and nurses, public health professionals, and quarantine professionals; (2) adults ≥60 years of age; (3) individuals with comorbidities; (4) people living in nursing homes or welfare homes and staff who take care of vulnerable, at-risk individuals; (5) pregnant women; (6) children 6-59 months of age; (7) family members and caregivers of infants under 6 months of age; and (8) people who work in nursery institutions, primary and secondary schools, and supervision places. Children 6 months to 8 years of age who receive inactivated influenza vaccine for the first time should receive two doses, with an inter-dose interval of 4 or more weeks. Children who previously received the influenza vaccine and anyone aged 9 years or older need only one dose. LAIV is recommended only for a single dose regardless of the previous influenza vaccination. Vaccination should begin as soon as influenza vaccines become available, and preferably should be completed before the onset of the local influenza season. Repeated influenza vaccination during a single influenza season is not recommended. Vaccination clinics should provide immunization services throughout the epidemic season. Pregnant women can receive inactivated influenza vaccine at any stage of pregnancy. These guidelines are intended for use by staff of CDCs, healthcare workers, maternity and child care institutions and immunization clinic staff members who work on influenza control and prevention. The guidelines will be updated periodically as new evidence becomes available.

Systematic review and Meta-analysis of efficacy and safety of Shufeng Jiedu Capsules in treatment of influenza / 中国中药杂志

This study aims to systematically review the efficacy and safety of Shufeng Jiedu Capsules in the treatment of influenza. The randomized controlled trial(RCT) of Shufeng Jiedu Capsules alone or in combination with conventional western medicine for treating influenza were retrieved from PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP, Wanfang, and ClinicalTrails.gov. The data analysis was performed in RevMan 5.4.1. The Cochrane risk of bias assessment tool was used to evaluate the quality of the involved RCT, and GRADEpro GDT to assess the quality of the evidence. A total of 11 RCTs involving 1 836 patients were included in this study. Compared with conventional western medicine, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.09, 95%CI[1.03, 1.15], P=0.002), shortened the time to relief of cough, and increased the 3-day sore throat relief rate, whereas there was no significant difference in the time to fever abatement, the time to relief of sore throat, 3-day cough relief rate, or 3-day runny nose relief rate. Subgroup-analysis showed that Shufeng Jiedu Capsules + conventional western medicine improved the response rate(RR=1.11, 95%CI[1.08, 1.15], P<0.000 01), shortened the time to relief of cough, and increased the 3-day relief rate of symptoms(cough, sore throat, and runny nose) compared with conventional western medicine alone, while there was no significant difference in the time to fever abatement or the time to relief of sore throat. Shufeng Jiedu Capsules alone could not improve the response rate(RR=0.97, 95%CI[0.93, 1.02], P=0.19). In addition, Shufeng Jiedu Capsules/Shufeng Jiedu Capsules + conventional western medicine vs conventional western medicine were no significant difference in adverse reactions(RR=0.98, 95%CI[0.57, 1.69], P=0.95). The available evidence suggests that Shufeng Jiedu Capsules is effective and safe in the treatment of influenza, and the combination of Shufeng Jiedu Capsules with conventional western medicine can accelerate the relief of symptoms. However, since the number and quality of the included studies were low, the above findings remained to be further verified by multicenter RCT with large sample sizes.

Application and prospect of natural active ingredients of traditional Chinese medicine in immunological adjuvant for influenza vaccine / 中国中药杂志

Vaccination is an effective method for preventing influenza, and adjuvants can enhance the immune response intensity and persistence of influenza vaccines. However, there are currently shortcomings in clinical adjuvant approvals, ineffectiveness against weak antigens, and a tendency to cause headaches. Therefore, the development of safe and effective novel adjuvants for influenza vaccines is particularly important to enhance vaccine immunogenicity and safety. Given the wide range of sources, high safety, and biodegradability of traditional Chinese medicine(TCM), some studies have described it as a vaccine adjuvant. This article reviewed the current status and challenges of influenza vaccine adjuvants, summarized the types of TCM adjuvants, the safety and immunomodulatory effects of natural active ingredients from TCM combined with influenza vaccines, the role of TCM adjuvants in antigen storage, antigen presentation capability, immune cells and cytokines, and immune responses, and analyzed the advantages and disadvantages of TCM adjuvants compared with small molecule adjuvants, with the aim of promoting the clinical development and commercialization of TCM adjuvants for influenza vaccines.

Cost-effectiveness analysis of Chaiyin Granules in treatment of influenza / 中国中药杂志

This study aimed to evaluate the cost-effectiveness of Chaiyin Granules compared with Oseltamivir Phosphate Capsules in the treatment of influenza(exogenous wind-heat syndrome). Based on a randomized, double-blind, positive drug parallel control clinical trial, this study evaluated the pharmacoeconomics of Chaiyin Granules with cost-effectiveness analysis method. A total of 116 patients with influenza from eight hospitals(grade Ⅱ level A above) in 6 cities were selected in this study, including 78 cases in the experimental group with Chaiyin Granules and Oseltamivir Phosphate Capsules placebo, and 38 cases in the control group with Oseltamivir Phosphate Capsules and Chaiyin Granules placebo. The total cost of this study included direct medical cost, direct non-medical cost, and indirect cost. The remission time of clinical symptoms, cure time/cure rate, antipyretic onset time/complete antipyretic time, viral nucleic acid negative rate, and traditional Chinese medicine(TCM) syndrome curative effect were selected as the effect indicators for cost-effectiveness analysis. Four-quadrant diagram was used to estimate the incremental cost-effectiveness ratio. The results showed that Chaiyin Granules were not inferior to Oseltamivir Phosphate Capsules in the remission time of clinical symptoms of influenza(3.1 d vs 2.9 d, P=0.360, non-inferiority margin was 0.5 d). Compared with Oseltamivir Phosphate Capsules, Chaiyin Granules would delay the remission time of clinic symptoms of influenza for 1 d, but could save 213.9 yuan. 1 d delay in cure time could save 149.3 yuan; 1% reduction in the cure rate could save 8.2 yuan; 1 d delay in antipyretic onset time could save 295.4 yuan; 1 d delay in complete antipyretic time could save 114.3 yuan; 1% reduction in the 5-day cure rate of TCM syndrome could save 19.2 yuan. Different from other indicators, there was no statistically significant difference between two groups in the effect of negative conversion rate of viral nucleic acid, but the cost was lower and the effect was superior, and the pharmacoeconomics was not different from that of Oseltamivir Phosphate Capsules in the field of influenza treatment.

Progress in research of influenza vaccination in pregnant women / 中华流行病学杂志

Influenza is an acute respiratory infectious disease caused by influenza virus. Pregnancy is associated with physiologic and immunological changes that may increase the risk for influenza virus infection and influenza-related complications. Influenza vaccination is the most effective way to prevent influenza virus infection. WHO and many countries have classified pregnant women as a priority population for influenza vaccination, however, there are still many challenges for promoting influenza vaccination in pregnant women in China, influenza vaccination coverage in pregnant women remains low and some influenza vaccine package inserts list pregnancy as an absolute contraindication. In this paper, we summarize the research progress in the effects of influenza infection and influenza vaccination during pregnancy both at home and abroad, then discuss the strategies to promote influenza vaccination in pregnancy for the purpose of providing reference for the related research and policy development in China.

Epidemiologic characteristics and influencing factors of influenza outbreaks in Guangdong Province, 2015-2022 / 中华流行病学杂志

Objective: To grasp the epidemiological characteristics of influenza outbreaks in Guangdong Province by analyzing the outbreaks of influenza-like cases reported in Guangdong Province from January 2015 to the end of August 2022. Methods: In response to the outbreak of epidemics in Guangdong Province from 2015 to 2022, information on on-site epidemic control was collected, and epidemiological analysis was conducted to describe the characteristics of the epidemics. The factors that influence the intensity and duration of the outbreak were determined through a logistic regression model. Results: A total of 1 901 influenza outbreaks were reported in Guangdong Province, with an overall incidence of 2.05%. Most outbreak reports occurred from November to January of the following year (50.24%, 955/1 901) and from April to June (29.88%, 568/1 901). A total of 59.23% (1 126/1 901) of the outbreaks were reported in the Pearl River Delta region, and primary and secondary schools were the main places where outbreaks occurred (88.01%, 1 673/1 901). Outbreaks with 10-29 cases were the most common (66.18%, 1 258/1 901), and most outbreaks lasted less than seven days (50.93%,906/1 779). The size of the outbreak was related to the nursery school (aOR=0.38, 95%CI:0.15-0.93), the Pearl River Delta region (aOR=0.60, 95%CI:0.44-0.83), the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=3.01, 95%CI:1.84-4.90), the influenza A(H1N1) (aOR=2.02, 95%CI:1.15-3.55) and the influenza B (Yamagata) (aOR=2.94, 95%CI: 1.50-5.76). The duration of outbreaks was related to school closures (aOR=0.65, 95%CI: 0.47-0.89), the Pearl River Delta region (aOR=0.65, 95%CI: 0.50-0.83) and the time interval between the onset of the first case and the time of report (>7 days compared with ≤3 days: aOR=13.33, 95%CI: 8.80-20.19; 4-7 days compared with ≤3 days: aOR=2.56, 95%CI: 1.81-3.61). Conclusions: An influenza outbreak in Guangdong Province exhibits two peaks, one in the winter and spring seasons and the other in the summer. Primary and secondary schools are high-risk areas, and early reporting of outbreaks is critical for controlling influenza outbreaks in schools. Furthermore, comprehensive measures should be taken to prevent the spread of the epidemic.

Spatial and temporal distribution characteristics of seasonal A(H3N2) influenza in China, 2014-2019 / 中华流行病学杂志

Objective: To analyze the spatial and temporal distribution characteristics of seasonal A(H3N2) influenza [influenza A(H3N2)] in China and to provide a reference for scientific prevention and control. Methods: The influenza A(H3N2) surveillance data in 2014-2019 was derived from China Influenza Surveillance Information System. A line chart described the epidemic trend analyzed and plotted. Spatial autocorrelation analysis was conducted using ArcGIS 10.7, and spatiotemporal scanning analysis was conducted using SaTScan 10.1. Results: A total of 2 603 209 influenza-like case sample specimens were detected from March 31, 2014, to March 31, 2019, and the influenza A(H3N2) positive rate was 5.96%(155 259/2 603 209). The positive rate of influenza A(H3N2) was statistically significant in the north and southern provinces in each surveillance year (all P<0.05). The high incidence seasons of influenza A (H3N2) were in winter in northern provinces and summer or winter in southern provinces. Influenza A (H3N2) clustered in 31 provinces in 2014-2015 and 2016-2017. High-high clusters were distributed in eight provinces, including Beijing, Tianjin, Hebei, Shandong, Shanxi, Henan, Shaanxi, and Ningxia Hui Autonomous Region in 2014-2015, and high-high clusters were distributed in five provinces including Shanxi, Shandong, Henan, Anhui, and Shanghai in 2016-2017. Spatiotemporal scanning analysis from 2014 to 2019 showed that Shandong and its surrounding twelve provinces clustered from November 2016 to February 2017 (RR=3.59, LLR=9 875.74, P<0.001). Conclusion: Influenza A (H3N2) has high incidence seasons with northern provinces in winter and southern provinces in summer or winter and obvious spatial and temporal clustering characteristics in China from 2014-2019.

Development and application syndromic surveillance and early warning system in border area in Yunnan Province / 中华流行病学杂志

Objective: To establish a dynamic syndromic surveillance system in the border areas of Yunnan Province based on information technology, evaluate its effectiveness and timeliness in the response to common communicable disease epidemics and improve the communicable disease prevention and control in border areas. Methods: Three border counties were selected for full coverage as study areas, and dynamic surveillance for 14 symptoms and 6 syndromes were conducted in medical institutions, the daily collection of information about students' school absence in primary schools and febrile illness in inbound people at border ports were conducted in these counties from January 2016 to February 2018 to establish an early warning system based on mobile phone and computer platform for a field experimental study. Results: With syndromes of rash, influenza-like illness and the numbers of primary school absence, the most common communicable disease events, such as hand foot and mouth disease, influenza and chickenpox, can be identified 1-5 days in advance by using EARS-3C and Kulldorff time-space scanning models with high sensitivity and specificity. The system is easy to use with strong security and feasibility. All the information and the warning alerts are released in the form of interactive charts and visual maps, which can facilitate the timely response. Conclusions: This system is highly effective and easy to operate in the detection of possible outbreaks of common communicable diseases in border areas in real time, so the timely and effective intervention can be conducted to reduce the risk of local and cross-border communicable disease outbreaks. It has practical application value.

The correlations between influenza and meteorological factors in 15 cities of northern China, 2008-2020 / 中华流行病学杂志

Objective: To understand the influence of meteorological factors on the morbidity of influenza in northern cities of China and explore the differences in the influence of meteorological factors on the morbidity of influenza in 15 cities. Methods: The monthly reported morbidity of influenza and monthly meteorological data from 2008 to 2020 were collected in 15 provincial capital cities, including Xi 'an, Lanzhou, Xining, Yinchuan and Urumqi (5 northwestern cities), Beijing, Tianjin, Shijiazhuang, Taiyuan, Hohhot, Ji'nan, Zhengzhou (7 northern cities), Shenyang, Changchun and Harbin (3 northeastern cities). The panel data regression model was applied to conduct quantitative analyze on the influence of meteorological factors on influenza morbidity. Results: The univariate and multivariate panel regression analysis showed that after controlling the population density and other meteorological factors, for each 5 ℃ drop of monthly average temperature, the morbidity change percentage (MCP) of influenza was 11.35%, 34.04% and 25.04% in the 3 northeastern cities, 7 northern cities and 5 northwestern cities, respectively, and the best lag period months was 1, 0 and 1 month; When the monthly average relative humidity decreased by 10%, the MCP was 15.84% in 3 cities in northeastern China and 14.80% in 7 cities in northern China respectively, and the best lag period months was 2 and 1 months respectively; The MCP of 5 cities in northwestern China was 4.50% for each 10 mm reduction of monthly accumulated precipitation, and the best lag period months was 1 month; The MCPs of 3 cities in northeastern China and 5 cities in northwestern China were 4.19% and 5.97% respectively when the accumulated sunshine duration of each month decreased by 10 hours, the best lag period months was 1 month. Conclusions: In northern cities of China from 2008 to 2020, the temperature, relative humidity, precipitation and sunshine duration all had negatively impact on the morbidity of influenza, and temperature and relative humidity were the main sensitive meteorological factors. Temperature had a strong direct impact on the morbidity of influenza in 7 cities in northern China, and relative humidity had a strong lag effect on the morbidity of influenza in 3 cities in northeastern China. The duration of sunshine in 5 cities in northwestern China had a greater impact on the morbidity of influenza compared with 3 cities in northeastern China.