ABSTRACT
We describe the clinical and epidemiological characteristics of patients hospitalised with confirmed 2009 pandemic influenza A(H1N1) in Spain from April to December 2009 and the risk factors associated with a worse outcome (admission to an intensive care unit or death) in adults. Case-based epidemiological information was collected as part of the national strategy for the surveillance of severe cases. Of 3,025 patients, 852 were admitted to an intensive care unit and overall, 200 died. The median patient age was 38 years (range: 094). A total of 662 (26%) patients had no underlying risk conditions. Antiviral therapy was initiated within 48 hours after symptom onset in only 35.2% (n=711); the median length of time before treatment was four days. In a multivariate analysis, the start of antiviral therapy more than 48 hours after symptom onset (odds ratio (OR) 2.39; 95% confidence interval (CI): 1.79 to 3.2), morbid obesity (OR: 2.01; 95% CI 1.38 to 2.94), cardiovascular disease (OR: 1.79; 95% CI: 1.2 to 2.67) and chronic obstructive pulmonary disease (OR: 1.51; 95% CI: 1.03 to 2.2) were significantly associated with a worse outcome in adults.
Subject(s)
Hospitalization , Influenza A Virus, H1N1 Subtype , Influenza, Human/epidemiology , Pandemics , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Influenza, Human/diagnosis , Influenza, Human/therapy , Male , Middle Aged , Risk Factors , Severity of Illness Index , Spain/epidemiology , Time Factors , Young AdultABSTRACT
The European Centre for Disease Prevention and Control (ECDC) started to work on information gathering for early detection of public health threats in June 2005. Since then, based on a framework including events and data-based surveillance, EDCD has been learning by doing. The internal tools and procedures for epidemic intelligence (EI) were developed while screening signals. Information including relevant epidemiological data, media news detected and actions taken are recorded in a specific event information system (Threat Tracking Tool). We describe the main elements, process and outputs of EI activities at ECDC. We also describe the main results regarding travel-related diseases. Efforts are needed to better identify and gather information about travellers coming to the EU with imported diseases with a potential for further spread inside our territory.
Subject(s)
Communicable Disease Control/methods , Disease Transmission, Infectious/prevention & control , Sentinel Surveillance , Travel , European Union , HumansABSTRACT
RATIONALE: The management of acute infarction often necessitates a network of organisation between different centres, thus making it the object of an evaluation of professional practices (EPP). We report the experience in the Franche Comté province of an EPP at a regional level in the management of infarction. METHODS: All of the patients admitted to 10 of the 11 centres in the region were included in a prospective survey. Quality indicators for acute and chronic care were defined, as well as scores, on the basis of use of treatments specified in guidelines. RESULTS: Between May 2005 and May 2006, 1,170 patients were admitted. The patients' risk levels and quality scores were calculated. The rate of use of the quality indicators was higher in our survey than that observed in all of the published studies, except for the use of betablockers. The quality of care could therefore be considered as highly satisfactory. Comparison between the centres revealed some differences. Even after adjustment for the risk score on admission, the quality score for acute care was related to mortality at 1 month. CONCLUSIONS: An EPP is possible for the management of infarction, on a regional scale such as in the province of Franche Comté. The acute quality score turned out to be an independent factor for mortality. The indicators showed that the quality of care was highly satisfactory, even though more progress could be made in the prescription of betablockers.
