[Epidemiological surveillance activities during the 2009 influenza pandemic in Spain: lessons learnt one year after]. / Actividades de vigilancia epidemiológica durante la pandemia de gripe (H1N1) 2009 en España: Reflexiones un año después.

In this article the actions taken in the area of epidemiological surveillance in Spain during the influenza pandemic and the recommendations drawn from them during the progression of the pandemic are reviewed. The performance of the Surveillance Subcommittee established in the National Influenza Preparedness and Response Plan was central to the coordination of these activities. The Surveillance Subcommittee was immediately activated when the alert was issued. Its role is also described in this review. The existence of a National Plan allowed a rapid and coordinated response after the alert declaration. The epidemiological and virological surveillance of the influenza pandemic was adapted to an evolving situation. In addition to routine influenza monitoring systems, new surveillance systems were put in place such as a case-based surveillance for community influenza cases and a case-based surveillance for severe cases and deaths due to the pandemic. Among the lessons learned from this pandemic, we would highlight the need to strengthen the timely analysis of data collected during an alert, the need to promote the exchange of information among public health and health care professionals, and to strengthen the response capacity in order to have resilient and consolidated public health structures for future health alerts.

[Pandemic influenza (H1N1) 2009 Outbreak in a Military Academy: start of community circulation in Spain]. / Brote de gripe pandémica (H1N1) 2009 en una academia militar: inicio de la circulación comunitaria en España.

BACKGROUND: On May 19, 2009, 21 cases of influenza-like illness were reported among soldiers from an Engineering Military Academy (ACING) in Hoyo de Manzanares, Spain. In the context of an influenza A (H1N1)2009 global alert, it was decided to investigate a possible pandemic influenza outbreak. To describe a possible outbreak of influenza A (H1N1)2009 in a Military Training Centre and to describe the measures adopted for transmission control of this new infection. METHODS: A specific questionnaire was administered and biological samples were collected from all cases under investigation. Isolation and quarantine were recommended for cases and contacts, respectively. RESULTS: Eighty-one cases were confirmed. Among 52 samples tested, 31 were positive for influenza virus A/California/7/2009. The average age of the cases was 22.0 years (range 18-31 years) and 84% were men. Most common reported symptoms were cough and fever. All cases were isolated and treated with oseltamivir, with full recovery. The total attack rate was 12.42%. None of the cases had history of travel to risk areas or contact with previously diagnosed cases outside the academy. Thirty-one confirmed cases related to this outbreak were identified outside the academy, 24 cases were family contacts and friends. CONCLUSIONS: This outbreak was the first evidence of community transmission of pandemic influenza H1N1 in Spain. The rapid detection of this outbreak enhanced an early implementation of measures aiming at the containment of its transmission.

[Critically ill patients with 2009 pandemic influenza A (H1N1) infection in Spain: factors associated with death, April 2009-January 2010]. / Casos de infección por gripe pandémica (H1N1) 2009 hospitalizados en cuidados intensivos en España: factores asociados a riesgo de muerte, Abril 2009-Enero 2010.

BACKGROUND: It is necessary to analyse the severe cases of pandemic influenza infection in order to identify vulnerable populations and adapt prevention and control policies accordingly. We analysed the clinical and epidemiological characteristics and risk factors associated with death in patients with 2009 pandemic influenza A (H1N1) infection hospitalised in intensive care units (ICUs) in Spain and reported from 24 April 2009 to 31 January 2010. METHODS: As part of the national strategy for surveillance of hospitalized cases with pandemic influenza, cased-based clinical and epidemiological information on all cases admitted to an ICU with 2009 pandemic virus (H1N1) infection was collected nationwide. RESULTS: Of 1,231 cases admitted to ICU, 271 died (case fatality ratio, 22%). The median age was 40 years (range: 0-90). A total of 838 (76.3%) patients had an underlying risk condition, being respiratory disease the most frequently reported (34.1%), followed by morbid obesity (18.8%), in adults. Antiviral treatment was given in 93.1% patients and in 25.6% (n = 231) it was initiated within 48 hours of symptoms onset. In a multivariate analysis, cancer (OR 2.71, 95%CI 1.44 to 5.1), immunodeficiency (OR 2.25, 95%CI 1.29 - 3.92) and morbid obesity (OR 1.79, 95%CI 1.13 to 2.85) were significantly associated with death in adults. CONCLUSIONS: The characterization of severe pandemic influenza cases has been crucial in identifying as risk factors of complications and death from influenza the presence of cancer and immunodeficiencies and for the first time, morbid obesity in adults.

[Enhanced surveillance of initial cases of pandemic influenza (H1N1) 2009 infection in Spain, April-June 2009]. / Vigilancia individualizada de los casos iniciales de infección por gripe pandémica (H1N1) 2009 en España, Abril-Junio 2009.

BACKGROUND: In April 2009, a new surveillance strategy for the detection of cases of pandemic influenza (H1N1) 2009 infection and for the implementation of appropriate control measures to contain its transmission was initiated in Spain. We describe the clinical and epidemiological characteristics of confirmed cases in Spain notified by the National Epidemiological Surveillance Network from April 24 to June 30, 2009. METHODS: As part of the initial surveillance response to the pandemic, case-based clinical and epidemiological information was collected nationwide on cases under investigation for pandemic virus (H1N1) 2009 infection and their contacts. RESULTS: Of 717 confirmed cases, 91% were notified by 5 Autonomous Communities. As of June 15,49.1% of cases belonged to school outbreaks. No nosocomial outbreaks were detected. The median incubation period was 3 days. Eighty-eight percent of cases were under the age of 30 years, and 24.9% were imported. The most frequent symptoms were cough (92%) and fever (81.8%). The median duration of symptoms was 5 days. Thirteen cases required hospitalization and one died. CONCLUSIONS: During the first months of the pandemic, pandemic influenza cases experienced a mild illness similar to seasonal influenza, predominantly affecting children and young adults. By the end of June 2009, the detection of outbreaks in different settings indicated the diffusion of the pandemic virus into the community and the start of its circulation.

[Physical activity and quality of life in older adults in Spain]. / Actividad física y calidad de vida de la población adulta mayor en España.

BACKGROUND AND OBJECTIVE: This study examined the relationship between leisure-time physical activity (LTPA) and health-related quality of life (HRQL) in the older adult population of Spain. SUBJECTS AND METHOD: Household cross-sectional survey on 3,066 subjects representatives of the non-institutionalized Spanish population aged 60 years and over. Data on LTPA was obtained with a structured questionnaire and HRQL was measured with the SF-36 instrument. Analyses were done through linear regression, where the dependent variable was each of the eight scales of the SF-36 and the main independent variable was LTPA. Analyses were adjusted for sociodemographic and social network variables, health habits, health services use, and chronic diseases. RESULTS: A total of 42.7% subjects had a sedentary activity, 54.2% light LTPA and 3% moderate/intense LTPA. As compared with sedentary activity, light LTPA was associated with a higher score in all SF-36 scales, except for the physical role and emotional role, among men and women. For subjects with light LTPA the increase in score was over 3 points in most SF-scales, which is usually considered as a clinically relevant change in HRQL. Results did not vary materially by age, level of education, obesity or chronic disease. The higher LTPA, the better HRQL (p for linear trend < 0.05 in most scales of the SF-36 questionnaire). CONCLUSIONS: Light LTPA is associated with better HRQL than sedentary activity. Because this association did not change with age, level of education, obesity or chronic disease, it is suggested that most older adults could improve their HRQL with, at least, a light LTPA.

Clinical characteristics and outcomes of diabetic patients who were hospitalised with 2009 pandemic influenza A H1N1 infection.

OBJECTIVES: To describe demographic and clinical data and outcomes of severe cases of 2009 pandemic influenza A H1N1 (pH1N1) infections for persons with diabetes. METHODS: We selected all person with diabetes (N = 252) among severe laboratory confirmed cases reported to the Spanish Surveillance System for detection of pH1N1 from June through December, 2009. One patient without diabetes matched by age and sex was selected. Collected variables included demographic characteristics, underlying medical conditions, outcome, clinical course and treatment. RESULTS: Among those suffering diabetes only 15.9% did not report any other underlying condition. 38% of diabetic patients and 27.4% of non diabetic patients were admitted to ICU (p = 0.008). Thirty subjects suffering diabetes and fifteen without the disease died (11.9% vs. 6%[p = 0.019]). Multivariable analysis showed that the independent risk factors for ICU admission or death were suffering cardiovascular disease (OR = 2.28), morbid obesity (OR = 2.08) and antiviral treatment started after 48 h of onset of symptoms (OR = 1.89). Suffering diabetes was not independent risk factors for ICU admission or death after adjusting for covariates. CONCLUSIONS: The worse outcome among diabetes sufferers could be a consequence of the higher prevalence of comorbid underlying medical conditions but not diabetes itself. Further prospective studies are needed to verify these results.