[Deadliest flu]. / La grippe la plus meurtrière.

Many questions remain unanswered regarding the so-called "Spanish" influenza pandemic of 1918. This article addresses three of them and describes the state of knowledge for each of them: Where did the pandemic start? How many people died? And why was it so deadly?

Beaucoup de questions restent sans réponses en ce qui concerne la pandémie grippale dite «  espagnole  ¼ de 1918. Cet article en traite trois et décrit l'état des connaissances pour chacune d'elles  : Où la pandémie a-t-elle commencé  ? Combien de personnes en sont mortes  ? Et pourquoi a-t-elle été si meurtrière  ?

COVID-19, Virtual Engagement and the Psychoid Imagination.

The impact of the COVID-19 pandemic on analytic training and the delivery of educational content is explored here. The proliferation of Zoom therapy and teaching is creating a post-human platform to which nearly everyone in contemporary society has had to adapt. Looking at the possible meanings of the pandemic, a psychoid factor (the virus) engaging the imagination has come to the fore as a response to climate change. The striking similarity to the H1N1 viral pandemic ("Spanish flu") is noted, especially in the context of C. G. Jung having had a case in 1919 during which he experienced a number of visions and dreams. The imagery produced can be seen as an implicit attempt at "re-enchanting the world" found in The red book. Finally, a reconsideration of pedagogy in response to the pandemic is discussed with an eye to the archetypal aspects of internet communications.

Cet article étudie l'impact de la pandémie de COVID-19 sur la formation des analystes et sur la manière dont le contenu éducatif est dispensé. La prolifération de thérapie et de formation par Zoom crée une plateforme post-humaine à laquelle quasiment toute personne dans la société contemporaine a eu à s'adapter. En regardant les sens possibles que l'on peut donner à la pandémie, un facteur psychoïde (le virus) qui mobilise l'imagination a pris le devant de la scène en tant que réponse au changement climatique. L'article souligne la similarité frappante avec la pandémie virale H1N1 (la grippe espagnole), particulièrement dans le contexte où C.G. Jung l'a attrapée en 1919 et a fait l'expérience d'un certain nombre de visions et de rêves. L'imagerie produite peut être vue comme une tentative implicite de « ré-enchanter le monde ¼ telle qu'on la trouve dans le Livre Rouge. En conclusion, une reconsidération de la pédagogie issue de la pandémie est discutée en tenant compte des aspects archétypaux des communications par internet.

Se exploran aquí las repercusiones de la pandemia de COVID-19 en la formación analítica y en la transmisión de contenidos educativos. La proliferación de la terapia y la enseñanza vía Zoom está creando una plataforma posthumana a la que casi todo el mundo en la sociedad contemporánea ha tenido que adaptarse. En cuanto a los posibles significados de la pandemia, un factor psicoide (el virus) que atrae la imaginación ha pasado a primer plano como respuesta al cambio climático. Se observa la sorprendente similitud con la pandemia viral H1N1 ("gripe española"), especialmente en el contexto de un caso que C.G. Jung tuvo en 1919 durante el cual experimentó una serie de visiones y sueños. La imaginería producida puede verse como un intento implícito de "reencantar el mundo" que se encuentra en El Libro Rojo. Por último, se plantea una reconsideración de la pedagogía en respuesta a la pandemia, teniendo en cuenta los aspectos arquetípicos de las comunicaciones por Internet.

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities.

A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted living facilities proactively in order to prevent such a disaster from occurring again. Vaccination, not just against COVID-19, but also against other vaccine-preventable illness, will be a key component of this effort. However, there are currently substantial gaps in the uptake of vaccines recommended for older adults. Technology offers an opportunity to assist in filling these vaccination gaps. Our experiences in Fredericton, New Brunswick suggest that a digital immunization solution would facilitate better uptake of adult vaccines for older adults in assisted and independent living facilities and would help policy and decision makers to identify coverage gaps and develop interventions to protect these individuals.

Open Secrets: Silence, Suppression, and Memory in the History of Canada's 1918-20 Influenza Pandemic.

For several decades, the 1918-20 global influenza outbreak has been called "the forgotten pandemic." Although recent scholarly and public interest in the pandemic has complicated the narrative of forgetting, the label has stuck. Highlighting historical evidence of influenza's long-term impact upon survivors, family, and community in Canada, the flu stories presented here, diverse in form and content, verify that a key question in pandemic influenza history is not whether the pandemic was forgotten or remembered, but by whom, and in what ways, it has been suppressed - or foregrounded. By moving beyond the classic epidemic plot line, with beginning, middle, and end, historians can find new methodologies and evidence with which to more fully understand the influenza pandemic's unfolding intersection with colonialism, war, social inequality, and labour struggles in the 20th century.

[Influenza A: H1N1 post-viral membranoproliferative glomerulonephritis occurring in aggressive systemic mastocytosis: Case report and literature review]. / Glomérulonéphrite membrano-proliférative post-grippale chez un patient atteint de mastocytose systémique agressive : observation commentée et revue de la littérature.

Systemic mastocytosis is characterised by tissular infiltration and a cytokine storm due to mast cells excessive proliferation and activation. Herein, we report an extraordinary case of AH1N1 influenza post-viral glomerulonephritis occurring in the course of an aggressive systemic mastocytosis with an associated hematological neoplasm. Because of a multisystemic involvement including the liver and lungs, we treated mastocytosis with midostaurin (multiple inhibitor of kinase protein), anti H1/H2 blockers and dexamethasone as first line treatment. One month later and despite vaccination, he developed a severe acute lung injury with respiratory distress due to AH1N1 influenza in association with the nephrotic syndrome. Kidney biopsy disclosed a membranoproliferative glomerulonephritis that was successfully treated with mycophenolate mofetil. Only a few cases of influenza post-viral or post-vaccination glomerulonephritis are documented in the medical literature. This is an exceptional association of uncommon conditions occurring within only a few months in the same patient.

[COVID-19 et flu: vaccination intent among health professionals]. / Covid-19 et grippe : intention de vaccination chez les professionnels de santé.

The infection protection and control team and occupational health service come together every year to promote the flu vaccine among health professionals. In 2020, the risk of the co-circulation of the flu virus and SARS-CoV-2 strengthened their case. During the last trimester, we surveyed health professionals to find out their intention with regard to the flu and covid-19 vaccines: 42% said they wanted to be vaccinated against the flu, but only 23% were willing to have the covid-19 vaccine.

Diabetes is a major cause of influenza-associated mortality in Mexico.

BACKGROUND: Influenza is a major cause of mortality worldwide. Most influenza-associated deaths are associated with cardiovascular or respiratory disorders. However, a large proportion of influenza-associated deaths do not have respiratory or cardiovascular disorders declared as the underlying cause of death. Diabetic individuals are at increased risk for influenza-mortality. In this study, we assessed the contribution of diabetes to influenza-associated mortality in Mexico. METHODS: Diabetes influenza-associated mortality was estimated for the Mexican population using National Mortality Databases from the Mexican Ministry of Health from 1998 through 2015. Diabetes influenza-associated mortality was calculated applying Serfling cyclical regression models to weekly mortality rates for persons 20-59 years, 60 and more years, and all ages, and by sex. RESULTS: There was a high correlation between weekly pneumonia and influenza mortality and diabetes-related mortality. Yearly influenza-associated diabetes mortality rates varied between 2.0 and 5.9/100,000. Up until the 2005-2006 season, diabetes-associated mortality rates were higher in females, while after that season rates were higher in males. Yearly influenza-associated diabetes mortality rates for adults 20-59 years of age ranged between 1.7 and 3.4/100,000, while estimates for adults 60 years and older ranged between 16.3 and 46.1/100,000. Approximately one third of estimated diabetes influenza-associated deaths occurred in adults 20-59 years of age. On average, diabetes deaths accounted for 19.6% of estimated influenza-associated all-cause mortality. CONCLUSION: Diabetes is a major cause of estimated influenza-associated mortality in Mexico. Health-care authorities and professionals in countries with high diabetes prevalence should be aware of the potential impact of influenza in individuals with this condition.

[Maternal deaths due to infections in France 2013-2015]. / Mortalité maternelle par infection en France 2013­2015.

Over the 2013-2015 period, maternal mortality due to infections accounted for 10 % of direct maternal deaths and 13 % of indirect maternal deaths. Among the 21 deaths from infection, and compared to the last triennium, maternal deaths from genital infection doubled with 11 deaths during the 2013-2015 period. This included 6 cases of puerperal toxic shock syndrome, 4 of which due to Streptococcus A, and 5 cases of sepsis caused by intrauterine infection due to Gram-Negative Bacillus. Indirect maternal deaths due to infections from extragenital sources represented 10 deaths in this triennium, including four influenza infections and three infectious complications of an immunosuppressive state (uncontrolled HIV infection for two patients and CMV encephalitis during an immunosuppressive treatment for one patient). Of these 21 deaths by infectious causes, 6 direct maternal deaths and 9 indirect maternal deaths were considered preventable. The most common preventable factors were those related to medical management (13 times): diagnostic failure or delayed diagnosis leading to a delayed medical treatment, absence of influenza vaccination. The other contributory factors were related to the organization of healthcare (delayed transfer, lack of communication between clincians) as well as factors related to patient social vulnerability.

The 1918 "Spanish Flu" Pandemic in the Ottoman Capital, Istanbul.

Although the general course, possible transmission routes, and actual sociodemographic destruction of the 1918 influenza pandemic in the Western world are well documented, the literature lacks similar data about the Middle East. On the calamity's centenary, this article aims to contribute to filling this gap, investigating the presence and effects of the pandemic in Istanbul, the city bridging the West and East, then as the capital of the Ottoman Empire. After the retrieval of the most relevant articles in Vakit, a daily Istanbul newspaper active throughout the pandemic, a variety of items, including articles with firsthand pronouncements from contemporaneous medical authorities and a clinical account of supportive autopsy findings, are scrutinized and interpreted. The reviewed data are concluded to indicate no epidemiological or factual exception, showing significant parallelism with the Western experience of the pandemic in terms of increased influenza mortality and morbidity, severe clinical presentation, common misinformation and misdiagnosis, and failure to provide effective prevention and medical treatment.

Management of seasonal influenza by family physicians.

INTRODUCTION: Seasonal influenza is responsible for approximately 2.5 million consultations with the family physician (FP) per year in France. We performed this study with FPs to assess whether their practice complied with French guidelines. MATERIAL AND METHOD: Descriptive survey carried out from June to August 2018 using a questionnaire sent electronically to 1,140 Alsatian FPs. RESULTS: A total of 121 FPs responded to the questionnaire (10.6%). The main clinical symptoms that FPs believed to be the most reliable to diagnose influenza were fever (95%) and arthromyalgia (76.9%), well ahead of cough (27.3%). Overall, 23.1% of FPs declared that they occasionally used microbiological confirmation; 80.2% of FPs performed hand hygiene once per consultation but 95.9% did not wear surgical masks when managing patients with influenza and only 53.7% wore them when they themselves presented with influenza-like symptoms. Hand sanitizers, masks, or tissues were made available to patients in 35.5%, 19.8%, and 30.6%, respectively. Overall, 77.7% of participating physicians were vaccinated against influenza. Influenza vaccination was widely offered to high-risk patients, but some groups were insufficiently vaccinated: obese patients (32.2%) and pregnant women (47.9%). Overall, 48.8% of physicians never prescribed oseltamivir at a curative dose and 72.7% never prescribed it at a preventive dose; 86.8% of physicians prescribed at least one non-recommended symptomatic treatment including an NSAID (24.8%) or aspirin (12.4%). CONCLUSION: This study revealed several mismatches with guidelines and suggested potential corrective actions.

[Insufficient influenza vaccination coverage in giant cell arteritis. A French population-based study]. / Couverture vaccinale anti grippale insuffisante dans l'artérite à cellules géantes.

PURPOSE: To evaluate the rate of seasonal influenza vaccination coverage (IVC) in incident giant cell arteritis (GCA) patients compared with controls. METHODS: The vaccination rate was estimated from vaccine dispensation. IVC was compared between GCA and their controls using longitudinal multivariate Poisson regression. RESULTS: During the influenza campaigns from 2005-2006 to 2010-2011, the IVC rates in the GCA group and the control group ranged from 60.8 to 74.7% vs. 56.6 to 70.4%, respectively. Incident GCA influenza vaccination rate was 20% higher than controls (RR=1.20 ; IC 1.09 to 1.32, P<0.001). CONCLUSION: Although suboptimal, IVC in incident GCA was statistically better than controls.

[The opinion of private duty nurses in Martinique on the vaccination of elderly subjects]. / L'opinion des infirmiers libéraux en Martinique sur la vaccination des sujets âgés.

Improving immunisation coverage for older adults is a public health issue. Since 2008, nurses have been authorised to vaccinate this population against influenza without a medical prescription. One study examined the opinions of a sample of 78 private duty nurses in Martinique on influenza and anti-tetanus vaccination of elderly populations. The majority of nurses said they were not in favour of vaccination.

[Vaccination During Pregnancy]. / Impfungen in der Schwangerschaft.

Vaccination During Pregnancy Abstract. Vaccinations administered to women during pregnancy can provide protection against serious infectious diseases for the mother, for the newborn, or both. Two vaccines are routinely recommended during pregnancy: Influenza and Pertussis. While the influenza vaccine protects mainly the pregnant mother, who is at an increased risk for severe affection, the pertussis vaccine is an effective protection to infants who are at particularly high risk of pertussis complications and mortality in the first three months of life.

[Alterations in responses to vaccines in older people]. / Altération des réponses vaccinales avec l'âge.

The aging population raises a number of public health issues including a need to address the severity and frequency of infections observed in older people. Vaccines play an important role in prevention. However, immunosenescence alters the intensity and quality of vaccine responses, thus limiting the impact of recommendations directed after 65 years for vaccination against flu, pneumococci, pertussis, tetanus and zoster. Immunosenescence, aggravated by co-morbidities, varies with age, becoming apparent after 60-65 years and more profound after 85 years. All stages of vaccine responses are affected by immunosenescence, from the innate immunity required to activate these responses to the induction of protective antibody responses and immune memory. Nevertheless, the capacity to develop new responses to primary vaccination is more affected than the ability to respond to recalls, although this is also impaired. Responses to vaccines are differentially altered depending on vaccine and age. Influenza vaccines are modestly immunogenic and several meta-analyses agree an estimate for efficacy of about 50% against virologically-proven flu and 40% against flu-related deaths. The anti-pneumococcal 23-valent non-conjugated vaccine does not induce memory while the 13-valent conjugated one does, but their efficacy are likely to be similar between 70 to 52% before 75 years. A sequential vaccination program with the 13-valent primo-vaccination followed by the 23-valent, recommended in immune-suppressed patients, is currently being studied in France. The waning of immunity to pertussis makes recalls necessary in the elderly who develop good antibody responses. Several research avenues are currently being pursued to try improve the degree of protection conferred by these vaccines in elderly.

[Influenza infection: An update for clinicians]. / La grippe : mise au point pour les cliniciens.

Lower respiratory infections remain the deadliest communicable disease in the world. Influenza infections are particularly involved, whether intrinsically, or more frequently, by promoting bacterial infections and superinfections. The flu is also responsible for the decompensation of many comorbidities and could lead to some myocardial infarction and stroke. The effect of antiviral therapies is limited but preventives measures, such as vaccination, remain a major public health issue. The flu is a major challenge at all levels and all times, from vaccine prevention, to the recognition of atypical forms, and the early management of bacterial complications.

Analysis of delays in the prescription of oseltamivir in hospitals and potential for improvement.

OBJECTIVES: Patients hospitalized for influenza should receive early treatment with a neuraminidase inhibitor. PATIENTS AND METHODS: We conducted a retrospective study of the prescription of oseltamivir during the 2016-2017 influenza epidemic among patients hospitalized for influenza confirmed by RT-PCR in the infectious disease department. RESULTS: Treatment with oseltamivir was initiated as recommended in 96% of hospitalized patients presenting with influenza. However, a delay in prescription was observed with only 18% of prescriptions made on the first day. The prescriptions were exclusively initiated in the infectious disease department. CONCLUSION: To improve the early prescription of oseltamivir during the influenza season, two recommendations are essential: oseltamivir availability in the emergency department pharmacy, awareness of physicians of the need to prescribe to any patient hospitalized for a lower respiratory tract infection treatment with a neuraminidase inhibitor upon admission to the emergency department.

[Influenza vaccination and cystic fibrosis. Impact of an incentivisation campaign about influenza vaccination for patients attending the Dunkerque cystic fibrosis treatment centre and their health care workers]. / Vaccination antigrippale et mucoviscidose. Impact d'une campagne d'incitation à la vaccination antigrippale chez les patients du Centre de ressources et de compétences de la mucoviscidose (CRCM) mixte de Dunkerque et leurs soignants.

INTRODUCTION: The main aim of this study is to evaluate the effectiveness of preventive actions regarding influenza in the studied populations. The secondary objective is to analyze and understand the mechanisms which bring about a behavioural change regarding influenza vaccination. METHODS: The interventional and prospective study was undertaken in the form of an anonymous questionnaire about influenza vaccination coverage and about the reasons for vaccinating or not vaccinating. The studied populations were patients followed for cystic fibrosis (n=67) in the Dunkerque cystic fibrosis treatment centre and their health care workers (n=117), before (April 2014) and after (April 2015) an information campaign and primary prevention actions (vaccination in the workplace with expanded time slots) in collaboration with the department of occupational medicine. RESULTS: In 2015, the vaccination coverage rate of health care workers rose to 65.63%, that is to say 2.38 times more than in 2014 (27.55%). This difference is significant (χ2[1]=29.17, P<0.0001). However, no significant difference between 2014 and 2015 was observed among patients (children and adults) (χ2[1]=0.24, NS) whose vaccination coverage was already optimal before the study. CONCLUSIONS: Raising awareness among health care workers about vaccination against influenza increases the coverage rate and decreases outbreaks of virus infection in the care services and among patients at risk. Three main levers were identified: the necessity of providing information on influenza vaccination to health care workers, the ease of vaccination access and the attitude towards vaccination of supervisory staff (health executives/doctors).