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.

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.

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.

Assessment of intensity of seasonal influenza activity in Beijing-Tianjin-Hebei region, 2019-2021 / 中华流行病学杂志

Objective: To explore the feasibility of moving epidemic method (MEM) in the assessment of seasonal influenza (influenza) activity intensity from the perspective of urban agglomeration, assess influenza activity intensity in the Beijing-Tianjin-Hebei region from 2019 to 2021 and evaluate the reliability of surveillance data and the effectiveness of the MEM model application. Methods: The weekly reported incidence rate (IR) of influenza and the percentage of influenza-like illness (ILI%) from 2011-2021 in Beijing-Tianjin-Hebei region were collected to establish MEM models respectively. The model fitting effect and the reliability of the two data were evaluated for the purpose of establishing an optimal model to assess the influenza activity intensity in Beijing-Tianjin-Hebei region from 2019-2021. A cross-validation procedure was used to evaluate the performance of the models by calculating the Youden's index, sensitivity and specificity. Results: The MEM model fitted with weekly ILI% had a higher Youden's index compared with the model fitted with weekly IR at both Beijing-Tianjin-Hebei region level and provincial level. The MEM model based on ILI% showed that the epidemic threshold in Beijing-Tianjin-Hebei region during 2019-2020 was 4.42%, the post-epidemic threshold was 4.66%, with medium, high and very high intensity thresholds as 5.38%, 7.22% and 7.84%, respectively. The influenza season during 2019-2020 had 10 weeks (week 50 of 2019 to week 7 of 2020). The influenza season started in week 50 of 2019, and the intensity fluctuated above and below medium epidemic level for six consecutive weeks. The high intensity was observed in week 4 of 2020, the threshold of very high intensity was excessed in week 5, and the intensity gradually declined and became lower than the threshold at the end of the influenza season in week 8. The epidemic threshold was 4.29% and the post-epidemic threshold was 4.35% during 2020-2021. Influenza activity level never excessed the epidemic threshold throughout the year, and no epidemic period emerged. Conclusions: The MEM model could be applied in the assessment of influenza activity intensity in Beijing-Tianjin-Hebei region, and the use of ILI% to assess influenza activity intensity in this region was more reliable than IR data. Influenza activity intensity in Beijing-Tianjin-Hebei region was higher during 2019-2020 but significantly lower in 2020-2021.

Consideration on the usage of full-dose influenza vaccine for the infants aged 6-35 months old / 中华预防医学杂志

Seasonal influenza has a high disease burden, and children infected with influenza are prone to multiple complications. Influenza vaccination is effective in preventing infection and reducing risks of severe diseases and complications. Influenza vaccines are trivalent and quadrivalent, depending on the components of the vaccine. According to the hemagglutinin content, it can be divided into full dose and half dose of influenza vaccine for children. The findings from clinical trials and real-world studies suggested, the full-dose influenza vaccine as in adults has the same safety profile and higher immunogenicity in children aged 6 to 35 months. The application of full-dose influenza vaccine in children aged 6 to 35 months can greatly improve the flexibility and convenience of vaccination, and help reduce the workload in the process.

Research progress of influenza vaccination, pneumococcal vaccination and COVID-19 vaccination among cancer patients / 中华预防医学杂志

This article reviews the relevant studies on the efficacy and safety of influenza, pneumococcal and COVID-19 vaccination among tumor patients worldwide in recent years. By combing and analyzing the retrieved literature, the results show that influenza and pneumococcal vaccination can significantly reduce the morbidity and hospitalization rate of infectious diseases in tumor patients, reduce the risk of cardiovascular events and death, and significantly improve survival prognosis. COVID-19 vaccination can also protect tumor patients, especially those who have completed full dose vaccination. Authoritative guidelines and consensuses worldwide all recommend that tumor patients receive influenza, pneumococcal and COVID-19 vaccines. We should carry out relevant researches, as well as take effective measures to strengthen patient education, so that tumor patients can fully experience the health protection brought by the vaccine to this specific group.

Assessing the impact of educational methods on influenza vaccine uptake and patient knowledge and attitudes: a randomised controlled trial

INTRODUCTION@#Although influenza vaccination reduces rates of pneumonia, hospitalisation and mortality, influenza vaccination uptake remains low in older patients. The primary aim was to compare individualised counselling with educational pamphlets alone in improving influenza vaccination uptake. The secondary aims were to evaluate knowledge and attitudes towards influenza vaccination and factors influencing uptake.@*METHODS@#A randomised controlled study was conducted in two government polyclinics with 160 participants per arm. Patients aged 65 years and above attending for doctor consultation were recruited. All participants received an educational pamphlet on influenza vaccination. The intervention group received additional face-to-face counselling. Participants filled a pre- and postintervention questionnaire assessing knowledge of influenza and attitudes towards the vaccine. Follow-up calls and verification of electronic records was done at three months to determine actual vaccine uptake.@*RESULTS@#At three months, 16 (10%) patients in the intervention group and 20 (12.5%) patients in the control group had completed influenza vaccination (P = 0.48). Factors positively associated with vaccine uptake were willingness to receive vaccination immediately after intervention (adjusted odds ratio [OR] 12.15, 95% confidence interval [CI] 4.42-33.38), and male gender (adjusted OR 2.96, 95% CI 1.23-7.12). Individualised counselling was more effective in improving knowledge (P < 0.01). Overall knowledge scores did not influence actual vaccine uptake rates. (adjusted OR 1.10 [0.90-1.3]).@*CONCLUSION@#Both arms of patient education increased uptake of influenza vaccination. Individualised counselling was not superior to pamphlets alone in improving uptake. Performing vaccination at the initial point of contact improves actual uptake rates.

Connotation of Xiao Chaihu Decoction combined with Maxing Shigan Decoction based on severe cases and modern pathophysiological mechanism and application for severe pulmonary infection and acute exacerbation of chronic obstructive pulmonary disease in critical care medicine / 中国中药杂志

Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic herbal formula. All of them are derived from Treatise on Cold Damage(Shang Han Lun) by ZHANG Zhong-jing. This combination has the effects of harmonizing lesser yang, relieving exterior syndrome, clearing lung heat, and relieving panting. It is mainly used for treating the disease involving the triple-Yang combination of diseases and accumulation of pathogenic heat in the lung. Xiao Chaihu Decoction combined with Maxing Shigan Decoction is a classic combination for the treatment of exogenous diseases involving the triple-Yang combination. They are commonly used in exogenous diseases, especially in the north of China. This combination is also the main treatment strategy for coronavirus disease 2019(COVID-19) accompanied by fever and cough. Maxing Shigan Decoction is a classical herbal formula for treating the syndrome of phlegm-heat obstructing the lung. "Dyspnea after sweating" suggests the accumulation of pathogenic heat in the lung. Patients with mild symptoms may develop cough and asthma along with forehead sweating, and those in critical severe may develop whole-body sweating, especially the front chest. Modern medicine believes that the above situation is related to lung infection. "Mild fever" refers to syndromes rather than pathogenesis. It does not mean that the heat syndrome is not heavy, instead, it suggests that severe heat and inflammation have occurred. The indications of Xiao Chaihu Decoction combined with Maxing Shigan Decoction are as follows.(1) In terms of diseases, it is suitable for the treatment of viral pneumonia, bronchopneumonia, lobar pneumonia, mycoplasma pneumonia, COVID-19 infection, measles with pneumonia, severe acute respiratory syndrome(SARS), avian influenza, H1N1 influenza, chronic obstructive pulmonary disease with acute exacerbation, pertussis, and other influenza and pneumonia.(2) In terms of syndromes, it can be used for the syndromes of bitter mouth, dry pharynx, vertigo, loss of appetite, vexation, vomiting, and fullness and discomfort in the chest and hypochondrium. It can also be used to treat alternate attacks of chill and fever and different degrees of fever, as well as chest tightness, cough, asthma, expectoration, dry mouth, wanting cold drinks, feeling agitated, sweating, yellow urine, dry stool, red tongue, yellow or white fur, and floating, smooth, and powerful pulse, especially the right wrist pulse.

Influenza pandemics throughout Brazilian history / Pandemias de influenza ao longo da história brasileira

Abstract Brazil has experienced several major epidemics of influenza, and the most destructive was in 1918-1919. This article focuses on mortality, mitigation policies, and the consequences of pandemic influenza during the national period. We provide the first mortality estimates for the 1890-1894 influenza pandemic and correct figures for later epidemics. The 1918-1919 episode cost more lives than assumed, although some cities suffered less, possibly because of public health actions. Influenza caused pandemics in 1957, 1968, 1976, and 2009, but these did not cause unusual outbreaks in Brazil.

Resumo O Brasil passou por várias epidemias importantes de influenza, a mais letal em 1918-1919. O artigo focaliza a mortalidade, as políticas de mitigação e as consequências das pandemias de influenza no período nacional. Fornecemos as primeiras estimativas de mortalidade para a pandemia de 1890-1894 e corrigimos números de epidemias posteriores. O episódio de 1918-1919 custou mais vidas do que se considerou anteriormente, embora algumas cidades tenham sofrido menos, possivelmente devido a ações de saúde pública. A influenza gerou pandemias em 1957, 1968, 1976 e 2009, mas elas não causaram surtos incomuns no Brasil.

Síndrome Respiratória Aguda Grave por Influenza A/B: Análise da Situação Vacinal / Severe Acute Respiratory Syndrome due to Influenza A/B: Analysis of Vaccination Status

Introdução: A Influenza é uma doença respiratória altamente contagiosa, prevenível por vacinação, afetando todos os grupos etários,com morbidade e mortalidade variáveis. O objetivo deste estudo foi analisar a relação da situação vacinal dos pacientes com Influenza A/B atendidos com Síndrome Respiratória Aguda Grave. Métodos: Estudo retrospectivo, a partir das notificações do Sistema de Informação de Agravos de Notificação Compulsório do Brasil, de pacientes com esquema vacinal conhecido para Influenza A/B em um hospital-escola do interior do Rio Grande do Sul (2012 a 2018). Resultados: Foram incluídos 596 casos de SRAG, sendo 179 (30,0%) por vírus respiratórios [92 (51,4%) Influenza A/B e 87 (48,6%) outros vírus respiratórios]. Na faixa etária de maiores de 50 anos, a frequência foi 28,2%, 6 meses a 1 ano foi de 19,6%, seguido de 13% no grupo etário de 2 a 4 anos. O esquema vacinal estava completo em 59,8% dos casos, sendo que em 37,5% dos pacientes apresentavam esquema vacinal incompleto. O tratamento antiviral foi administrado em 90,2% do pacientes com SRAG por Influenza A/B, e a alta hospitalar ocorreu em 91,3% dos casos. Conclusão: A vacinação é uma estratégia para prevenção de complicações relacionadas à Influenza. No entanto, a SRAG é uma apresentação com diagnóstico diferencial amplo, e as causas virais necessitam de confirmação para uma otimização da terapêutica antiviral. A equipe de saúde deve estar atenta a pacientes com riscos de SRAG, a fim de minimizar os desfechos negativos, mesmo nos vacinados.

Introduction: Influenza is a highly contagious respiratory disease, preventable by vaccination, affecting all age groups, with variable morbidity and mortality. The objective of this study was to analyze the relationship between the vaccination status of Influenza A/B patients seen with Severe Acute Respiratory Syndrome. Methods: Retrospective study, from notifications of the Brazilian Compulsory Notification Agencies Information System (Sistema de Informação de Agravos de Notificação Compulsório do Brasil), of patients with known vaccination schemes for Influenza A/B in a teaching hospital in the interior of Rio Grande do Sul (2012 to 2018). Results: Of the 596 cases of SARS included, 179 (30.0%) were due to respiratory viruses [92 (51.4%) Influenza A/B and 87 (48.6%) other respiratory viruses]. In the age group over 50 years, the frequency was 28.2%, from 6 months to 1 year old was 19.6%, followed by 13% in the age group of 2 to 4 years. The vaccination schedule was complete in 59.8% of cases, with 37.5% having an incomplete vaccination scheme. Antiviral treatment was administered in 90.2% of the patients with SARS by Influenza A/B, and hospital discharge occurred in 91.3% of the cases. Conclusion: Vaccination is a strategy to prevent complications related to Influenza. However, SARS is a presentation with wide differential diagnosis, and the viral causes need confirmation for an optimization of the antiviral therapy. The healthcare team must be aware of patients at risk of SARS to minimize negative outcomes, even in vaccinated patients.

Vigilancia de virus sincicial respiratorio e influenza en niños escolarizados asistidos en un hospital pediátrico durante 2 meses del segundo semestre de 2021 / Respiratory syncytial virus and influenza surveillance in schoolchildren seen at a children's hospital over 2 months of the second semester of 2021

Introducción. Durante la pandemia de COVID-19, disminuyeron las notificaciones de infecciones respiratorias. El objetivo fue estimar la prevalencia de virus sincicial respiratorio (VSR) e influenza en niños escolarizados asistidos en un hospital pediátrico durante el retorno a la presencialidad. Métodos. Estudio transversal de casos sospechosos de COVID-19, de 3-18 años, con prueba negativa para SARSCoV-2, entre agosto y octubre de 2021. Se estratificó por nivel educativo. Se utilizó PCR para detectar VSR e influenza. Resultados. Se incluyeron 619 niños: 234 del nivel inicial, 224 del primario y 161 del secundario; 25,5 % (158) fueron positivos para VSR (36,3 % del nivel inicial versus 21 % del primario y 16 % del secundario); en adolescentes se asoció la infección al contacto escolar con caso sintomático (OR 2,5; IC95%: 1-6,80; p = 0,04). No se aisló virus influenza. Conclusión. VSR se aisló en un cuarto de la población estudiada, con mayor frecuencia en el nivel inicial; en adolescentes, se asoció con contacto escolar sintomático. No se detectaron casos de influenza

Introduction. Reporting of respiratory infections reduced during the COVID-19 pandemic. The objective was to estimate the prevalence of respiratory syncytial virus (RSV) and influenza in schoolchildren seen at a children's hospital during the return to school. Methods. Cross-sectional study of patients aged 3­18 years suspected of COVID-19 with a negative test for SARS-CoV-2 between August and October 2021. Participants were stratified by level of education. PCR was used to detect RSV and influenza. Results. A total of 619 children were included: 234 in preschool, 224 in primary and 161 in secondary school; 25.5% (158) tested positive for RS (36.3% in the pre-school level versus 21% in primary and 16% in secondary school). Infection among adolescents was associated with school contact with symptomatic cases (OR 2.5; 95%CI 1­6.80; p = 0.04). No case of influenza was detected. Conclusion. RSV was isolated in one fourth of the study population, with a higher frequency in pre-school; among adolescents, it was associated with school contact with symptomatic cases. No case of influenza was detected.