ABSTRACT
Background: Uncertainty about risk of illness and the value of influenza vaccines negatively affects vaccine uptake among persons targeted for influenza vaccination. Methods: During 2016-2019, we followed a cohort of healthcare personnel (HCP) targeted for free-of-charge influenza vaccination in five Lima hospitals to quantify risk of influenza, workplace presenteeism (coming to work despite illness), and absenteeism (taking time off from work because of illness). The HCP who developed acute respiratory illnesses (ARI) (≥1 of acute cough, runny nose, body aches, or feverishness) were tested for influenza using reverse-transcription polymerase chain reaction (rt-PCR). Findings: The cohort (2968 HCP) contributed 950,888 person-days. Only 36 (6%) of 605 HCP who participated every year were vaccinated. The HCP had 5750 ARI and 147 rt-PCR-confirmed influenza illnesses. The weighted incidence of laboratory-confirmed influenza was 10.0/100 person-years; 37% used antibiotics, and 0.7% used antivirals to treat these illnesses. The HCP with laboratory-confirmed influenza were present at work while ill for a cumulative 1187 hours. Interpretation: HCP were frequently ill and often worked rather than stayed at home while ill. Our findings suggest the need for continuing medical education about the risk of influenza and benefits of vaccination and stay-at-home-while-ill policies.
Subject(s)
Influenza Vaccines , Influenza, Human , Virus Diseases , Humans , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Antiviral Agents/therapeutic use , Prospective Studies , Anti-Bacterial Agents , Delivery of Health CareABSTRACT
BACKGROUND: The Estudio Vacuna de Influenza Peru (VIP) cohort aims to describe the frequency of influenza virus infection, identify predictors of vaccine acceptance, examine the effects of repeated influenza vaccination on immunogenicity, and evaluate influenza vaccine effectiveness among HCP. METHODS: The VIP cohort prospectively followed HCP in Lima, Peru, during the 2016-2018 influenza seasons; a fourth year is ongoing. Participants contribute blood samples before and after the influenza season and after influenza vaccination (for vaccinees). Weekly surveillance is conducted to identify acute respiratory or febrile illnesses (ARFI). When an ARFI is identified, participants self-collect nasal swabs that are tested for influenza viruses by real-time reverse transcriptase-polymerase chain reaction. Influenza vaccination status and 5-year vaccination history are ascertained. We analyzed recruitment and enrollment results for 2016-2018 and surveillance participation for 2016-2017. RESULTS: In the first 3 years of the cohort, VIP successfully contacted 92% of potential participants, enrolled 76% of eligible HCP, and retained >90% of participants across years. About half of participants are medical assistants (54%), and most provide "hands-on" medical care (76%). Sixty-nine percent and 52% of participants completed surveillance for >70% of weeks in years 1 and 2, respectively. Fewer weeks of completed surveillance was associated with older age (≥50 years), being a medical assistant, self-rated health of fair or poor, and not receiving the influenza vaccine during the current season (P-values < .05). CONCLUSIONS: The VIP cohort provides an opportunity to address knowledge gaps about influenza virus infection, vaccination uptake, effectiveness and immunogenicity among HCP.
Subject(s)
Health Personnel/statistics & numerical data , Influenza Vaccines/immunology , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Vaccine Potency , Adolescent , Adult , Delivery of Health Care , Epidemiological Monitoring , Female , Health Personnel/classification , Humans , Immunogenicity, Vaccine , Influenza Vaccines/administration & dosage , Influenza, Human/immunology , Longitudinal Studies , Male , Middle Aged , Peru/epidemiology , Prospective Studies , Seasons , Vaccination , Young AdultABSTRACT
El presente trabajo se baso en la importancia que tiene el musculo soleo como colgajo local para cubrir defectos con exposición ósea de la tibia, en su tercio medio y distal, así como defectos del área del tendón de aquiles. Se realizo 52 disecciones anatomo-quirúrgicas en piernas frescas estudiando las características del músculo su vascularidad y su arco de rotación al usarlo como colgajo sóleo, hemisóleo y sóleo invertido. Se practico en las 52 piernas, las técnicas descritas de dichos colgajos llegando a engranar criterios y sugerencias para un mejor reconocimiento anatómico, fácil disección y transposición muscular, logrando una cobertura adecuada del defecto a trata. Los hallazgos de pedículos vasculares secundarios en la porción distal del músculo sóleo que sire de base al colgajo "sóleo invertido" fueron variables en número y ubicación; así tenemos que la ubicación de los dos pedículos distales estan a 5.5 cm y 8.14 cm. por encima del maleolo. Se evaluo la cobertura comparativa entre el colgajo sóleo y hemisóleo para cubrir el tercio medio de la tibia y obtuvimos que el ccolgajo hemisóleo ofrecía la misma cobertura o la ssobrepasaba logrando asi un mejor resultado estético funcional en el miembro afectado.
