Does the weather play a role in the spread of pandemic influenza? A study of H1N1pdm09 infections in France during 2009-2010.

Understanding patterns of influenza spread and persistence is crucial for pandemic preparedness. The H1N1pdm09 virus caused the first influenza pandemic of the 21st century which resulted in at least 18500 deaths. Based on laboratory-confirmed primary-care case reports we investigated the role of weather conditions and socio-demographic variables in its initial spread and subsequent presence in France. Our findings suggest that low relative humidity and high population density were determinants in shaping the early spread of the virus at the national level. Those conditions also favoured the persistence of viral presence throughout the first 33 weeks of the pandemic. Additionally this persistence was significantly favoured by low insolation. These results confirm the increasingly recognized role of humidity in influenza dynamics and underlie the concomitant effect of insolation. Therefore climatic factors should be taken into account when designing influenza control and prevention measures.

Estudio de caso sobre el centro de salud mental comunitaria "La Casa de Ramos Mejía" / A case study about a comunity mental health service named "La Casa de Ramos Mejía"

INTRODUCCIÓN Es esencial transformar los determinantes sociales de la salud para observar cambios positivos en la salud mental de los individuos. Esto implica ampliar el conocimiento acerca de la intervención de los dispositivos comunitarios sobre esos determinantes para incrementar la asignación de recursos en salud mental y modificar su distribución, de los monovalentes a los hospitales generales y a estos dispositivos. OBJETIVOS Caracterizar cómo interviene actualmente el Centro de Salud Mental Comunitaria "La Casa de Ramos Mejía" sobre los determinantes sociales de la salud de los usuarios con padecimiento mental. MÉTODOS Se realizó un estudio de caso con metodología cualitativa de tipo exploratorio descriptivo. Se recogieron datos a través de observaciones participantes, entrevistas etnográficas y notas del trabajo de campo. RESULTADOS Muchos usuarios provienen de sectores de alta vulnerabilidad social, con trayectorias inconclusas en el sistema de educación y dificultades de acceso al sistema de salud. La interdisciplina y la intersectorialidad suelen colisionar con la escasez de recursos comunitarios debido a su centralización en los hospitales psiquiátricos, la resistencia o la falta de capacidad en los hospitales generales para adecuarse al trabajo en el marco de la Ley Nacional de Salud Mental (LNSM). Entre las intervenciones del Centro sobre los determinantes sociales de la salud, cobra mayor importancia la decisión de posicionar a los usuarios como sujetos de derechos y protagonistas de su proceso de atención, lo que potencia sus capacidades para conseguir un mayor grado de autonomía en la vida. DISCUSIÓN La LNSM sustenta el andamiaje legislativo para cambiar el paradigma y afirmar las prácticas y los valores del Centro con la concepción del paciente con padecimiento mental como sujeto de derechos. Sin embargo, algunas prácticas institucionales del sistema de salud y las asignaciones presupuestarias en salud mental siguen en línea con las concepciones hospitalocéntricas y asilares que se quieren modifica.

[Clusters of respiratory tract infections and alert strategy in nursing homes]. / Cas groupés d'infections respiratoires aiguës et stratégie d'alerte en institutions de personnes âgées.

OBJECTIVE: Outbreaks of acute respiratory infections (ARI) are common in institutions for elderly people. We had for objective to investigate clusters of cases (lower respiratory tract infection and influenza-like illness [LRTI/ILI]) in order to improve and validate alert strategies in these institutions. METHODOLOGY: Prospective surveillance for LRTI/ILI was implemented in 11 institutions in Alsace, over five years. Clinical criteria were used to identify infected residents and clusters. Nasopharyngeal swabs were collected and rapid tests (Immunoassay) were performed to identify the influenza virus. RESULTS: The three week periods were analyzed if three cases or more were recorded during the first week. This analysis demonstrated an important risk of epidemic when this number of cases was reached in healthcare units. The influenza virus (10 clusters) and respiratory syncytial virus ([RSV], two clusters) were identified. CONCLUSION: The authors confirmed and emphasized the importance of adequate surveillance for clusters of respiratory tract infection cases. Early identification of an outbreak (three cases) is an important point to prevent transmission, especially during epidemic periods and if a virus is identified in the unit or institution.

[Immunoassay rapid test for influenza diagnosis in institutions for elderly people: a four-year surveillance with the GROG Géronto-Alsace]. / Tests rapides de surveillance (TRS) de la grippe en établissements accueillant des personnes âgées: évaluation de quatre années d'utilisation dans le cadre du réseau GROG Géronto-Alsace.

OBJECTIVE: Outbreaks of acute respiratory infections (ARI) are common in institutions for elderly people. The objective of our study was the assessment of immunoassay rapid test used for influenza diagnosis in institutions for elderly people. METHODOLOGY: Prospective surveillance for ARI was conducted in 11 institutions in Alsace over a four-year period. Clinical case definitions are used to identify the infected residents. For the identification of influenza virus, nasopharyngeal swabs are obtained and rapid tests (immunoassay) are performed. RESULTS: Influenza virus was identified with immunoassay rapid test. Then, prophylaxis according to the Conseil supérieur d'hygiène publique de France guidelines was implemented. Nevertheless, the use of the rapid test was not frequent in the individual institution and the information recorded at the GROG Géronto-Alsace level could be use to inform the institutions when it is important to perform these rapid tests. CONCLUSION: Ours findings show the value of the rapid test used in the influenza surveillance and how the networks could help to improve their uses.

[Respiratory tract infections in institutions for elderly people: the GROG Géronto-Alsace, strategy of surveillance and alert]. / Infections respiratoires aiguës dans les collectivités de personnes âgées: le GROG Géronto-Alsace, une démarche expérimentale de surveillance et d'alerte.

OBJECTIVE: Outbreaks of respiratory tract infections are common in institutions for elderly people. The objective of our study was the implementation of a network including 11 institutions to determine the frequency of such outbreaks. Using the collected data, criteria and alert levels are defined to assess the level of respiratory tract infections and develop appropriate interventions. METHODOLOGY: Prospective surveillance for respiratory tract infection was conducted in 11 institutions in Alsace for 2 years. Clinical definitions were used to identify the infected residents. For the identification of influenza virus, nasopharyngeal samples using swabs were obtained and rapid tests (immunoassay) were performed. RESULTS: During the surveillance, outbreaks were identified in institutions. The same observations occurred in all institutions at the same time. Alert levels were defined in order to characterize the outbreak period and to improve detection and control of outbreaks of respiratory tract infections. CONCLUSION: Ours findings show the importance of an adequate surveillance and networks improve the impact of such measures.

Harmonisation of national influenza surveillance morbidity data from EISS: a simple index.

The European Influenza Surveillance Scheme is a collaboration with 18 member countries (2001/02) which monitors the activity and impact of influenza by collecting morbidity and virological data in primary care facilities throughout the winter season each year. Despite being in principle similar in the surveillance concept, the indicators used and observations made are very different. Different healthcare systems and organisational needs (eg a certificate of illness for the employer) influence the consultation behaviour. Furthermore, and partly as a result of differences in the healthcare systems, the definitions used for the numerator and denominator when calculating morbidity rates are different. Thus comparative interpretation of participating countries' morbidity data is extremely difficult. Reporting 'harmonisation' by using equivalent numerators and denominators is one option but is difficult to achieve in the short term. Moreover, several additional issues would need to be considered, for example, the need for continuity of surveillance and whether such steps would indeed result in direct comparability etc. A simple index was tested, through which the impact of influenza morbidity in any one year is compared with what is considered a 'usual' epidemic in that country. The index in principle describes numerically the extent to which the influenza-attributable excess morbidity in the current epidemic in each country is within, exceeds, or is less than a range typical for an influenza epidemic. In this pilot study, the usefulness of such an index is explored with the example of eight countries for the seasons 1999/2000 and 2000/01. A fine tuning of the methods has not yet been performed.

Prenatal exposure to influenza as a risk factor for adult schizophrenia.

OBJECTIVE: Several, but not all epidemiological studies, have demonstrated a positive correlation between exposure to the virus during the second trimester of pregnancy and an increased risk to the infants for subsequently developing schizophrenia. The present study is the first be designed in France to examine the risk of gestational exposure to the influenza virus and subsequent development of schizophrenia. METHOD: A total of 974 adults with schizophrenia born between 1949 and 1981 were compared for risk of exposure to influenza with their non-schizophrenic siblings and with matched control patients. RESULTS: Significantly more schizophrenic subjects than controls (both groups) had been exposed to the influenza virus during the fifth month of pregnancy (OR=2.24, CI: 1.49-3.35, and OR=1.61, CI: 1.04-2.49). CONCLUSION: These results suggest that influenza infection during pregnancy is a neurodevelopmental risk factor for schizophrenia in adult life.