Effect of antiviral treatment in older patients hospitalized with confirmed influenza.

Seasonal influenza causes significant morbidity and mortality in people aged ≥65 years. Antiviral treatment can reduce complications and disease severity. The objective of this study was to investigate the effect of antiviral treatment in patients aged ≥65 years hospitalized with confirmed influenza in preventing intensive care unit (ICU) admission or death. A retrospective cohort study was carried out in 20 hospitals from seven Spanish regions during 2013-2015 in patients aged ≥65 years. Hospitalized cases of laboratory-confirmed influenza were selected. To assess the association between antiviral treatment and ICU admission or death, the adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated using multivariate logistic regression. We included 715 hospitalized patients, of whom 640 (87.9%) received antiviral treatment, 77 (10.8%) required ICU admission and 66 (9.2%) died. In the 64-74 years age group, receipt of antiviral treatment ≤48 h (aOR 0.20; 95% CI 0.04-0.89), 3-4 days (aOR 0.23; 95% CI 0.05-0.92) and 5-7 days (aOR 0.24; 95% CI 0.03-0.91) after clinical symptom onset was associated with reduced mortality. Receipt of treatment >7 days after symptom onset was not associated with reduced mortality. No association of antiviral treatment with reduced mortality was observed in the >74 years age group or with the prevention of ICU admission in any age group. Antiviral treatment had a protective effect in avoiding death in patients aged 65-74 years hospitalized due to influenza when administered ≤48 h after symptom onset and when no more than 7 days had elapsed.

The effectiveness of influenza vaccination in preventing hospitalisations of elderly individuals in two influenza seasons: a multicentre case-control study, Spain, 2013/14 and 2014/15.

Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case-control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22-47). VE was 51% (95% CI: 15-71) in patients without high-risk medical conditions and 30% (95% CI: 14-44) in patients with them. VE was 39% (95% CI: 20-53) in patients aged 65-79 years and 34% (95% CI: 11-51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals.

Factors associated with acceptance of pandemic flu vaccine by healthcare professionals in Spain, 2009-2010.

The A(H1N1)pdm09 influenza virus reached pandemic level in Spain in 2009, prompting a national vaccination campaign. To avoid transmission to patients, healthcare professionals' vaccination against pandemic influenza is crucial. The main objective of this study was to analyze factors associated with the failure by healthcare professionals to accept the pandemic vaccination in 2009. A cross-sectional survey was conducted of healthcare professionals in seven of Spain's autonomous regions. A questionnaire was used to collect information about personal and professional details, the respondents' flu vaccination status in the 2008-2009 and 2009-2010 seasons (seasonal and pandemic vaccines), and their knowledge and attitudes. A total of 1,661 professionals completed the survey. In the 2009-2010 season, 38.2% had both the seasonal and the pandemic vaccine, 22.1% had had only the seasonal, and 4.7% only the pandemic vaccine. The strongest predictor of not receiving the pandemic vaccine was not having had seasonal vaccinations in that year or the previous year. Those who had not received the pandemic vaccine were more often female; nurses; under 45; denied contact with at-risk groups; and had negative beliefs about the vaccine effectiveness and little concern for getting the disease, being infected at work, or passing it on to patients. It would be prudent to direct preventive campaigns not only at individuals at risk of catching flu but also at health professionals with a negative view of flu vaccine, with a particular focus on nurses, who have a key role in recommending flu vaccine.

Heterologous Humoral Response against H5N1, H7N3, and H9N2 Avian Influenza Viruses after Seasonal Vaccination in a European Elderly Population.

Avian influenza viruses are currently one of the main threats to human health in the world. Although there are some screening reports of antibodies against these viruses in humans from Western countries, most of these types of studies are conducted in poultry and market workers of Asian populations. The presence of antibodies against avian influenza viruses was evaluated in an elderly European population. An experimental study was conducted, including pre- and post-vaccine serum samples obtained from 174 elderly people vaccinated with seasonal influenza vaccines of 2006-2007, 2008-2009, 2009-2010, and 2010-2011 Northern Hemisphere vaccine campaigns. The presence of antibodies against A/H5N1, A/H7N3, and A/H9N2 avian influenza viruses were tested by using haemaglutination inhibition assays. Globally, heterotypic antibodies were found before vaccination in 2.9% of individuals against A/H5N1, 1.2% against A/H7N3, and 25.9% against A/H9N2. These pre-vaccination antibodies were present at titers ≥1/40 in 1.1% of individuals against A/H5N1, in 1.1% against H7N3, and in 0.6% against the A/H9N2 subtype. One 76 year-old male showed pre-vaccine antibodies (Abs) against those three avian influenza viruses, and another three individuals presented Abs against two different viruses. Seasonal influenza vaccination induced a significant number of heterotypic seroconversions against A/H5N1 (14.4%) and A/H9N2 (10.9%) viruses, but only one seroconversion was observed against the A/H7N3 subtype. After vaccination, four individuals showed Abs titers ≥1/40 against those three avian viruses, and 55 individuals against both A/H5N1 and A/H9N2. Seasonal vaccination is able to induce some weak heterotypic responses to viruses of avian origin in elderly individuals with no previous exposure to them. However, this response did not accomplish the European Medicament Agency criteria for influenza vaccine efficacy. The results of this study show that seasonal vaccines induce a broad response of heterotypic antibodies against avian influenza viruses, albeit at a low level.

Prevalencia de virus del papiloma humano en mujeres españolas de un programa de cribado poblacional / Prevalence of human papillomavirus in Spanish women from a population screening program

Introducción. El virus del papiloma humano (VPH), es causa necesaria para el desarrollo de cáncer de cuello uterino. El objetivo del estudio fue estimar la prevalencia de mujeres con infección por VPH, adheridas al Programa de Prevención y Detección precoz de Cáncer de cuello de útero de Castilla y León (España). Material y métodos. Se han evaluado los resultados del análisis de VPH en las muestras de las mujeres incluidas en el programa de cribado poblacional. El estudio incluye un total de 120.326 muestras de frotis de cérvix, recogidas en el periodo comprendido entre enero de 2012 y diciembre de 2014. Resultados. Se obtuvieron 12.183 muestras con detección positiva de ADN de VPH, correspondiendo a una prevalencia de 9,6‰ (IC 95% 9,5%-9,8%), en la población femenina. Los VPH asociados a un alto riesgo de transformación celular se encuentran en mayor proporción que los de bajo riesgo (5,9% vs 2,23%). La prevalencia está inversamente relacionada con la edad de las mujeres del cribado. La presencia de infecciones múltiples de VPH se demuestra en un tercio de las mujeres analizadas. Conclusiones. Estos resultados son los primeros y más amplios de un programa de cribado poblacional estructurado en España y deben servir como referencia para futuros estudios y medir el impacto futuro de la vacunación (AU)

Introduction. The human papillomavirus (HPV), is necessary to cause a woman developing cervical cancer. The aim of the study was to estimate the prevalence of women with HPV infection, covered by the program of prevention and early detection of cervical cancer of Castile and León (Spain). Material and methods. Samples of women included in the screening program were analyzed. Including a total of 120,326 cervical swab samples, collected in the period from January 2012 to December 2014. Results. 12,183 HPV positive samples were detected, representing a prevalence of 9.6 ‰, (IC 95% 9.5%-9.8%) in the female population. High-risk HPV were found in higher proportion that HPV low-risk genotypes. HPV prevalence correlates inversely with women age. Coinfections of multiple genotypes were found in one third of screened women population. Conclusions. Data showed in this study are the first and wider Spanish results from a cervical cancer screening program population non opportunistic based on HPV detection. These results would serve as a reference for future prevalence studies and to evaluate the future impact of HPV vaccination campaigns (AU)

Effect of Occupational Exposure on A(H1N1)pdm09 Infection and Hospitalization.

OBJECTIVE: To analyze relationships between occupational exposure and influenza infection and hospitalization during the 2009-2010 pandemic wave and the 2010-2011 influenza seasonal epidemic in Spain. METHODS: Occupations were classified as high, medium, or low risk of influenza exposure. To assess the risk of infection, 588 outpatient cases of influenza confirmed by reverse-transcription polymerase-chain-reaction (RT-PCR) were compared with 588 outpatients without influenza symptoms. To assess the risk of hospitalization, 337 outpatient influenza cases were compared with 337 inpatient influenza cases. RESULTS: The high risk of occupational exposure group was composed only of health care workers. After adjustment for age, sex, vaccination status, and predictive variables of influenza infection, patients with a high risk of occupational exposure had an aOR of 2.14 (95%CI: 1.25-3.66) of being an outpatient influenza case and an aOR of 0.43 (95%CI: 0.20-0.95) of being an inpatient influenza case, compared with those with a low risk. CONCLUSIONS: A high risk of occupational exposure is a risk factor for influenza infection but not for hospitalization.

Economic Evaluation of Health Services Costs During Pandemic Influenza A (H1N1) Pdm09 Infection in Pregnant and Non-Pregnant Women in Spain.

BACKGROUND: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old). METHODS: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the requirements in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utilisation. The mean cost per patient was calculated in this group of women. RESULTS: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher (€4,689.4/non-pregnant and €2,945.07/pregnant). CONCLUSIONS: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning.

Factors associated with pneumococcal polysaccharide vaccination of the elderly in Spain: A cross-sectional study.

Vaccination of the elderly is an important factor in limiting the impact of pneumonia in the community. The aim of this study was to investigate the factors associated with pneumococcal polysaccharide vaccination in patients aged ≥ 65 years hospitalized for causes unrelated to pneumonia, acute respiratory disease, or influenza-like illness in Spain. We made a cross-sectional study during 2013-2014. A bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking into account sociodemographic variables and risk medical conditions. A multivariate analysis was performed using multilevel regression models. 921 patients were included; 403 (43.8%) had received the pneumococcal vaccine (394 received the polysaccharide vaccine). Visiting the general practitioner ≥ 3 times during the last year (OR = 1.79; 95% CI 1.25-2.57); having received the influenza vaccination in the 2013-14 season (OR = 2.57; 95% CI 1.72-3.84) or in any of the 3 previous seasons (OR = 11.70; 95% CI 7.42-18.45) were associated with receiving the pneumococcal polysaccharide vaccine. Pneumococcal vaccination coverage of hospitalized elderly people is low. The elderly need to be targeted about pneumococcal vaccination and activities that encourage healthcare workers to proactively propose vaccination might be useful. Educational campaigns aimed at the elderly could also help to increase vaccination coverages and reduce the burden of pneumococcal disease in the community.

Smoking may increase the risk of hospitalization due to influenza.

BACKGROUND: Smoking may facilitate influenza virus infections and their severity. The objective was to investigate the risk of hospitalization due to influenza in Spanish smokers and ex-smokers. METHODS: We carried out a multicentre, case-control study in 2011. Cases [patients ≥ 18 years hospitalized > 24 h with real time polymerase chain reaction (RT-PCR)-confirmed influenza] were selected from 29 Spanish hospitals. For each case, we selected an outpatient aged ≥ 18 years with RT-PCR-confirmed influenza matched by age (±5 years), date of hospitalization of the case (±10 days) and province of residence. We collected epidemiological variables, comorbidities and the smoking history. The risk of hospitalization due to smoking was determined by the adjusted odds ratio (aOR) using logistic regression. RESULTS: We studied 471 hospitalized cases and 476 outpatient cases. Hospitalized cases had a higher frequency of influenza risk factors compared with outpatient cases. Hospitalized cases had a higher frequency of smoking (30.9% vs. 17.1%) and being ex-smokers (29.3% vs. 25.3%). Current smoking (aOR = 2.18, 95% CI: 1.23-3.87) and being an ex-smoker (aOR = 1.73, 95% CI: 1.07-2.82) were associated with the risk of hospitalization. CONCLUSIONS: Smoking may increase the risk of hospitalization in smokers and ex-smokers when infected by the influenza virus. Smoking prevention could reduce hospitalizations. Influenza vaccination is recommended for smokers.

Factors Associated with Influenza Vaccination of Hospitalized Elderly Patients in Spain.

Vaccination of the elderly is an important factor in limiting the impact of influenza in the community. The aim of this study was to investigate the factors associated with influenza vaccination coverage in hospitalized patients aged ≥ 65 years hospitalized due to causes unrelated to influenza in Spain. We carried out a cross-sectional study. Bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking in to account sociodemographic variables and medical risk conditions. Multivariate analysis was performed using multilevel regression models. We included 1038 patients: 602 (58%) had received the influenza vaccine in the 2013-14 season. Three or more general practitioner visits (OR = 1.61; 95% CI 1.19-2.18); influenza vaccination in any of the 3 previous seasons (OR = 13.57; 95% CI 9.45-19.48); and 23-valent pneumococcal polysaccharide vaccination (OR = 1.97; 95% CI 1.38-2.80) were associated with receiving the influenza vaccine. Vaccination coverage of hospitalized elderly people is low in Spain and some predisposing characteristics influence vaccination coverage. Healthcare workers should take these characteristics into account and be encouraged to proactively propose influenza vaccination to all patients aged ≥ 65 years.

Effect of influenza vaccination on the prognosis of hospitalized influenza patients.

OBJECTIVES: This study aimed to assess whether influenza vaccination reduces the risk of severe and fatal outcomes in influenza inpatients aged ≥65 years. METHODS: During the 2013-2014 influenza season persons aged ≥65 years hospitalized with laboratory-confirmed influenza were selected in 19 Spanish hospitals. A severe influenza case was defined as admission to the intensive care unit, death in hospital or within 30 days after admission. Logistic regression was used to compare the influenza vaccination status between severe and non-severe influenza inpatients. RESULTS: Of 433 influenza confirmed patients, 81 (19%) were severe cases. Vaccination reduced the risk of severe illness (odds ratio: 0.57; 95%CI: 0.33-0.98). The cumulative number of influenza vaccine doses received since the 2010-2011 season was associated with a lower risk of severe influenza (odds ratio: 0.78; 95% CI 0.66-0.91). CONCLUSION: Adherence to seasonal influenza vaccination in the elderly may reduce the risk of severe influenza outcomes.

Vacunación antigripal. Efectividad de las vacunas actuales y retos de futuro / Influenza vaccination. Effectiveness of current vaccines and future challenges

La gripe estacional supone un desafío anual para los sistemas sanitarios debido a factores como la cocirculación de 2 subtipos de gripe A junto con otros 2 linajes de gripe B, la variación antigénica de estos virus, que escapan a la inmunidad natural y a la conferida por las vacunas, sumados al impacto que produce la gripe en la morbimortalidad. Las vacunas frente a la gripe están disponibles desde hace más de 70 años y han ido evolucionando en su formulación, fabricación y administración. Las recomendaciones de vacunación se centran en las personas con mayor probabilidad de enfermedad grave y son recomendaciones progresivamente más amplias, clásicamente basadas en las vacunas inactivadas, pero con una importancia creciente de vacunas vivas atenuadas. Entre las vacunas inactivadas van estando disponibles mejoras desde las vacunas adyuvadas y virosomales a las de administración intradérmica, de cultivo celular o las tetravalentes. La efectividad vacunal globalmente es del 65%, pero varía en función de las características de la vacuna, del virus, de la población y del objetivo que se persigue prevenir, yendo desde menos del 10% hasta casi el 90%. Los retos futuros son formulaciones que confieran una protección más extensa y duradera, así como el incremento de coberturas vacunales, especialmente en grupos como embarazadas y sanitarios o la población pediátrica

Seasonal influenza is an annual challenge for health-care systems, due to factors such as co-circulation of 2 influenza A subtypes jointly with 2 influenza B lineages; the antigenic drift of these virus, which eludes natural immunity, as well as immunity conferred by vaccination; together with influenza impact in terms of morbidity and mortality. Influenza vaccines have been available for more than 70 years and they have progressed in formulation, production and delivery route. Recommendations on vaccination are focused on those with a higher probability of severe disease, and have a progressively wider coverage, and classically based on inactivated vaccines, but with an increasing importance of attenuated live vaccines. More inactivated vaccines are becoming available, from adyuvanted and virosomal vaccines to intradermal delivery, cell-culture or quadrivalent. Overall vaccine effectiveness is about 65%, but varies depending on characteristics of vaccines, virus, population and the outcomes to be prevented, and ranges from less than 10% to almost 90%. Future challenges are formulations that confer more extensive and lasting protection, as well as increased vaccination coverage, especially in groups such as pregnant women and health-care professionals, as well as being extended to paediatrics

[Influenza vaccination. Effectiveness of current vaccines and future challenges]. / Vacunación antigripal. Efectividad de las vacunas actuales y retos de futuro.

Seasonal influenza is an annual challenge for health-care systems, due to factors such as co-circulation of 2 influenza A subtypes jointly with 2 influenza B lineages; the antigenic drift of these virus, which eludes natural immunity, as well as immunity conferred by vaccination; together with influenza impact in terms of morbidity and mortality. Influenza vaccines have been available for more than 70 years and they have progressed in formulation, production and delivery route. Recommendations on vaccination are focused on those with a higher probability of severe disease, and have a progressively wider coverage, and classically based on inactivated vaccines, but with an increasing importance of attenuated live vaccines. More inactivated vaccines are becoming available, from adyuvanted and virosomal vaccines to intradermal delivery, cell-culture or quadrivalent. Overall vaccine effectiveness is about 65%, but varies depending on characteristics of vaccines, virus, population and the outcomes to be prevented, and ranges from less than 10% to almost 90%. Future challenges are formulations that confer more extensive and lasting protection, as well as increased vaccination coverage, especially in groups such as pregnant women and health-care professionals, as well as being extended to paediatrics.

Viral Etiology of Chronic Obstructive Pulmonary Disease Exacerbations during the A/H1N1pdm09 Pandemic and Postpandemic Period.

Viral infections are one of the main causes of acute exacerbations of chronic obstructive pulmonary disease (AE-COPD). Emergence of A/H1N1pdm influenza virus in the 2009 pandemic changed the viral etiology of exacerbations that were reported before the pandemic. The aim of this study was to describe the etiology of respiratory viruses in 195 Spanish patients affected by AE-COPD from the pandemic until the 2011-12 influenza epidemic. During the study period (2009-2012), respiratory viruses were identified in 48.7% of samples, and the proportion of viral detections in AE-COPD was higher in patients aged 30-64 years than ≥65 years. Influenza A viruses were the pathogens most often detected during the pandemic and the following two influenza epidemics in contradistinction to human rhino/enteroviruses that were the main viruses causing AE-COPD before the pandemic. The probability of influenza virus detection was 2.78-fold higher in patients who are 30-64 years old than those ≥65. Most respiratory samples were obtained during the pandemic, but the influenza detection rate was higher during the 2011-12 epidemic. There is a need for more accurate AE-COPD diagnosis, emphasizing the role of respiratory viruses. Furthermore, diagnosis requires increased attention to patient age and the characteristics of each influenza epidemic.

Influenza vaccination of primary healthcare physicians may be associated with vaccination in their patients: a vaccination coverage study.

BACKGROUND: To assess the contribution of physician-related factors, especially their influenza vaccine status, in the vaccination coverage of their patients. METHODS: A study of vaccination coverage was carried out in Spain in 2011-12. The dependent variable (vaccination coverage in patients aged ≥ 65 years) was obtained from regional records. Information was gathered on the vaccination of physicians through an anonymous web survey. We compared the vaccination coverage of patients with the vaccination of their physicians using the Student t test. Associations were determined using a multilevel regression model. RESULTS: The coverage in patients aged ≥ 65 years was 56.3% and was higher (57.3%) in patients whose physician had been vaccinated than in those whose physician had not (55.2%) (p = 0.008). In the multilevel regression model, vaccination of the physician was associated (p = 0.049) with vaccination of their patients after controlling for the effects of age (p = 0.046), region (p = 0.089), and opinions on the effectiveness of the vaccine (p = 0.013). CONCLUSIONS: Vaccination of physicians together with their opinions on the effectiveness of the vaccine may be a predictor of vaccination coverage in their patients. Further studies are required to confirm this.

Managing an online survey about influenza vaccination in primary healthcare workers.

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2-1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders.

Visualizing knowledge and attitude factors related to influenza vaccination of physicians.

PURPOSE: To characterize groups of primary healthcare physicians according to sociodemographic data, years of professional experience and knowledge of and attitudes to influenza, and to evaluate differences between groups with respect to influenza vaccination in the 2011-2012 season. METHODS: We carried out an anonymous web survey of Spanish primary healthcare physicians in 2012. Information on vaccination, and knowledge of and attitudes to influenza was collected. Multiple correspondence analysis and cluster analysis were used to define groups of physicians. RESULTS: We included 835 physicians and identified three types. Type B were physicians with low professional experience of influenza. Types A and C were physicians with high professional experience with influenza, type A also had a high awareness of influenza and seasonal vaccination. Types A and C were older and more often male than type B (p<0.0001). Knowledge of influenza was greatest in type A and lowest in type B. Awareness of influenza was greatest in type A and lowest in type C. In type A, 71.0% of physicians were vaccinated in the 2011-2012 season, compared with 48.1% and 33.6% from types B and C, respectively (p<0.001). CONCLUSIONS: Additional efforts should be made to increase interest and concerns about preventing the transmission of influenza in physicians who do not believe influenza is a severe disease and are not concerned about its transmission.

Knowledge of and attitudes to influenza in unvaccinated primary care physicians and nurses.

Primary healthcare workers, especially nurses, are exposed to the vast majority of patients with influenza and play an important role in vaccinating patients. Healthcare workers' misconceptions about influenza and influenza vaccination have been reported as possible factors associated with lack of vaccination. The objective of this study was to compare the characteristics of unvaccinated physicians and unvaccinated nurses in the 2011-2012 influenza season. We performed an anonymous web survey of Spanish primary healthcare workers in 2012. Information was collected on vaccination and knowledge of and attitudes to the influenza vaccine. Multivariate analysis was performed using unconditional logistic regression. We included 461 unvaccinated physicians and 402 unvaccinated nurses. Compared with unvaccinated nurses, unvaccinated physicians had more frequently received seasonal influenza vaccination in the preceding seasons (aOR 1.58; 95% CI 1.11-2.25), and more frequently believed that vaccination of high risk individuals is effective in reducing complications (aOR 2.53; 95% CI 1.30-4.95) and that influenza can be a serious illness (aOR 1.65; 95% CI 1.17-2.32). In contrast, unvaccinated physicians were less concerned about infecting patients (aOR 0.62; 95% CI 0.40-0.96). Unvaccinated nurses had more misconceptions than physicians about influenza and the influenza vaccine and more doubts about the severity of annual influenza epidemics in patients with high risk conditions and the prevention of complications by means of the influenza vaccination. For unvaccinated physicians, strategies to improve vaccination coverage should stress the importance of physicians as a possible source of infection of their patients. The effectiveness of influenza vaccination of high risk persons should be emphasized in nurses.

Pandemic influenza A (H1N1) infection in pregnant and nonpregnant women in Spain (2009-2010).

The present study aimed to compare the main features of infection with pandemic influenza A virus in pregnant and nonpregnant women admitted to hospitals in Spain during the first waves of the 2009-2010 influenza pandemic. This was a prospective (November 2009 to June 2010), multicenter observational study. All cases were women of reproductive age who had not been vaccinated against seasonal or pandemic influenza A. Influenza infection was confirmed by reverse transcription-polymerase chain reaction (RT-PCR). The sociodemographic and clinical data of all cases were reviewed. A total of 219 inpatients, including 49 pregnant women and 170 nonpregnant women, were enrolled in the study upon admission to participating hospitals. The most substantially different symptoms between the groups were respiratory distress and unilobar consolidation, both of which were more frequent among nonpregnant women. Antibiotics and systemic corticosteroids were more frequently used in nonpregnant women; however, there were no differences in the rates of treatment with antivirals. Our findings indicated that the compared with nonpregnant women, pregnant women in this study did not have significantly different symptoms and were not at increased risk of complications from pandemic influenza virus infection.