Doenças crônicas em idosos e vacinação contra a influenza: orientação dos profissionais de saúde e o papel da mídia / Chronic diseases in older people and influenza vaccination: the guidance of health professionals and the role of the media / Enfermedades crónicas em adultos mayores y vacunación contra la influenza: la orientación de los profesionales de la salud y el papel de los medios de comunicación

Introdução: As informações sobre a presença de doenças crônicas nos idosos não são registradas durante as campanhas de vacinação contra influenza, o que dificulta sua identificação (proporção) nos idosos vacinados. Objetivo: Descrever a prevalência de doenças crônicas autorreferidas em idosos vacinados contra a influenza; verificar a influência da mídia na decisão de tomar a vacina; e se recebeu orientações sobre a importância dela, segundo o tipo de profissional de saúde. Métodos: Estudo transversal descritivo, com dados coletados por meio de entrevistas com idosos vacinados contra influenza (n=798) em um Centro de Saúde de Campinas (SP) em 2019. Resultados: Na amostra estudada, a maioria eram mulheres (58,0%), indivíduos com ensino médio completo ou ensino superior (53,0%) e com plano de saúde (72,3%). As doenças mais prevalentes foram hipertensão arterial (56,9%; intervalo de confiança ­ IC95% 53,4­60,3), diabetes(24,7%; IC95% 21,8­27,8), doenças cardíacas (13,6%; IC95% 11,4­16,2) e respiratórias (5,6%; IC95% 4,2­7,5). A maioria (58,0%) considerou que a mídia influenciou sua decisão de tomar a vacina. Receberam orientações sobre a importância da vacinação 21,1% dos idosos, fornecidas principalmente por médicos/as (67,4%), enfermeiros/as (18,2%) e agentes de saúde (7,0%). Conclusões: A investigação mostrou que as principais doenças referidas pelos idosos vacinados foram hipertensão arterial, diabetes, cardiopatias e doenças respiratórias. A orientação de profissionais da saúde foi pouco relatada pelos idosos e a maioria referiu influência da mídia na decisão de vacinar-se. Ressaltam-se a necessidade e a relevância de investir em estratégias de comunicação em saúde, a fim de esclarecer a população sobre a importância da vacinação contra a influenza para as pessoas idosas e com doenças crônicas.

Introduction: Information on the presence of chronic diseases in older adults is not registered during influenza vaccination campaigns, which hinders its identification (proportion) in vaccinated older people. Objective: To describe the prevalence of self-reported chronic diseases in older people vaccinated against influenza; to verify the influence of the media in the decision to receive the vaccine; and if older adults received guidance on the importance of the vaccine, according to the type of health professional. Methods: This is a descriptive, cross-sectional study with data collected via interviews with older people vaccinated against influenza (n=798) in a Health Center of Campinas (state of São Paulo, Brazil) in 2019. Results: Most individuals were women (58.0%), with high school degree or higher education (53.0%), and with health insurance (72.3%). The most prevalent diseases were hypertension (56.9%; 95%CI 53.4-60.3), diabetes (24.7%; 95%CI 21.8-27.8), heart diseases (13.6%; 95%CI 11.4-16.2), and respiratory diseases (5.6%; 95%CI 4.2-7.5). A maioria (58,0%) considerou que a mídia influenciou sua decisão de tomar a vacina. The majority (58.0%) considered that the media influenced the decision to have the vaccine; 21.1% of the older adults received guidance on the importance of vaccination, mainly provided by physicians (67.4%), nurses (18.2%), and health workers (7.0%). Conclusions: The main diseases reported by the vaccinated older adults were hypertension, diabetes, heart diseases, and respiratory diseases. The guidance of health professionals was little reported, and most older people mentioned that the media influenced the decision to be vaccinated. The authors emphasize the need and relevance of investing in health communication strategies to inform the population about the importance of influenza vaccination for older adults and those with chronic diseases.

Introducción: Información sobre la presencia de enfermedades en los adultos mayores no se registra durante las campañas de vacunación antigripal, lo que dificulta la identificación (proporción) en los adultos mayores. Objetivo: Describir la prevalencia de enfermedades crónicas en adultos mayores vacunados contra la influenza; verificar la influencia de los medios de comunicación en la decisión de vacunarse y; orientación sobre la importancia de la vacuna, según los profesionales de la salud. Métodos: Estudio descriptivo transversal con adultos mayores vacunados contra la influenza (n=798) en un Centro de Salud de Campinas/SP en 2019. Resultados: La mayoría era mujeres (58,0%), individuos con educación secundaria completa o superior (53,0%) y seguro de salud (72,3%). Las principales enfermedades fueron hipertensión arterial (56,9%; IC95% 53,4-60,3), diabetes (24,7%; IC95% 21,8-27,8), cardiopatías (13,6%; IC95% 11,4-16,2) y enfermedades respiratorias (5,6%; IC95% 4,2-7,5). La mayoría (58,0%) consideró que los medios de comunicación influyeron en la decisión de recibir la vacuna. El 21,1% de los adultos mayores recibió orientación sobre la importancia de la vacunación, proporcionada principalmente por médicos (67,4%), enfermeras (18,2%), agentes comunitarios de salud (7,0%). Conclusiones: La investigación ha demonstrado que las principales enfermedades reportadas fueron hipertensión, diabetes, enfermedades del corazón y respiratorias. La orientación de los profesionales de la salud fue poco mencionada y la mayoría refirió que los medios de comunicación influyeron en la decisión de vacunarse. Se enfatiza la necesidad y relevancia de invertir en estrategias de comunicación en salud con el fin de aclararle a la población sobre la importancia de la vacunación para los adultos mayores y las personas con enfermedades crónicas.

Influenza: evolución a cuatro años de la pandemia: Hospital Nacional Profesor Alejandro Posadas, Argentina / Influenza: A four-year evolution of the pandemic: Prof. Alejandro Posadas National Hospital, Argentina

En el Hospital Nacional Profesor Alejandro Posadas se estudiaron la incidencia de influenza, las características de casos y tipos y subtipos de virus circulantes de enero a agosto de 2013 inclusive, semanas epidemiológicas (SE) 1-35, y se compararon con los años 2009-2012. De fin de mayo a agosto inclusive de 2013 (SE 18 a 35) se observó un aumento del porcentaje de consulta por enfermedades respiratorias, enfermedad tipo influenza e internación por neumonía y se diagnosticaron 207 casos: 153 influenza A (FLU-A)(H1N1pdm09), 46 A(H3), ocho A(sin subtipificar). La mayor frecuencia fue en menores de 5 años, seguida por el grupo de 60 a 64.La chance de tener la enfermedad fue tres veces mayor en el grupo de 40-64 años versus 15-39 o > 64 años. La letalidad, que aumentó con la edad, fue de 7.2% y la chance de morir fue seis veces mayor en los > 64 años. El porcentaje de vacunación entre los casos fue11.6%. Ninguno de los fallecidos estaba vacunado. Luego de la pandemia de 2009 el porcentaje de consultas anuales disminuyó hasta 2012, con un aumento en el período invernal de 2013 de 52.0% con respecto a 2012. La circulación viral en 2013 fue más temprana que en los años anteriores. En 2009 y 2013 la mayor circulación fue FLU-A (H1N1pdm), en 2011 FLU-A(H3) y en 2010 y 2012 FLU-A(H3) y FLU-B.

As from January to August 2013, epidemiological weeks 1-35 (EW), Influenza incidence, case characteristics, types and subtypes of circulating influenza virus in the Nacional Profesor Alejandro Posadas Hospital were studied, and were compared to incidences during 2009-2012. From late May to the end of August 2013 (EW18-35), an increase was observed in the proportion of patients' visits for respiratory disease, influenza-like illness and hospitalizations due to pneumonia; of 207 cases diagnosed with influenza A virus, 153 were infected by H1N1pdm09, 46 by H3, and eight without subtype. The highest proportion of cases was found in children under five years of age, followed by the group 60-64.The chances of having the illness were three times greater among the group 40-64 years old compared to 15-39 or those older than 64. Mortality, which increased with age, was 7.2%, and the odds of death were six times higher among those older than 64. Vaccination rate among the cases was 11.6%. None of the fatal cases had received the vaccine. After the 2009 pandemic, the proportions of annual patients´ visits decreased until 2012; in 2013, an increase of 52.0% during the winter period compared to 2012. The viral circulation started earlier in 2013 compared to previous years. FLU-A(H1N1pdm) was the predominant circulating virus in 2009 and 2013, FLU-A(H3) in 2011, FLU-A(H3) and FLU-B in both 2010 and 2012.

Representações de idosos sobre a vacina da gripe / Representations of the elderly on the influenza vaccine

O presente estudo objetivou conhecer as representações sociais de saúde e imunização para idosos vacinados/não vacinados com a Influenza. Adotamos como referencial teórico a Teoria das Representações Sociais, tendo cunho qualitativo. A pesquisa foi desenvolvida com trinta idosos, sendo quinze vacinados contra a gripe e quinze não vacinados. Realizou-se entrevista individual, utilizando questionário para caracterização e Teste de Associação Livre de Palavras (TALP) como instrumentos de coleta. A análise ocorreu através da Teoria do Núcleo Central, pela ordem das evocações. Os dados revelaram diferenças entre as representações para os dois grupos: os idosos vacinados representaram a saúde como sinônimo de bem-estar, que possibilita a manutenção das atividades cotidianas, e a imunização como algo que protege de diversos males; já aqueles não vacinados definiram saúde como produto da vontade divina, e a vacina como algo que protege, mas que causa variadas reações, o que os desencoraja a utilizá-la. O estudo apontou para a importância de educar em saúde e desmitificar o imaginário sobre esta como também acerca de vacinas, uma vez que hábitos saudáveis precisam ser cada dia mais estimulados, minimizando os altos índices de morbimortalidade evitáveis.

This study sought to understand the social representations of health and immunization for elderly individuals vaccinated and unvaccinated with influenza vaccine. The theoretical benchmark adopted was the Theory of Social Representations of a qualitative nature. The research was carried out with thirty elderly individuals, fifteen of whom were vaccinated against influenza and fifteen who were not. Individual interviews were conducted using a questionnaire for characterization and the Free Word Association of Test (TALP) as data collection instruments and analysis was conducted using Central Nucleus Theory. TALP data revealed differences between the representations for the elderly of the two groups. Those vaccinated considered health as being synonymous with well-being, permitting the conduct of daily activities and immunization as something that protects them from various evils. However, those who remained unvaccinated defined health as a product of divine will and immunization as something that protects, but has side effects, which discouraged them from taking it. The study indicated the importance of health education and demystification of misconceptions about vaccines, since healthy habits must be increasingly encouraged, thereby reducing the high rates of preventable morbidity and mortality.

Conhecimento sobre a influenza A(H1N1)pdm09 entre indivíduos vacinados no Centro Universitário Metodista IPA, Porto Alegre,Rio Grande do Sul / Knowledge about influenza A(H1N1)pdm09 by individuals vaccinated at theIPA Metodist University Center, Porto Alegre, Rio Grande do Sul

no Centro Universitário Metodista IPA, após uma ação educativa e interdisciplinar em saúde realizada na instituição.Métodos: Foram elegíveis para o estudo todos os indivíduos que buscaram a vacinação para influenza A(H1N1)pdm09 que foi aplicada na instituição. Os dados foram coletados através de questionário, após a pessoa aceitar participar do estudo e assinar o Termo de Consentimento Livre e Esclarecido. O questionário abordava aspectos demográficos e de saúde e continha questões relativas ao conhecimento sobre a influenza A(H1N1)pdm09 e a respectiva vacina.Resultados: Do total de 269 pessoas vacinadas no Centro Universitário Metodista IPA, incluindo professores, alunos e colaboradores, 82 indivíduos (30%) aceitaram participar do estudo. Entre os participantes, mais de 80% responderam corretamente às questões sobre a influenza A(H1N1)pdm09 e os métodos preventivos. As idades situaram-se entre 19 e 39 anos, sendo 58,5% mulheres e 57,4% estudantes (73,2% com ensino superior incompleto). Do total, 58,6% estavam hígidos e 80,5% não fumavam.Conclusões: O alto grau de conhecimento sobre a influenza A(H1N1)pdm09 e sua vacina pode refletir a eficiência das ações educativas e a influência do local (centro universitário) e do período (pandemia) de realização da vacinação.

Aims: To assess the knowledge and profile of the population vaccinated against influenza A(H1N1)pdm09 virus in IPA Methodist University, after an educational and interdisciplinary health action carried out at the institution.Methods: All individuals seeking vaccination for influenza A(H1N1)pdm09 that was applied in the institution were eligible for the study. Data were collected through a questionnaire, after signing the informed consent. The questionnaire addressed the following aspects: gender, age, education, health problems, continued use of any drug, smoking and others. It also contained questions relating to prior knowledge about influenza A (what it is, symptoms, means of prevention, transmission, differences between seasonal flu and influenza, who should get the vaccine, side effects).Results: Out of 269 people vaccinated at IPA Methodist University Center, including teachers, students and coworkers, 82 individuals (30%) agreed to participate in the study. Among the participants, more than 80% responded correctly to the questions about influenza A (H1N1) pdm09 and its preventive methods. Their ages ranged from 19 to 39 years, with 58.5% women and 57.4% students (73.2% with incomplete higher education). Of the total, 58.6% were healthy and 80.5% were nonsmokers.Conclusions: The high degree of knowledge about influenza A(H1N1)pdm09 and its vaccine may reflect the efficiency of educational activities and the influence of place (university center) and period (pandemic) of carrying out the vaccination.

Influenza pandémica a un año de la primera ola: ¿qué podemos decir ahora? / Pandemic influenza one year after the first wave: what did we learn?

During year 2009 our nation experimented the first influenza pandemic wave due to the novel influenza A (H1N1) 2009 virus that emerged in the Northern hemisphere at the end of April, 2009. Estimated attack rate was about 6 to 12 percent affecting mainly to schoolchildren who presented with a mild disease. Age groups with highest risk of hospitalization were elderly people and children under 5 years old. Elderly patients and patients with co-morbidities had the highest risk to die. We have learnt that clinical diagnosis of influenza has a laboratory confirmation in about 80 percent of cases but its correlation is lower in kids under 5 years old, especially in infants when RSV co-circulates with influenza virus. Laboratory diagnostic methods like DFA and immuno-cromatography have about 80 percent of sensitivity but a significantly lower rate in elderly patients compared to PCR. The clinical impact of this new virus justifies the recommendation to vaccinate traditionally established risk groups and to prescribe antiviral treatment to patients that acquire severe influenza or have risk factors to progress to complications.

Durante el año 2009 nuestro país vivió la primera ola pandémica causada por el nuevo virus de influenza A (H1N1) 2009 aparecido en el hemisferio norte a fines de abril del ese año. La tasa de ataque estimada fue entre 6 a 12 por ciento afectando más frecuentemente a los escolares quienes presentaron una enfermedad leve. Los grupos etáreos con mayor riesgo de hospitalización fueron los adultos mayores y los niños bajo 5 años de edad. Tuvieron mayor riesgo de fallecer los adultos mayores y aquellas personas con una co-morbilidad asociada. Aprendimos que el diagnóstico clínico de influenza se confirma por laboratorio en alrededor del 80 por ciento pero tiene una baja correlación en los niños bajo 5 años de edad, especialmente en lactantes bajo 1 año de edad, al circular concomitantemente con VRS. Los métodos de diagnóstico como la IFD y los inmunocromatográficos tienen una sensibilidad que no supera el 80 por ciento y es muy baja en los adultos mayores cuando se compara con PCR. Dado el impacto clínico de este nuevo virus se justifica el uso de vacunación en los grupos de riesgo previamente descritos y el tratamiento con antivirales en los pacientes que cursan con enfermedad grave o con riesgo de evolucionar a una enfermedad más complicada.

Occurrence of early adverse events after vaccination against influenza at a brazilian reference center

INTRODUCTION: Since 1999, the Ministry of Health in Brazil has conducted campaigns of vaccination against influenza targeted towards the elderly, chronically-diseased people and health care workers. The vaccine against influenza is associated with adverse events of minor importance. OBJECTIVE: To investigate the early adverse events related to the vaccine against influenza. CASUISTICS AND METHODS: One hundred and ninety seven elderly individuals and health care workers vaccinated against influenza were included. An inquiry regarding adverse events related to the vaccine was applied seven days after the vaccination. RESULTS: Local adverse events were reported by 32.5 percent and systemic effects by 26.4 percent of the vaccinated subjects. Pain in the region of the injection, headache, myalgia, malaise, and coryza were more frequent in the workers than in the elderly (p<0.05). There was no statistically significant difference in the occurrence of fever. CONCLUSIONS: The belief of part of the population that credits frequent and uncomfortable adverse events to the vaccine was not confirmed. The subjective adverse events were more frequent in the health care workers, which can influence, in a negative way, the disclosure of the benefits of this vaccine due to their role as opinion makers.