Open Secrets: Silence, Suppression, and Memory in the History of Canada's 1918-20 Influenza Pandemic.

For several decades, the 1918-20 global influenza outbreak has been called "the forgotten pandemic." Although recent scholarly and public interest in the pandemic has complicated the narrative of forgetting, the label has stuck. Highlighting historical evidence of influenza's long-term impact upon survivors, family, and community in Canada, the flu stories presented here, diverse in form and content, verify that a key question in pandemic influenza history is not whether the pandemic was forgotten or remembered, but by whom, and in what ways, it has been suppressed - or foregrounded. By moving beyond the classic epidemic plot line, with beginning, middle, and end, historians can find new methodologies and evidence with which to more fully understand the influenza pandemic's unfolding intersection with colonialism, war, social inequality, and labour struggles in the 20th century.

Diabetes is a major cause of influenza-associated mortality in Mexico.

BACKGROUND: Influenza is a major cause of mortality worldwide. Most influenza-associated deaths are associated with cardiovascular or respiratory disorders. However, a large proportion of influenza-associated deaths do not have respiratory or cardiovascular disorders declared as the underlying cause of death. Diabetic individuals are at increased risk for influenza-mortality. In this study, we assessed the contribution of diabetes to influenza-associated mortality in Mexico. METHODS: Diabetes influenza-associated mortality was estimated for the Mexican population using National Mortality Databases from the Mexican Ministry of Health from 1998 through 2015. Diabetes influenza-associated mortality was calculated applying Serfling cyclical regression models to weekly mortality rates for persons 20-59 years, 60 and more years, and all ages, and by sex. RESULTS: There was a high correlation between weekly pneumonia and influenza mortality and diabetes-related mortality. Yearly influenza-associated diabetes mortality rates varied between 2.0 and 5.9/100,000. Up until the 2005-2006 season, diabetes-associated mortality rates were higher in females, while after that season rates were higher in males. Yearly influenza-associated diabetes mortality rates for adults 20-59 years of age ranged between 1.7 and 3.4/100,000, while estimates for adults 60 years and older ranged between 16.3 and 46.1/100,000. Approximately one third of estimated diabetes influenza-associated deaths occurred in adults 20-59 years of age. On average, diabetes deaths accounted for 19.6% of estimated influenza-associated all-cause mortality. CONCLUSION: Diabetes is a major cause of estimated influenza-associated mortality in Mexico. Health-care authorities and professionals in countries with high diabetes prevalence should be aware of the potential impact of influenza in individuals with this condition.

The 1918 "Spanish Flu" Pandemic in the Ottoman Capital, Istanbul.

Although the general course, possible transmission routes, and actual sociodemographic destruction of the 1918 influenza pandemic in the Western world are well documented, the literature lacks similar data about the Middle East. On the calamity's centenary, this article aims to contribute to filling this gap, investigating the presence and effects of the pandemic in Istanbul, the city bridging the West and East, then as the capital of the Ottoman Empire. After the retrieval of the most relevant articles in Vakit, a daily Istanbul newspaper active throughout the pandemic, a variety of items, including articles with firsthand pronouncements from contemporaneous medical authorities and a clinical account of supportive autopsy findings, are scrutinized and interpreted. The reviewed data are concluded to indicate no epidemiological or factual exception, showing significant parallelism with the Western experience of the pandemic in terms of increased influenza mortality and morbidity, severe clinical presentation, common misinformation and misdiagnosis, and failure to provide effective prevention and medical treatment.

[The opinion of private duty nurses in Martinique on the vaccination of elderly subjects]. / L'opinion des infirmiers libéraux en Martinique sur la vaccination des sujets âgés.

Improving immunisation coverage for older adults is a public health issue. Since 2008, nurses have been authorised to vaccinate this population against influenza without a medical prescription. One study examined the opinions of a sample of 78 private duty nurses in Martinique on influenza and anti-tetanus vaccination of elderly populations. The majority of nurses said they were not in favour of vaccination.

[Real-time monitoring of anti-influenza vaccination in the 65 and over population in France based on vaccine sales]. / Suivi en quasi-temps réel de la vaccination contre la grippe chez les 65 ans et plus en France à partir des ventes de vaccins en pharmacie.

BACKGROUND: The aim of this study was to describe a tool based on vaccine sales to estimate vaccination coverage against seasonal influenza in near real-time in the French population aged 65 and over. METHODS: Vaccine sales data available on sale-day +1 came from a stratified sample of 3004 pharmacies in metropolitan France. Vaccination coverage rates were estimated between 2009 and 2014 and compared with those obtained based on vaccination refund data from the general health insurance scheme. RESULTS: The seasonal vaccination coverage estimates were highly correlated with those obtained from refund data. They were also slightly higher, which can be explained by the inclusion of non-reimbursed vaccines and the consideration of all individuals aged 65 and over. We have developed an online tool that provides estimates of daily vaccination coverage during each vaccination campaign. CONCLUSION: The developed tool provides a reliable and near real-time estimation of vaccination coverage among people aged 65 and over. It can be used to evaluate and adjust public health messages.

[Effectiveness of preventive treatment by Influenzinum in the winter period against the onset of influenza-like illnesses]. / Efficacité d'un traitement préventif par Influenzinum en période hivernale contre la survenue d'un syndrome grippal.

AIM: In vitro Influenzinum induce a cellular change. We present the results of the first study examining the effectiveness of Influenzinum against influenza-like illnesses. METHOD: Retrospective cohort study during winter 2014-2015. After influenza epidemic, a self-assessment questionnaire was offered to patients presenting for a consultation. The primary endpoint was the declaration of an influenza-like illness. The exposed patients (treated by Influenzinum) were matched to two non-exposed patients (untreated) with a propensity score. A conditional logistic model expressed influenza-like illness risk reduction provided by the Influenzinum. RESULTS: The cohort included 3514 patients recruited from 46 general practitioners. After matching, the treated group (n=2041) and the untreated group (n=482) did not differ on variables collected. Influenzinum preventive therapy does not significantly alter the likelihood of influenza-like illness (adjusted odds ratio=0,91 [0,62 to 1,35], p=0,64). CONCLUSION: Influenzinum preventive therapy did not appear effective in preventing influenza-like illness.

Benefits of pharmacist-led flu vaccination services in community pharmacy.

Seasonal influenza is a major cause of excess winter deaths and increased hospital admissions. There is a high level of economic burden associated with the infection. Although vaccination targets have been set to tackle this international issue, many countries struggle to reach these coverage targets for their at-risk populations using traditional delivery methods. Traditional providers include family doctors and nurses; however, pharmacist-led influenza vaccination has become a more commonly utilised aid to support vaccination targets. Community pharmacies are convenient and widely accessible and evaluations consistently demonstrate that patients are satisfied with pharmacist-led vaccinations. Allowing community pharmacists to administer influenza vaccination as an alternative option for delivery helps to increase the coverage rate of vaccination. In addition, commissioning community pharmacists to provide this service has been shown to contribute to achieving targets for those at-risk. Pharmacist-led influenza vaccination services can create value for payors and reduce pressure on health systems. This review aims to demonstrate the success of pharmacy-led influenza vaccinations, and the impact it has had in driving up immunisation rates within other countries. Experiences of countries such as England, Portugal and the United States provide evidence to demonstrate the benefit to both the patient and the health system.

Implementation of flu vaccination in community pharmacies: Understanding the barriers and enablers.

Improving influenza vaccination coverage has been, and still remains a challenge internationally. There are now many examples where countries have pursued a pharmacist-led influenza vaccination service in order to enhance vaccination coverage of at-risk populations. England, Portugal and the United States are successful examples where their experience implementing this service can now be explored retrospectively and learnt from. This review aims to provide evidence to help overcome barriers to commissioning and implementation of such services in countries new to the experience. Implementation is influenced by differing regulatory frameworks underpinning the provision of pharmacist-led influenza vaccination, methods of remuneration, training, and operating procedures. Practical aspects such as the facilities required, how patient records are maintained and how patients and other healthcare professionals are engaged also have an impact. These examples illustrate how community pharmacists can be trained to deliver influenza vaccinations safely, and coupled with their accessibility and convenience, can provide a complementary service to that already provided by family doctors and nurses to deliver influenza vaccinations for the benefit of patients.

[The seasonal flu vaccination among caregivers in geriatric units: Up-to-date]. / La couverture vaccinale contre la grippe saisonnière du personnel soignant en gériatrie : mise au point.

BACKGROUND: Flu vaccinations for healthcare professionals seems to be one of the most effective preventive actions in the face of a disease that carries a high risk of a potentially serious nosocomial epidemic in a geriatric environment. The aim of this study was to take stock of the flu vaccination status among caregivers in the geriatric units and to understand the reasons for their reluctance to be vaccinated, in order to put forward proposals to improve vaccination coverage. METHOD: A literature search of articles published since 2000 in the area of geriatrics, infectious diseases or pneumology was mainly conducted on PubMed using the keywords "caregivers", "elderly", "flu", "influenza", "nosocomial" and "vaccination". After reading all abstracts in English or French and ruling out irrelevant articles, only 64 relevant articles have been listed in bibliography section. RESULTS: Despite official recommendations, the literature reveals insufficient vaccination coverage of healthcare personnel at both the national and international level. Vaccination coverage seems to be lower among younger female non-medical staff. The factors that determine the likelihood of vaccination are the wish to protect one's self, one's family and patients/residents, as well as the experience of earlier bouts of flu. Factors that oppose vaccination are complex and related to the fear of side effects, the use of other preventive measures, the feeling that vaccination is ineffective, poor understanding of the disease and the vaccine, forgetfulness and problems of organization. Campaigns to promote vaccination that target healthcare professionals must be multidimensional and very incentive. The pedagogical message must be centered on the benefits to the individual and adjusted to socio-professional categories. Mobile strategies in the different departments to encourage staff are a pragmatic solution to this challenge. The referring doctor has an essential role to play, as does the occupational doctor in association with the hospital hygiene services. CONCLUSION: Flu vaccinations must be included in the education and training of caregivers.

[Influenza pandemic deaths in Germany from 1918 to 2009. Estimates based on literature and own calculations]. / Todesfälle durch Influenzapandemien in Deutschland 1918 bis 2009. Schätzwerte auf Basis der Literatur und ergänzende eigene Berechnungen.

BACKGROUND AND OBJECTIVE: Estimation of the number of deaths as a consequence of the influenza pandemics in the twentieth and twenty-first centuries (i.e. 1918-1919, 1957-1958, 1968-1970 and 2009) is a challenge worldwide and also in Germany. After conducting a systematic literature search complemented by our own calculations, values and estimates for all four pandemics were collated and evaluated. METHOD: A systematic literature search including the terms death, mortality, pandemic, epidemic, Germany, 1918, 1957, 1968, 2009 was performed. Hits were reviewed by title and abstract and selected for possible relevance. We derived our own estimates using excess mortality calculations, which estimate the mortality exceeding that to be expected. All identified values were evaluated by methodology and quality of the database. Numbers of pandemic deaths were used to calculate case fatality rates and were compared with global values provided by the World Health Organization. RESULTS: For the pandemic 1918-1919 we identified 5 relevant publications, 3 for the pandemics 1957-1958 and 1968-1970 and 3 for 2009. For all four pandemics the most plausible estimations were based on time series analyses, taken either from the literature or from our own calculations based on monthly or weekly all cause death statistics. For the four pandemics these estimates were in chronological order 426,600 (1918-1919), 29,100 (1957-1958), 46,900 (1968-1970) and 350 (2009) excess pandemic-related deaths. This translates to an excess mortality ranging between 691 per 100,000 (0.69 % in 1918-1919) and 0.43 per 100,000 (0.00043 % in 2009). Case fatality rates showed good agreement with global estimates. CONCLUSION: We have proposed plausible estimates of pandemic-related excess number of deaths for the last four pandemics as well as excess mortality in Germany. The heterogeneity among pandemics is large with a variation factor of more than 1000. Possible explanations include characteristics of the virus or host (immunity), social conditions, status of the healthcare system and medical advances.

[Caregivers and residents, raising awareness of the influenza vaccine]. / Soignants et résidents, sensibilisation à la vaccination antigrippale.

Influenza epidemics in nursing homes can lead to serious complications with a high level of lethality. It has been shown that an active policy of awareness campaigns with obligatory information materials and easy access to influenza immunisation increases the rate of vaccination coverage.

Episodic adaptive diversification of classical swine fever virus RNA-dependent RNA polymerase NS5B.

Classical swine fever virus (CSFV) is the pathogen that causes a highly infectious disease of pigs and has led to disastrous losses to pig farms and related industries. The RNA-dependent RNA polymerase (RdRp) NS5B is a central component of the replicase complex (RC) in some single-stranded RNA viruses, including CSFV. On the basis of genetic variation, the CSFV RdRps could be clearly divided into 2 major groups and a minor group, which is consistent with the phylogenetic relationships and virulence diversification of the CSFV isolates. However, the adaptive signature underlying such an evolutionary profile of the polymerase and the virus is still an interesting open question. We analyzed the evolutionary trajectory of the CSFV RdRps over different timescales to evaluate the potential adaptation. We found that adaptive selection has driven the diversification of the RdRps between, but not within, CSFV major groups. Further, the major adaptive divergence-related sites are located in the surfaces relevant to the interaction with other component(s) of RC and the entrance and exit of the template-binding channel. These results might shed some light on the nature of the RdRp in virulence diversification of CSFV groups.

[How do we catch flu? Beliefs in France in 2010]. / Comment attrape-t-on la grippe ? Les croyances des Français en 2010.

AIMS: Our goals were to describe beliefs held by French people concerning the contagiosity of influenza and analyze the relationship of these beliefs with vaccination against seasonal flu. METHODS: A subsample (4749 people aged 15-79) of the Health Barometer 2010 responded to questions dealing with influenza. Responses were analyzed using clustering analysis and logistic regression. RESULTS: Overall, observed beliefs were quite good, but also socially differentiated. 'False' beliefs were more frequent among people with a lower socioeconomic status. Those who overestimated the contagiosity of influenza were less likely to have been vaccinated against seasonal influenza in 2008. CONCLUSIONS: The beliefs analyzed here were associated with vaccination behaviors. 'False' beliefs may be difficult to change as they are nevertheless coherent. These beliefs also exhibit social inequalities that should be taken into account when determining preventive measures.

[Impact of the A influenza pandemic on anti-seasonal influenza vaccination of French general practitioners: A cohort follow-up 2007-2010]. / Impact de la pandémie de grippe A sur la vaccination des médecins généralistes français contre la grippe saisonnière : suivi d'une cohorte entre 2007 et 2010.

BACKGROUND: Our objective was to assess the impact of the A influenza pandemic on the anti-seasonal influenza vaccination of French general practitioners. METHODS: A survey was conducted in 2007 in a random sample of general practitioners. A second survey conducted in 2010 included all general practitioners who had not been vaccinated in 2007 and one-third of those who had been. RESULTS: Responses were obtained from 1010 general practitioners in 2007. The coverage rate of anti-seasonal influenza vaccination reached 73%. In 2010, the coverage was 73.5% and rate of anti-A influenza vaccination was 59% (weighted numbers). Between the two surveys, 130 family physicians (15.5%) changed their behavior. Analysis showed that the A influenza pandemic had a slight positive impact on anti-seasonal influenza vaccination. CONCLUSION: This first cohort of French general practitioners concerning influenza vaccination found the same anti-seasonal influenza vaccination rates widely reported in the literature and showed that the A influenza pandemic had slight impact on it.

[Seasonal influenza vaccination coverage of general practitioners and their patients. Practice survey of French general practitioners after vaccination campaign 2011-2012]. / Couverture par le vaccin de la grippe saisonnière des médecins généralistes et de leurs patients. Enquête de pratique auprès de médecins généralistes français après la campagne de vaccination 2011-2012.

BACKGROUND: In France, vaccination coverage against seasonal influenza for risk groups was inadequate: 55.2% of people aged 65 and older, and 33% of the 16-64 year group with chronic targeted disorders were vaccinated in March 2012. Three quarters of general practitioners were vaccinated. Our objective was to estimate the influence of the vaccination status of general practitioners on vaccine coverage of their patients at risk. METHODS: A questionnaire was sent in March 2012 to a sample of 500 general practitioners. Their professional characteristics, vaccination status against seasonal influenza and the determinants of these vaccinations were collected and compared to the vaccine coverage of their patients obtained from the French healthcare fund. RESULTS: Self-reported vaccination coverage of the 225 general practitioners respondents was 81.3%. There was a positive correlation with age greater than 50 years, high activity level, rural practice and the absence of particular mode of exercise. The doctors wanted to be vaccinated to protect themselves and protect their patients or their family. Of the 42 doctors unvaccinated, 42.5% feared the side effects of the vaccine, 40% considered influenza to be a benign illness and 32.5% considered low risk of catching or spreading it. The vaccination rate for patients aged 65 and older was 62.3% among 147 doctors vaccinated versus 58.3% in unvaccinated 31 physicians (P<0.0001). These rates were 39% versus 36.7% (P=0.29) for patients with chronic targeted disorders. CONCLUSION: This study shows a positive association between the reported vaccination of general practitioners and effective influenza vaccination of their patients aged 65 years and older. This result is less clear for patients with chronic targeted disorders. All this findings argue in favor of promoting seasonal influenza vaccination among general practitioners.

The response of medical virology laboratories to the influenza A(H1N1)pdm09 outbreak in Paris Île-de-France region.

The outbreak of influenza A(H1N1)pdm09 was a challenge for the laboratories of Paris Île-de-France region in charge of virological diagnosis. In order to evaluate the quality of their response to this challenge, a retrospective survey based on a self-administered standardized questionnaire was undertaken among the 18 hospital laboratories involved in A(H1N1)pdm09 virus detection over a period of 10 months from April 2009 to January 2010. All concerned laboratories responded to the survey. Due to imposed initial biosafety constraints and indications, virological diagnosis was performed in only two laboratories at the start of the studied period. Step by step, it was further settled in the other laboratories starting from June to November 2009. From the beginning, A(H1N1)pdm09-specific RT-PCR was considered the reference method while the use of rapid influenza detection tests remained temporary and concerned a minority of these laboratories. Among the overall 21,656 specimens received, a positive diagnosis of influenza A(H1N1)pdm09 was obtained in 5,390 cases (25%), the positivity range being significantly higher among women as compared to men (P<0.0001) and subjects below 45 years of age as compared to those over 65 years (P<0.0001). Two peaks in positivity frequency were observed at weeks 24 (30%, 8-12 June 2009) and 44 (50%, 26-30 October 2009) respectively, the latter one occurring 2 weeks earlier than the peak of epidemic at the national level. In contrast, a low positivity rate was detected at weeks 38-40 in relationship with other respiratory virus infections which were clinically misinterpreted as a peak of influenza epidemic. These data demonstrate the ability of medical virology laboratories of Paris Île-de-France region to provide in real time a valuable diagnosis of A(H1N1)pdm09 virus infection and a relevant view of outbreak evolution, suggesting they will be a crucial component in the management of future influenza epidemics.

[Deadliest flu]. / La grippe la plus meurtrière.

Many questions remain unanswered regarding the so-called "Spanish" influenza pandemic of 1918. This article addresses three of them and describes the state of knowledge for each of them: Where did the pandemic start? How many people died? And why was it so deadly?

Beaucoup de questions restent sans réponses en ce qui concerne la pandémie grippale dite «  espagnole  ¼ de 1918. Cet article en traite trois et décrit l'état des connaissances pour chacune d'elles  : Où la pandémie a-t-elle commencé  ? Combien de personnes en sont mortes  ? Et pourquoi a-t-elle été si meurtrière  ?

Digital Immunization Tracking in Long-Term Care and Assisted Living Facilities.

A disproportionate share of the health impacts of COVID-19 has been borne by older adults, particularly those in long-term care facilities (LTCs). Vaccination has been critical to efforts to combat this issue, but as we begin to emerge from this pandemic, questions remain about how to protect the health of residents of LTC and assisted living facilities proactively in order to prevent such a disaster from occurring again. Vaccination, not just against COVID-19, but also against other vaccine-preventable illness, will be a key component of this effort. However, there are currently substantial gaps in the uptake of vaccines recommended for older adults. Technology offers an opportunity to assist in filling these vaccination gaps. Our experiences in Fredericton, New Brunswick suggest that a digital immunization solution would facilitate better uptake of adult vaccines for older adults in assisted and independent living facilities and would help policy and decision makers to identify coverage gaps and develop interventions to protect these individuals.

COVID-19, Virtual Engagement and the Psychoid Imagination.

The impact of the COVID-19 pandemic on analytic training and the delivery of educational content is explored here. The proliferation of Zoom therapy and teaching is creating a post-human platform to which nearly everyone in contemporary society has had to adapt. Looking at the possible meanings of the pandemic, a psychoid factor (the virus) engaging the imagination has come to the fore as a response to climate change. The striking similarity to the H1N1 viral pandemic ("Spanish flu") is noted, especially in the context of C. G. Jung having had a case in 1919 during which he experienced a number of visions and dreams. The imagery produced can be seen as an implicit attempt at "re-enchanting the world" found in The red book. Finally, a reconsideration of pedagogy in response to the pandemic is discussed with an eye to the archetypal aspects of internet communications.

Cet article étudie l'impact de la pandémie de COVID-19 sur la formation des analystes et sur la manière dont le contenu éducatif est dispensé. La prolifération de thérapie et de formation par Zoom crée une plateforme post-humaine à laquelle quasiment toute personne dans la société contemporaine a eu à s'adapter. En regardant les sens possibles que l'on peut donner à la pandémie, un facteur psychoïde (le virus) qui mobilise l'imagination a pris le devant de la scène en tant que réponse au changement climatique. L'article souligne la similarité frappante avec la pandémie virale H1N1 (la grippe espagnole), particulièrement dans le contexte où C.G. Jung l'a attrapée en 1919 et a fait l'expérience d'un certain nombre de visions et de rêves. L'imagerie produite peut être vue comme une tentative implicite de « ré-enchanter le monde ¼ telle qu'on la trouve dans le Livre Rouge. En conclusion, une reconsidération de la pédagogie issue de la pandémie est discutée en tenant compte des aspects archétypaux des communications par internet.

Se exploran aquí las repercusiones de la pandemia de COVID-19 en la formación analítica y en la transmisión de contenidos educativos. La proliferación de la terapia y la enseñanza vía Zoom está creando una plataforma posthumana a la que casi todo el mundo en la sociedad contemporánea ha tenido que adaptarse. En cuanto a los posibles significados de la pandemia, un factor psicoide (el virus) que atrae la imaginación ha pasado a primer plano como respuesta al cambio climático. Se observa la sorprendente similitud con la pandemia viral H1N1 ("gripe española"), especialmente en el contexto de un caso que C.G. Jung tuvo en 1919 durante el cual experimentó una serie de visiones y sueños. La imaginería producida puede verse como un intento implícito de "reencantar el mundo" que se encuentra en El Libro Rojo. Por último, se plantea una reconsideración de la pedagogía en respuesta a la pandemia, teniendo en cuenta los aspectos arquetípicos de las comunicaciones por Internet.

[Influenza A: H1N1 post-viral membranoproliferative glomerulonephritis occurring in aggressive systemic mastocytosis: Case report and literature review]. / Glomérulonéphrite membrano-proliférative post-grippale chez un patient atteint de mastocytose systémique agressive : observation commentée et revue de la littérature.

Systemic mastocytosis is characterised by tissular infiltration and a cytokine storm due to mast cells excessive proliferation and activation. Herein, we report an extraordinary case of AH1N1 influenza post-viral glomerulonephritis occurring in the course of an aggressive systemic mastocytosis with an associated hematological neoplasm. Because of a multisystemic involvement including the liver and lungs, we treated mastocytosis with midostaurin (multiple inhibitor of kinase protein), anti H1/H2 blockers and dexamethasone as first line treatment. One month later and despite vaccination, he developed a severe acute lung injury with respiratory distress due to AH1N1 influenza in association with the nephrotic syndrome. Kidney biopsy disclosed a membranoproliferative glomerulonephritis that was successfully treated with mycophenolate mofetil. Only a few cases of influenza post-viral or post-vaccination glomerulonephritis are documented in the medical literature. This is an exceptional association of uncommon conditions occurring within only a few months in the same patient.