The 2017–2018 influenza season in Bucharest, Romania: epidemiology and characteristics of hospital admissions for influenza-like illness

Abstract Background Seasonal influenza causes a considerable burden to healthcare services every year. To better measure the impact of severe influenza cases in Romania, we analyzed active surveillance data collected during the 2017–2018 season from patients admitted for influenza-like illness (ILI) at a tertiary care hospital in Bucharest. Methods Patients admitted for acute ILI were included if they were resident in the Bucharest-Ilfov region, had been hospitalized for at least 24 h, and had onset of symptoms within 7 days before admission. Patient demographics, healthcare use, vaccination status, and outcome data were collected by questionnaire or by searching clinical records. Respiratory swabs were also obtained from each patient to confirm influenza A (A/H1 and A/H3 subtypes) or influenza B (Yamagata and Victoria lineages) infection by real-time reverse-transcription polymerase chain reaction assay. Results The study included 502 patients, many (45.2%) of whom were aged < 5 years. Overall, 108 patients (21.5%) had one or more comorbidities. Seventeen adults aged 18–64 years (3.4%) had been vaccinated against influenza. Patients were hospitalized for a median of 5 days and most (90.4%) were prescribed antiviral treatment. More than one-half of the patients (n = 259, 51.6%) were positive for influenza. Most influenza cases were caused by B viruses (172/259, 66.4%), which were mostly of the B/Yamagata lineage (85 of 94 characterized, 90.4%). Most of the subtyped A viruses were A/H1 (59/74, 79.7%). A/H1 viruses were frequently detected in influenza-positive admissions throughout the 2017–2018 season, whereas the predominant B/Yamagata viruses were detected around the middle of the season, with a peak in cases at week 7 of 2018. Eleven patients were admitted to an intensive care unit; of these, one patient with confirmed B/Yamagata infection died. Conclusions These results show that seasonal influenza results in considerable hospitalization in Bucharest-Ilfov, Romania and suggest vaccine coverage should be extended, especially to the youngest age groups. The data from this study should help inform and optimize national influenza healthcare policies.

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The impact of the Tsunami on hospitalzations at the tertiary care hospital in the Southern Province of Sri Lanka

American Journal of Disaster Medicine ◽

10.5055/ajdm.2008.0020 ◽

2008 ◽

Vol 3 (3) ◽

pp. 147-155 ◽

Cited By ~ 5

Author(s):

Truls Østbye, MD, PhD ◽

Thyagi Ponnamperuma, MBBS ◽

Nayana Fernando, MBBS, MSc ◽

Vathsala Abeygunawardena, MSc ◽

W.A.A. Wijayasiri, MBBS, MSc ◽

...

Keyword(s):

Hospital Admissions ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

International Classification Of Diseases ◽

Care Hospital ◽

Disease Patterns ◽

Disaster Relief Operations ◽

Classification Of Diseases ◽

Relief Operations ◽

The Impact

Objective: Sri Lanka’s human, physical, social, and economic resources suffered a massive impact after the tsunami of December 26, 2004. To assist in preparing for future disasters, the authors sought to characterize the pattern of hospitalizations from the main impact zone in the Southern Province.Design: Retrospective chart review.Setting: Patients admitted to Teaching Hospital, Karapitiya, the only tertiary care hospital in the Southern Province.Patients, Participants: All hospital admissions on the day of and week following the tsunami, and a random sample (5 percent) of admissions from the month preceding, and the 3 months following the tsunami were coded according to the International Classification of Diseases, 10th Edition, analyzed, and geomapped.Intervention: N/A.Main Outcome Measure(s): The overall daily number of hospitalizations increased by 50 percent on the day of the tsunami and decreased in the following week.Results: Before the tsunami, injuries typically accounted for 20 percent of hospital admissions. However, injuries were markedly higher (89 percent of the total) on the day of the tsunami and remained elevated (35 percent) during the following week. After the initial peak in injuries (including near drownings), there was no increase in the frequency of infectious, cardiac, or psychiatric admissions.Conclusions: Injuries (including near drownings) were the most common cause of admissions immediately after the tsunami.The distribution of specific diagnoses differed from that seen after other natural disasters such as earthquakes and hurricanes. A central aspect of disaster relief operations and planning includes a thorough understanding of the postdisaster health effects and changes in disease patterns.

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Determining the Impact of the Opioid Crisis on a Tertiary-Care Hospital in Central New York to Identify Critical Areas of Intervention in the Local Community

Journal of Addiction ◽

10.1155/2020/3956187 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Sanjay K. Yadava ◽

Stephen J. Thomas ◽

Scott Riddell ◽

Dongliang Wang ◽

Timothy P. Endy

Keyword(s):

New York ◽

Hospital Admissions ◽

Tertiary Care ◽

Case Fatality ◽

Hospitalized Patients ◽

Care Hospital ◽

Opioid Use ◽

Medical Reason ◽

Central New York ◽

The Impact

Background. Central New York has been afflicted by the heroin epidemic with an increase in overdose deaths involving opioids. Objective. The objective of the study was to understand the epidemiology of hospitalizations related to a diagnosis of opioid use (OU). Design. The study was designed as a retrospective analysis of hospitalized patients admitted from January 1, 2008, to December 30, 2018, using ICD-9 and 10 codes for heroin or opiate use, overdose, or poisoning. Setting. The study was conducted in a tertiary-care and teaching hospital located in Central New York. Patients. Hospitalized patients were included as study participants. Results. Opioid use-related admissions increased from .05/100 hospital admissions in 2008 to a peak of 2.9/100 in 2018, a 58-fold increase. There were 49 deaths over the 11-year period for an overall case fatality of 1.2 per 100 OU admissions. The median age for all years was 40 years (SD of 13.7 years), and admissions were largely white caucasians (67.0% of all admissions). The mean length of stay was 8.55 days (SD 12 days), with a range of 1 to 153 days. The most frequent discharge diagnosis was due to infections (15.0% of discharge diagnoses) followed by trauma (5.8% of discharge diagnoses). Methicillin-resistant Staphylococcus aureus was more common in patients with OU (58.1%) than in patients with non-OU (43%) (p<0.0001 by chi-square with Yates’ correction). Spatial analysis was performed by zip code and demonstrated regional hotspots for OU-related admissions. Limitations. The limitations of this study are its retrospective nature and largely numerator-based analysis. The use of ICD codes underrepresents the true burden due to underreporting and failure to code appropriately. This study focuses on patients who are hospitalized for a medical reason with a secondary diagnosis of opioid use and does not include patients who present to the emergency room with an overdose underrepresenting the true burden of the problem. Conclusions. Our results demonstrate the impact of the opioid epidemic in one tertiary-care center and the need to prepare for the costs and resources to address addiction care for this population.

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Effects of human immunodeficiency virus status on symptom severity in influenza-like illness in an otherwise healthy adult outpatient cohort

Journal of Investigative Medicine ◽

10.1136/jim-2020-001694 ◽

2021 ◽

pp. jim-2020-001694

Author(s):

Rhonda E Colombo ◽

Christina Schofield ◽

Stephanie A Richard ◽

Mary Fairchok ◽

Wei-Ju Chen ◽

...

Keyword(s):

Symptom Severity ◽

Influenza A ◽

Medical Center ◽

Antiviral Treatment ◽

Human Immunodeficiency Virus Status ◽

Hiv Positive ◽

Influenza B ◽

Minimal Impact ◽

Influenza Like Illness ◽

The Impact

The impact of HIV on influenza-like illness (ILI) has been incompletely described in the era of combination antiretroviral therapy, particularly in the post-H1N1 pandemic period. This analysis informs on ILI in an otherwise healthy, predominantly outpatient cohort of adults with HIV in the USA. From September 2010 to March 2015, this multisite observational cohort study enrolled otherwise healthy adults presenting to a participating US military medical center with ILI, a subset of whom were HIV positive. Demographics, clinical data, and self-reported symptom severity were ascertained, and enrollees completed a daily symptom diary for up to 10 days. 510 men were included in the analysis; 50 (9.8%) were HIV positive. Subjects with HIV were older and less likely to be on active duty. Rhinovirus and influenza A were the most commonly identified pathogens. Moderate–severe diarrhea (p<0.001) and fatigue (p=0.01) were more frequently reported by HIV-positive men. HIV positivity was associated with higher gastrointestinal scores, but not other measures of ILI symptom severity, after controlling for age, race, military status, and influenza season. Few were hospitalized. HIV-positive subjects had more influenza B (p=0.04) and were more likely to receive antivirals (32% vs 6%, p<0.01). Antiviral use was not significantly associated with symptom scores when accounting for potential confounders. In this predominantly outpatient cohort of adult men, HIV had minimal impact on ILI symptom severity. Despite similar illness severity, a higher percentage of subjects with HIV reported undergoing antiviral treatment for ILI, likely reflecting differences in prescribing practices.Trial registration number: NCT01021098.

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Impact of influenza vaccine in reduction of incidence and severity of influenza-like illness

Eastern Mediterranean Health Journal ◽

10.26719/emhj.21.041 ◽

2021 ◽

Author(s):

Anwar Ahmed

Keyword(s):

Influenza Vaccine ◽

Vaccine Coverage ◽

Tertiary Care ◽

Weak Form ◽

Hospital Staff ◽

Health Staff ◽

Influenza Like Illness ◽

Before And After ◽

Flu Vaccine ◽

The Impact

Background: Vaccination is useful for protection against seasonal influenza but has a low uptake. Evidence of a protective effect of influenza vaccine among Arab populations would be a useful tool for advocacy. Aims: To evaluate the impact of vaccine in reducing the incidence and severity of influenza-like illness (ILI) among health staff of a tertiary care eye hospital in Saudi Arabia. Methods: This retrospective cohort study was conducted in 2018–2019. Hospital staff were divided into vaccinated and unvaccinated groups. ILI episodes and their severity were compared between the groups and ILI rate before and after vaccination was reviewed in the vaccinated group. Results: The uptake of flu vaccine among 1180 health staff was 41%. There were 28 (9.3%) and 51 (17%) persons with ILI in the vaccinated (n = 300) and nonvaccinated (n = 300) groups, respectively. The nonvaccinated group had a significantly higher rate of ILI than the vaccinated group had. Vaccination, young age and absence of comorbidity were independent protectors against ILI. Conclusions: Influenza vaccine confers significant protection and reduces the incidence and severity of ILI. However, this was a retrospective review of health data; therefore, the association of vaccine with outcomes should be considered as a weak form of evidence. The low uptake of influenza vaccine in hospital staff and their dependents is a matter of concern and should be addressed by greater awareness and education. This evidence can be used to improve overall vaccine coverage.

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Facial Protective Equipment, Personnel, and Pandemics: Impact of the Pandemic (H1N1) 2009 Virus on Personnel and Use of Facial Protective Equipment

Infection Control and Hospital Epidemiology ◽

10.1086/656564 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1011-1016 ◽

Cited By ~ 26

Author(s):

Melanie Murray ◽

Jennifer Grant ◽

Elizabeth Bryce ◽

Paul Chilton ◽

Leslie Forrester

Keyword(s):

Influenza Season ◽

Tertiary Care ◽

Protective Equipment ◽

Care Hospital ◽

Pandemic H1n1 ◽

Influenza Like Illness ◽

Employee Absenteeism ◽

The Mean ◽

Pandemic H1n1 2009 ◽

The Impact

Background.Before the emergence of the pandemic (H1N1) 2009 virus, estimates of the stockpiles of facial protective equipment (FPE) and the impact that information had on personnel during a pandemic varied.Objective.To describe the impact of H1N1 on FPE use and hospital employee absenteeism.Setting.One tertiary care hospital and 2 community hospitals in the Vancouver Coastal Health (VCH) region, Vancouver, Canada.Patients.All persons with influenza-like illness admitted to the 3 VCH facilities during the period from June 28 through December 19, 2009.Methods.Data on patients and on FPE use were recorded prospectively. Data on salaried employee absenteeism were recorded during the period from August 1 through December 19, 2009.Results.During the study period, 865 patients with influenza-like illness were admitted to the 3 VCH facilities. Of these patients, 149 (17.2%) had laboratory-confirmed H1N1 influenza infection. The mean duration of hospital stay for these patients was 8.9 days, and the mean duration of intensive care unit stay was 9.2 days. A total of 134,281 masks and 173,145 N95 respirators (hereafter referred to as respirators) were used during the 24-week epidemic, double the weekly use of both items, compared with the previous influenza season. A ratio of 3 masks to 4 respirators was observed. Use of disposable eyewear doubled. Absenteeism mirrored the community epidemiologic curve, with a 260% increase in sick calls at the epidemic peak, compared with the nadir.Conclusion.Overall, FPE use more than doubled, compared with the previous influenza season, with respirator use exceeding literature estimates. A significant proportion of FPE resources were used while managing suspected cases. Planners should prepare for at least a doubling in mask and respirator use, and a 3.6-fold increase in staff sick calls.

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IMPACT OF SOCIO-DEMOGRAPHIC VARIABLES AND MORBID CONDITIONS ON PERCEIVED MENTAL HEALTH COMPONENTS USING SF-36 QUESTIONNAIRE

SRMS Journal of Medical Science ◽

10.21761/jms.v1i1.10935 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

S. K. Sharma ◽

V. P. Shrotriya ◽

D. Imtiaz ◽

S. B. Gupta

Keyword(s):

Mental Health ◽

Diabetes Mellitus ◽

Social Functioning ◽

Tertiary Care ◽

Perceived Health ◽

Subjective Assessment ◽

Care Hospital ◽

Sf 36 ◽

The Social ◽

The Impact

<bold>Introduction:</bold> Perceived Health is a subjective assessment of the physical as well as mental health and includes so many aspects as mentioned in SF-36 form that are difficult to capture clinically such as incipient disease, physiological, psychological reserves and social functions. To assess the impact of Diabetes Mellitus, Hypertension and other socio-demographic factors on the Social Functioning component of mental health of the patients attending a tertiary care hospital in Bareilly. <bold>Material and Methods:</bold> Perceived health status of the patients was assessed by the Social Functioning dimension of the Mental Component Summary (MCS) using the SF-36 form. <bold>Results:</bold> The presence of both Diabetes Mellitus and Hypertension was associated with lower Social Functioning scores compared to those with diabetes (p = 0.013) and hypertension alone. Age was negatively related with Social Functioning scores (p<0.001) but male gender (p>0.000) and higher income (p<0.424) were all associated with higher Social Functioning scores. Rural subjects were found to have better SF score compared to urban. <bold>Conclusion:</bold> Age, gender and morbidity was found to have profound influence on Social Functioning scoring of the subjects. However, the results should be interpreted in terms of the study’s limitations.

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Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.830 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s264

Author(s):

Jordan Polistico ◽

Avnish Sandhu ◽

Teena Chopra ◽

Erin Goldman ◽

Jennifer LeRose ◽

...

Keyword(s):

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Turnaround Time ◽

Care Hospital ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Rapid Pcr ◽

The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

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Impact of COVID-19 pandemic on stroke admissions in Qatar

BMJ Neurology Open ◽

10.1136/bmjno-2020-000084 ◽

2021 ◽

Vol 3 (1) ◽

pp. e000084

Author(s):

Naveed Akhtar ◽

Salman Al Jerdi ◽

Ziyad Mahfoud ◽

Yahia Imam ◽

Saadat Kamran ◽

...

Keyword(s):

Hospital Admissions ◽

Small Vessel Disease ◽

Tertiary Care ◽

Relative Increase ◽

Large Vessel ◽

Tertiary Care Centre ◽

Transient Ischaemic Attacks ◽

Stroke Mimics ◽

Coronary Syndromes ◽

The Impact

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

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600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.794 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S362-S363

Author(s):

Gaurav Agnihotri ◽

Alan E Gross ◽

Minji Seok ◽

Cheng Yu Yen ◽

Farah Khan ◽

...

Keyword(s):

Hospital Readmission ◽

Multinomial Logistic Regression ◽

Univariate Analysis ◽

Tertiary Care ◽

Intervention Group ◽

Care Hospital ◽

Full Time ◽

Post Intervention ◽

Before And After ◽

The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

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Impact of national influenza vaccination strategy in severe influenza outcomes among the high-risk Portuguese population

BMC Public Health ◽

10.1186/s12889-019-7958-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ausenda Machado ◽

Irina Kislaya ◽

Amparo Larrauri ◽

Carlos Matias Dias ◽

Baltazar Nunes

Keyword(s):

High Risk ◽

Influenza Vaccination ◽

Seasonal Influenza ◽

Vaccine Coverage ◽

Vaccination Strategy ◽

High Risk Population ◽

Risk Population ◽

Seasonal Influenza Vaccination ◽

Severe Influenza ◽

The Impact

Abstract Background All aged individuals with a chronic condition and those with 65 and more years are at increased risk of severe influenza post-infection complications. There is limited research on cases averted by the yearly vaccination programs in high-risk individuals. The objective was to estimate the impact of trivalent seasonal influenza vaccination on averted hospitalizations and death among the high-risk population in Portugal. Methods The impact of trivalent seasonal influenza vaccination was estimated using vaccine coverage, vaccine effectiveness and the number of influenza-related hospitalizations and deaths. The number of averted events (NAE), prevented fraction (PF) and number needed to vaccinate (NVN) were estimated for seasons 2014/15 to 2016/17. Results The vaccination strategy averted on average approximately 1833 hospitalizations and 383 deaths per season. Highest NAE was observed in the ≥65 years population (85% of hospitalizations and 95% deaths) and in the 2016/17 season (1957 hospitalizations and 439 deaths). On average, seasonal vaccination prevented 21% of hospitalizations in the population aged 65 and more, and 18.5% in the population with chronic conditions. The vaccination also prevented 29% and 19.5% of deaths in each group of the high-risk population. It would be needed to vaccinate 3360 high-risk individuals, to prevent one hospitalization and 60,471 high-risk individuals to prevent one death. Conclusion The yearly influenza vaccination campaigns had a sustained positive benefit for the high-risk population, reducing hospitalizations and deaths. These results can support public health plans toward increased vaccine coverage in high-risk groups.

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