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Management of seasonal influenza by family physicians. Med Mal Infect 2020; 50:401-406. [PMID: 32173166 DOI: 10.1016/j.medmal.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/30/2019] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Seasonal influenza is responsible for approximately 2.5 million consultations with the family physician (FP) per year in France. We performed this study with FPs to assess whether their practice complied with French guidelines. MATERIAL AND METHOD Descriptive survey carried out from June to August 2018 using a questionnaire sent electronically to 1,140 Alsatian FPs. RESULTS A total of 121 FPs responded to the questionnaire (10.6%). The main clinical symptoms that FPs believed to be the most reliable to diagnose influenza were fever (95%) and arthromyalgia (76.9%), well ahead of cough (27.3%). Overall, 23.1% of FPs declared that they occasionally used microbiological confirmation; 80.2% of FPs performed hand hygiene once per consultation but 95.9% did not wear surgical masks when managing patients with influenza and only 53.7% wore them when they themselves presented with influenza-like symptoms. Hand sanitizers, masks, or tissues were made available to patients in 35.5%, 19.8%, and 30.6%, respectively. Overall, 77.7% of participating physicians were vaccinated against influenza. Influenza vaccination was widely offered to high-risk patients, but some groups were insufficiently vaccinated: obese patients (32.2%) and pregnant women (47.9%). Overall, 48.8% of physicians never prescribed oseltamivir at a curative dose and 72.7% never prescribed it at a preventive dose; 86.8% of physicians prescribed at least one non-recommended symptomatic treatment including an NSAID (24.8%) or aspirin (12.4%). CONCLUSION This study revealed several mismatches with guidelines and suggested potential corrective actions.
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Souty C, Masse S, Valette M, Behillil S, Bonmarin I, Pino C, Turbelin C, Capai L, Vilcu AM, Lina B, van der Werf S, Blanchon T, Falchi A, Hanslik T. Baseline characteristics and clinical symptoms related to respiratory viruses identified among patients presenting with influenza-like illness in primary care. Clin Microbiol Infect 2019; 25:1147-1153. [PMID: 30703528 PMCID: PMC7172742 DOI: 10.1016/j.cmi.2019.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 11/28/2022]
Abstract
Objectives We aimed to identify patients' clinical characteristics associated with respiratory viruses identified among patients presenting with influenza-like illness (ILI). Methods A sample of patients of all ages presenting with ILI was included by physicians of the French Sentinelles network during two seasons (2015/16 and 2016/17). Nasopharyngeal samples were tested for the presence of influenza virus (IV), respiratory syncytial virus (RSV), human rhinovirus (HRV) and human metapneumovirus (HMPV). Patients' characteristics associated with each of the four virus classes were studied using multivariate logistic regressions. Results A total of 5859 individuals were included in the study: 48.0% tested positive for IV, 7.9% for HRV, 7.5% for RSV and 4.1% for HMPV. Cough was associated with IV (OR 2.14, 95% CI 1.81–2.52) RSV (OR 2.52, 95% CI 1.75–3.74) and HMPV detection (OR 2.15, 95% CI 1.40–3.45). Rhinorrhoea was associated mainly with HRV detection (OR 1.75, 95% CI 1.34–2.32). Headache was associated with IV detection (OR 1.75, 95% CI 1.34–2.32), whereas absence of headache was associated with RSV and HMPV detection. Dyspnoea was associated with RSV detection (OR 2.33, 95% CI 1.73–3.12) and absence of dyspnoea with IV detection. Conjunctivitis was associated with IV detection (OR 1.27, 95% CI 1.08–1.50). Some associations were observed only in children: dyspnoea and cough with RSV detection (age <5 years), conjunctivitis with IV detection (age <15 years). Period of onset of symptoms differed among aetiological diagnoses. Seasonal influenza vaccination decreased the risk of IV detection (OR, 0.67, 95% CI 0.51–0.86). Conclusions This study allowed the identification of symptoms associated with several viral aetiologies in patients with ILI. A proper knowledge and understanding of these clinical signs may improve the medical management of patients.
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Affiliation(s)
- C Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France.
| | - S Masse
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - M Valette
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Centre National de Référence des virus respiratoires (dont la grippe), Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, France
| | - S Behillil
- Institut Pasteur, Unité de Génétique Moléculaire des Virus à ARN, Paris, France; Institut Pasteur, Centre Coordonnateur du Centre National de Référence des virus des infections respiratoires (dont la grippe), Paris, France; UMR CNRS 3569, 75015, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - I Bonmarin
- Santé publique France, French National Public Health Agency, Saint-Maurice, France
| | - C Pino
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - C Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - L Capai
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - A M Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - B Lina
- Hospices Civils de Lyon, Laboratoire de Virologie, Institut des Agents Infectieux (IAI), Centre National de Référence des virus respiratoires (dont la grippe), Centre de Biologie et de Pathologie Nord, Groupement Hospitalier Nord, Lyon, France; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, France
| | - S van der Werf
- Institut Pasteur, Unité de Génétique Moléculaire des Virus à ARN, Paris, France; Institut Pasteur, Centre Coordonnateur du Centre National de Référence des virus des infections respiratoires (dont la grippe), Paris, France; UMR CNRS 3569, 75015, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France
| | - A Falchi
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - T Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique, Paris, France; Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, Versailles, France; Assistance Publique - Hôpitaux de Paris APHP, Hôpital Ambroise Paré, Service de Médecine Interne, Boulogne Billancourt, France
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Epidemiology of Respiratory Pathogens among Elderly Nursing Home Residents with Acute Respiratory Infections in Corsica, France, 2013-2017. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1423718. [PMID: 29392127 PMCID: PMC5748090 DOI: 10.1155/2017/1423718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/25/2017] [Accepted: 11/16/2017] [Indexed: 12/02/2022]
Abstract
Background The current study aims to describe the demographical and clinical characteristics of elderly nursing home (NH) residents with acute respiratory infections (ARIs) during four winter seasons (2013/2014–2016/2017), as well as the microbiological etiology of these infections. Methods Seventeen NHs with at least one ARI resident in Corsica, France, were included. An ARI resident was defined as a resident developing a sudden onset of any constitutional symptoms in addition to any respiratory signs. Nasopharyngeal swabs from ARI residents were screened for the presence of 21 respiratory agents, including seasonal influenza viruses. Results Of the 107 ARI residents enrolled from NHs, 61 (57%) were positive for at least one of the 21 respiratory pathogens. Forty-one (38.3%) of the 107 ARI residents had influenza: 38 (92%) were positive for influenza A (100% A(H3N2)) and three (8%) for influenza B/Victoria. Axillary fever (≥38°C) was significantly more common among patients infected with influenza A(H3N2). Conclusion The circulation of seasonal respiratory viruses other than influenza A(H3N2) seems to be sporadic among elderly NH residents. Investigating the circulation of respiratory viruses in nonwinter seasons seems to be important in order to understand better the dynamic of their year-round circulation in NHs.
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Masse S, Minodier L, Heuze G, Blanchon T, Capai L, Falchi A. Influenza-like illness outbreaks in nursing homes in Corsica, France, 2014-2015: epidemiological and molecular characterization. SPRINGERPLUS 2016; 5:1338. [PMID: 27563533 PMCID: PMC4981007 DOI: 10.1186/s40064-016-2957-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/29/2016] [Indexed: 11/25/2022]
Abstract
Background To study the molecular epidemiology of the influenza outbreaks in nursing homes (NHs) to determine whether multiple influenza strains were involved. Methods From September to December 2014, NHs in Corsica were invited to participate in an ongoing daily epidemiological and microbiological surveillance for influenza-like illness (ILI) among residents and health care workers (HCWs). Results The study involved 12 NHs. Respiratory illness meeting the ILI case definition was observed among 44 residents from whom 22 specimens were collected. Of the 22 residents with a nasopharyngeal sample, 13 (59 %) were positive for at least one of the 11 pathogens analysed. Among these 13 patients, 11 (92 %) presented a confirmed influenza (A/H3N2) and two had another respiratory virus: one human metapneumovirus and one human coronavirus. Of patients with a confirmed influenza A(H3N2), 10 (91 %) were vaccinated against influenza during the 2014–2015 season. Two influenza outbreaks were reported in two NHs, caused by influenza A(H3N2) strains belonging to cluster 3C.3 and 3C.2a. Although antivirals were available, prophylaxis was not used. Conclusions Phylogenetic analysis seems to suggest no multiple introduction into the two NHs reporting the two influenza A(H3N2) outbreaks. A number of factors could have contributed to transmitting influenza in NHs including, the absence of administration of antiviral treatment for prophylaxis of all residents/staff regardless of immunization status because of the poor vaccine match during each outbreak, the intensive contacts with incompletely protected residents and HCWs, and the low adherence of NHs to notification of ILI outbreaks to the health authorities. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2957-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Masse
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France
| | - L Minodier
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France
| | - G Heuze
- CIRE-SUD Paca Corse, InVS, Saint-Maurice Cedex, Paris, France
| | - T Blanchon
- UPMC Univ Paris 06, UMR_S 1136, Sorbonne Universités, Paris, France ; INSERM, UMR_S 1136, Paris, France
| | - L Capai
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France ; UPMC Univ Paris 06, UMR_S 1136, Sorbonne Universités, Paris, France ; INSERM, UMR_S 1136, Paris, France
| | - A Falchi
- EA 7310, Laboratory of Virology, University of Corsica-Inserm, Corte, France
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