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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Influenza is a viral disease that presents as seasonal disease outbreaks every year, coinciding with the winter months. Due to this epidemiological nature, with numerous cases within a short time interval (8–12 weeks), influenza is considered a significant public health problem.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> To control these epidemics, community surveillance networks for influenza have been created, composed of sentinel physicians and hospital networks that monitor severe cases of influenza that require hospital admission.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the main problems with influenza is that despite a case definition (sudden onset and the presence of at least 1 of the 4 general symptoms: fever or febricula, general discomfort, headaches and myalgia; and at least 1 of the following respiratory symptoms: cough, sore throat and dyspnea; and, lastly, with the absence of other suspected diagnoses),<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> this definition is only used by the sentinel network. In hospitals and especially in emergency departments, the clinical suspicion of influenza, due to its lack of specificity, coincides with most cases of acute respiratory infection (ARI) of viral etiology.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> In most cases, only the detection of the influenza virus in respiratory samples allows for a definitive diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is therefore of interest to determine the true value of the disease burden caused by influenza in the hospital setting. Thus, 2 extensive studies showed that only 7% and 16% of all cases of ARI with suspected influenza infection were laboratory-confirmed as influenza.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few studies in Spain analyzing the disease burden of influenza. We therefore analyzed the burden for the past 5 influenza seasons by conducting a study conducted between November 1 and March 31 for each of these influenza seasons (2013–2018). Every patient who visited the hospital (hospitalized or not) with a clinical suspicion of ARI, influenza syndrome or influenza was administered a throat swab. The influenza virus was detected using a commercial real-time polymerase chain reaction assay (Allplex Respiratory Full Panel Assay; Seegene, North Korea, which can detect 16 different respiratory viruses, including influenza A and B and its subtypes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Over the course of the study, we analyzed 15,017 patients, 6010 (40%) of whom were pediatric (<15 years), and 9007 (60%) of whom were adults. A respiratory virus was detected in 7986 patients, including the influenza virus, which represented a mean positivity of 53.1%. The overall disease burden due to influenza during this period was 22.3% (3346 cases of influenza), with 1228 cases (8.1%) in the pediatric group and 2118 (14.2%) in the adult group. However, if the cases of influenza are analyzed in each age group, the 1228 pediatric cases represented a burden of 20.4%, compared with the 23.5% detected in the adults. There were 4640 cases of ARI caused by other noninfluenza viruses, representing a disease burden of 30.8%.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There were differences in the disease burden due to influenza over the course of the various seasons, with its value ranging from 14% (2016/2017 season) to 27.5% (2017/2018 season). In the first season, the most common type was the influenza A virus (H3N2); in the second season, the most common were the influenza A virus (H1N1)pdm09 and the Yamagata-lineage of influenza B.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Overall, influenza represented 41.8% of all samples positive to some respiratory virus, a rate that varied over the course of the seasons. Thus, the 2016/2017 season showed the lowest rate of positivity (25.8%), while the last season showed the highest rate (53.1%), very close to that observed in the 2014/2015 season (52.6%) in which the influenza A virus (H3N2) was the most common (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Based on these results, it seems clear that influenza represents a disease burden in our geographical area that ranges from 14% to 27.5% of all cases of ARI with clinical suspicion. These values have varied according to the circulating strains and their correlation with the vaccine strains.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The lack of the routine use of the case definition of influenza meant that any ARI in the winter season was considered a probable influenza infection. However, the mean burden attributed to influenza in this study (22.3%) is higher than that reported in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> Flu-like symptoms caused by other respiratory viruses represented 30.8% of cases, a higher rate than that caused by influenza itself. In other words, only 1 of every 5 cases with influenza symptoms will be a true influenza infection.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Therefore, from the epidemiological and public health standpoint, influenza with a laboratory etiological diagnosis is not the same as influenza symptoms that can be caused by other respiratory viruses.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> The coinciding of other often unidentified respiratory viruses within the same period could give greater value to the true disease burden caused by influenza. We should demand a confirmation diagnosis to accept an ARI during the epidemic era as a real case of influenza.</p></span>"
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