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Reina, P. Fraile, J. Murillas" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Reina" "email" => array:1 [ 0 => "jorge.reina@ssib.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Fraile" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Murillas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la carga de enfermedad de la gripe en las últimas cinco temporadas (2013-2018)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1308 "Ancho" => 2083 "Tamanyo" => 94621 ] ] "descripcion" => array:1 [ "en" => "Evolution of the influenza burden in percentages over the total number of samples analyzed and the total number of samples positive to respiratory viruses." ] ] ] "textoCompleto" => "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">1</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">2,3</a>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">3</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">4,5</a> In most cases, only the detection of the influenza virus in respiratory samples allows for a definitive diagnosis.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">6,7</a>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.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%.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.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>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>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.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">6,7</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.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">8</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." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Reina J, Fraile P, Murillas J. Análisis de la carga de enfermedad de la gripe en las últimas cinco temporadas (2013-2018). Rev Clin Esp. 2019;219:348–349." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1308 "Ancho" => 2083 "Tamanyo" => 94621 ] ] "descripcion" => array:1 [ "en" => "Evolution of the influenza burden in percentages over the total number of samples analyzed and the total number of samples positive to respiratory viruses." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influenza viruses: update on epidemiology, clinical features, treatment and vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. 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"autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Red Centinela de Vigilancia de la Gripe en las Islas Baleares" "etal" => false "autores" => array:2 [ 0 => "J. Reina" 1 => "C. López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2013.07.010" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "334" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24126245" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de la especificidad de la definición de caso en el diagnóstico clínico de la gripe" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Red Centinela de Vigilancia de la Gripe (RCVG) de Baleares" "etal" => false "autores" => array:4 [ 0 => "J. Reina" 1 => "R. 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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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