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fever or febricula&#44; general discomfort&#44; headaches and myalgia&#59; and at least 1 of the following respiratory symptoms&#58; cough&#44; sore throat and dyspnea&#59; and&#44; lastly&#44; with the absence of other suspected diagnoses&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> this definition is only used by the sentinel network&#46; In hospitals and especially in emergency departments&#44; the clinical suspicion of influenza&#44; due to its lack of specificity&#44; coincides with most cases of acute respiratory infection &#40;ARI&#41; of viral etiology&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a> In most cases&#44; only the detection of the influenza virus in respiratory samples allows for a definitive diagnosis&#46;</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&#46; Thus&#44; 2 extensive studies showed that only 7&#37; and 16&#37; of all cases of ARI with suspected influenza infection were laboratory-confirmed as influenza&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few studies in Spain analyzing the disease burden of influenza&#46; 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 &#40;2013&#8211;2018&#41;&#46; Every patient who visited the hospital &#40;hospitalized or not&#41; with a clinical suspicion of ARI&#44; influenza syndrome or influenza was administered a throat swab&#46; The influenza virus was detected using a commercial real-time polymerase chain reaction assay &#40;Allplex Respiratory Full Panel Assay&#59; Seegene&#44; North Korea&#44; which can detect 16 different respiratory viruses&#44; including influenza A and B and its subtypes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Over the course of the study&#44; we analyzed 15&#44;017 patients&#44; 6010 &#40;40&#37;&#41; of whom were pediatric &#40;&#60;15 years&#41;&#44; and 9007 &#40;60&#37;&#41; of whom were adults&#46; A respiratory virus was detected in 7986 patients&#44; including the influenza virus&#44; which represented a mean positivity of 53&#46;1&#37;&#46; The overall disease burden due to influenza during this period was 22&#46;3&#37; &#40;3346 cases of influenza&#41;&#44; with 1228 cases &#40;8&#46;1&#37;&#41; in the pediatric group and 2118 &#40;14&#46;2&#37;&#41; in the adult group&#46; However&#44; if the cases of influenza are analyzed in each age group&#44; the 1228 pediatric cases represented a burden of 20&#46;4&#37;&#44; compared with the 23&#46;5&#37; detected in the adults&#46; There were 4640 cases of ARI caused by other noninfluenza viruses&#44; representing a disease burden of 30&#46;8&#37;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There were differences in the disease burden due to influenza over the course of the various seasons&#44; with its value ranging from 14&#37; &#40;2016&#47;2017 season&#41; to 27&#46;5&#37; &#40;2017&#47;2018 season&#41;&#46; In the first season&#44; the most common type was the influenza A virus &#40;H3N2&#41;&#59; in the second season&#44; the most common were the influenza A virus &#40;H1N1&#41;pdm09 and the Yamagata-lineage of influenza B&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Overall&#44; influenza represented 41&#46;8&#37; of all samples positive to some respiratory virus&#44; a rate that varied over the course of the seasons&#46; Thus&#44; the 2016&#47;2017 season showed the lowest rate of positivity &#40;25&#46;8&#37;&#41;&#44; while the last season showed the highest rate &#40;53&#46;1&#37;&#41;&#44; very close to that observed in the 2014&#47;2015 season &#40;52&#46;6&#37;&#41; in which the influenza A virus &#40;H3N2&#41; was the most common &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Based on these results&#44; it seems clear that influenza represents a disease burden in our geographical area that ranges from 14&#37; to 27&#46;5&#37; of all cases of ARI with clinical suspicion&#46; These values have varied according to the circulating strains and their correlation with the vaccine strains&#46;</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&#46; However&#44; the mean burden attributed to influenza in this study &#40;22&#46;3&#37;&#41; is higher than that reported in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6&#44;7</span></a> Flu-like symptoms caused by other respiratory viruses represented 30&#46;8&#37; of cases&#44; a higher rate than that caused by influenza itself&#46; In other words&#44; only 1 of every 5 cases with influenza symptoms will be a true influenza infection&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Therefore&#44; from the epidemiological and public health standpoint&#44; influenza with a laboratory etiological diagnosis is not the same as influenza symptoms that can be caused by other respiratory viruses&#46;<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&#46; We should demand a confirmation diagnosis to accept an ARI during the epidemic era as a real case of influenza&#46;</p></span>"
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Correspondence
Analysis of the disease burden of influenza in the last five seasons (2013–2018)
Análisis de la carga de enfermedad de la gripe en las últimas cinco temporadas (2013-2018)
J. Reinaa,
Corresponding author
jorge.reina@ssib.es

Corresponding author.
, P. Frailea, J. Murillasb
a Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Sección de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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        "titulo" => "An&#225;lisis de la carga de enfermedad de la gripe en las &#250;ltimas cinco temporadas &#40;2013-2018&#41;"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the influenza burden in percentages over the total number of samples analyzed and the total number of samples positive to respiratory viruses&#46;</p>"
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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&#44; coinciding with the winter months&#46; Due to this epidemiological nature&#44; with numerous cases within a short time interval &#40;8&#8211;12 weeks&#41;&#44; influenza is considered a significant public health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> To control these epidemics&#44; community surveillance networks for influenza have been created&#44; composed of sentinel physicians and hospital networks that monitor severe cases of influenza that require hospital admission&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the main problems with influenza is that despite a case definition &#40;sudden onset and the presence of at least 1 of the 4 general symptoms&#58; fever or febricula&#44; general discomfort&#44; headaches and myalgia&#59; and at least 1 of the following respiratory symptoms&#58; cough&#44; sore throat and dyspnea&#59; and&#44; lastly&#44; with the absence of other suspected diagnoses&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> this definition is only used by the sentinel network&#46; In hospitals and especially in emergency departments&#44; the clinical suspicion of influenza&#44; due to its lack of specificity&#44; coincides with most cases of acute respiratory infection &#40;ARI&#41; of viral etiology&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4&#44;5</span></a> In most cases&#44; only the detection of the influenza virus in respiratory samples allows for a definitive diagnosis&#46;</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&#46; Thus&#44; 2 extensive studies showed that only 7&#37; and 16&#37; of all cases of ARI with suspected influenza infection were laboratory-confirmed as influenza&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few studies in Spain analyzing the disease burden of influenza&#46; 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 &#40;2013&#8211;2018&#41;&#46; Every patient who visited the hospital &#40;hospitalized or not&#41; with a clinical suspicion of ARI&#44; influenza syndrome or influenza was administered a throat swab&#46; The influenza virus was detected using a commercial real-time polymerase chain reaction assay &#40;Allplex Respiratory Full Panel Assay&#59; Seegene&#44; North Korea&#44; which can detect 16 different respiratory viruses&#44; including influenza A and B and its subtypes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Over the course of the study&#44; we analyzed 15&#44;017 patients&#44; 6010 &#40;40&#37;&#41; of whom were pediatric &#40;&#60;15 years&#41;&#44; and 9007 &#40;60&#37;&#41; of whom were adults&#46; A respiratory virus was detected in 7986 patients&#44; including the influenza virus&#44; which represented a mean positivity of 53&#46;1&#37;&#46; The overall disease burden due to influenza during this period was 22&#46;3&#37; &#40;3346 cases of influenza&#41;&#44; with 1228 cases &#40;8&#46;1&#37;&#41; in the pediatric group and 2118 &#40;14&#46;2&#37;&#41; in the adult group&#46; However&#44; if the cases of influenza are analyzed in each age group&#44; the 1228 pediatric cases represented a burden of 20&#46;4&#37;&#44; compared with the 23&#46;5&#37; detected in the adults&#46; There were 4640 cases of ARI caused by other noninfluenza viruses&#44; representing a disease burden of 30&#46;8&#37;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There were differences in the disease burden due to influenza over the course of the various seasons&#44; with its value ranging from 14&#37; &#40;2016&#47;2017 season&#41; to 27&#46;5&#37; &#40;2017&#47;2018 season&#41;&#46; In the first season&#44; the most common type was the influenza A virus &#40;H3N2&#41;&#59; in the second season&#44; the most common were the influenza A virus &#40;H1N1&#41;pdm09 and the Yamagata-lineage of influenza B&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Overall&#44; influenza represented 41&#46;8&#37; of all samples positive to some respiratory virus&#44; a rate that varied over the course of the seasons&#46; Thus&#44; the 2016&#47;2017 season showed the lowest rate of positivity &#40;25&#46;8&#37;&#41;&#44; while the last season showed the highest rate &#40;53&#46;1&#37;&#41;&#44; very close to that observed in the 2014&#47;2015 season &#40;52&#46;6&#37;&#41; in which the influenza A virus &#40;H3N2&#41; was the most common &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Based on these results&#44; it seems clear that influenza represents a disease burden in our geographical area that ranges from 14&#37; to 27&#46;5&#37; of all cases of ARI with clinical suspicion&#46; These values have varied according to the circulating strains and their correlation with the vaccine strains&#46;</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&#46; However&#44; the mean burden attributed to influenza in this study &#40;22&#46;3&#37;&#41; is higher than that reported in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6&#44;7</span></a> Flu-like symptoms caused by other respiratory viruses represented 30&#46;8&#37; of cases&#44; a higher rate than that caused by influenza itself&#46; In other words&#44; only 1 of every 5 cases with influenza symptoms will be a true influenza infection&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Therefore&#44; from the epidemiological and public health standpoint&#44; influenza with a laboratory etiological diagnosis is not the same as influenza symptoms that can be caused by other respiratory viruses&#46;<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&#46; We should demand a confirmation diagnosis to accept an ARI during the epidemic era as a real case of influenza&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Reina J&#44; Fraile P&#44; Murillas J&#46; An&#225;lisis de la carga de enfermedad de la gripe en las &#250;ltimas cinco temporadas &#40;2013-2018&#41;&#46; Rev Clin Esp&#46; 2019&#59;219&#58;348&#8211;349&#46;</p>"
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Original language: English
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