UMR S 707, INSERM, Paris, France.
Influenza Other Respir Viruses. 2013 Jan;7(1):74-84. doi: 10.1111/j.1750-2659.2012.00356.x. Epub 2012 Mar 22.
The case-hospitalization ratio (CHR) is a key quantity for the management of emerging pathogens such as pandemic influenza. Yet, few running surveillance systems prospectively monitor the CHR during influenza epidemics. Here, we analyze the proportion of recommended hospitalizations (PRH) among influenza-like illness (ILI) patients attended in general practice in France and compare the PRH observed during the 2009-2010 A(H1N1) pandemic with the one of the twelve previous seasons.
ILI cases were recorded by general practitioners (GPs) involved in surveillance, who indicated for each case whether they recommended hospitalization. We stratify the analysis by age, sex, and viral subtype. We investigate the reasons why GPs recommended hospitalization and the presence of risk factors for pandemic A(H1N1) complications.
The average PRH over the seasons 1997-1998 to 2008-2009 was 3·4‰ (3-3·9). It was three times higher during the 2009-2010 pandemic than during seasonal influenza epidemics (OR = 2·89, 95% CI: 2·28-3·64). The highest increase was among 20-39-year-old women: OR = 11·8 (5·04-29·59). Overall, the principal reasons for recommending hospitalization were "respiratory problems" and "bad general condition." However, during the pandemic, "age" (mainly associated with infants), "pregnancy," and "diagnostic" became more frequent than before (P < 0·001). Finally, pregnancy was the reported risk factor for pandemic A(H1N1) complications that had the largest impact on hospitalization recommendation during the pandemic (OR = 38·62, P < 0·001).
Easily implemented in surveillance systems, this protocol has the potential to reveal changes in hospitalization recommendation by GPs. Moreover, if the right data are collected alongside, it could give timely insights into epidemic severity.
病例住院比（CHR）是管理新出现的病原体（如大流行性流感）的关键指标。然而，很少有正在运行的监测系统在流感流行期间前瞻性地监测 CHR。在这里，我们分析了法国普通科医生就诊的流感样疾病（ILI）患者中推荐住院的比例（PRH），并比较了 2009-2010 年 A（H1N1）大流行期间的 PRH 与前 12 个季节的 PRH。
参与监测的普通科医生记录了 ILI 病例，并为每个病例指出他们是否建议住院。我们按年龄、性别和病毒亚型对分析进行分层。我们调查了普通科医生建议住院的原因以及大流行性 A（H1N1）并发症的危险因素的存在情况。
1997-1998 年至 2008-2009 年各季节的平均 PRH 为 3.4‰（3-3.9）。在 2009-2010 年大流行期间，PRH 是季节性流感流行期间的三倍（OR=2.89，95%CI：2.28-3.64）。增幅最大的是 20-39 岁的女性：OR=11.8（5.04-29.59）。总体而言，建议住院的主要原因是“呼吸问题”和“一般状况不佳”。然而，在大流行期间，“年龄”（主要与婴儿有关）、“怀孕”和“诊断”比以前更常见（P<0.001）。最后，怀孕是大流行性 A（H1N1）并发症的报告风险因素，对大流行期间的住院建议影响最大（OR=38.62，P<0.001）。
该方案易于在监测系统中实施，有可能揭示普通科医生建议住院的变化。此外，如果同时收集了正确的数据，它可以及时洞察疫情的严重程度。
