Meerhoff Tamara J, Simaku Artan, Ulqinaku Dritan, Torosyan Liana, Gribkova Natalia, Shimanovich Veronica, Chakhunashvili Giorgi, Karseladze Irakli, Yesmagambetova Aizhan, Kuatbayeva Ainagul, Nurmatov Zuridin, Otorbaeva Dinagul, Lupulescu Emilia, Popovici Odette, Smorodintseva Elizaveta, Sominina Anna, Holubka Olga, Onyshchenko Olga, Brown Caroline S, Gross Diane
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
Institute of Public Health, Tirana, Albania.
BMC Infect Dis. 2015 Jan 8;15:1. doi: 10.1186/s12879-014-0722-x.
The 2009 H1N1 pandemic highlighted the need to routinely monitor severe influenza, which lead to the establishment of sentinel hospital-based surveillance of severe acute respiratory infections (SARI) in several countries in Europe. The objective of this study is to describe characteristics of SARI patients and to explore risk factors for a severe outcome in influenza-positive SARI patients.
Data on hospitalised patients meeting a syndromic SARI case definition between 2009 and 2012 from nine countries in Eastern Europe (Albania, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russian Federation and Ukraine) were included in this study. An exploratory analysis was performed to assess the association between risk factors and a severe (ICU, fatal) outcome in influenza-positive SARI patients using a multivariate logistic regression analysis.
Nine countries reported a total of 13,275 SARI patients. The majority of SARI patients reported in these countries were young children. A total of 12,673 SARI cases (95%) were tested for influenza virus and 3377 (27%) were laboratory confirmed. The majority of tested SARI cases were from Georgia, the Russian Federation and Ukraine and the least were from Kyrgyzstan. The proportion positive varied by country, season and age group, with a tendency to a higher proportion positive in the 15+ yrs age group in six of the countries. ICU admission and fatal outcome were most often recorded for influenza-positive SARI cases aged > 15 yrs. An exploratory analysis using pooled data from influenza-positive SARI cases in three countries showed that age > 15 yrs, having lung, heart, kidney or liver disease, and being pregnant were independently associated with a fatal outcome.
Countries in Eastern Europe have been able to collect data through routine monitoring of severe influenza and results on risk factors for a severe outcome in influenza-positive SARI cases have identified several risk groups. This is especially relevant in the light of an overall low vaccination uptake and antiviral use in Eastern Europe, since information on risk factors will help in targeting and prioritising vulnerable populations.
2009年甲型H1N1流感大流行凸显了定期监测重症流感的必要性，这促使欧洲多个国家建立了以医院为基础的重症急性呼吸道感染（SARI）哨点监测。本研究的目的是描述SARI患者的特征，并探讨流感阳性SARI患者出现严重后果的危险因素。
本研究纳入了2009年至2012年期间来自东欧九个国家（阿尔巴尼亚、亚美尼亚、白俄罗斯、格鲁吉亚、哈萨克斯坦、吉尔吉斯斯坦、罗马尼亚、俄罗斯联邦和乌克兰）符合症状性SARI病例定义的住院患者数据。采用多变量逻辑回归分析进行探索性分析，以评估流感阳性SARI患者的危险因素与严重（入住重症监护病房、死亡）后果之间的关联。
九个国家共报告了13275例SARI患者。这些国家报告的大多数SARI患者为幼儿。共对12673例（95%）SARI病例进行了流感病毒检测，其中3377例（27%）经实验室确诊。检测的SARI病例大多数来自格鲁吉亚、俄罗斯联邦和乌克兰，最少来自吉尔吉斯斯坦。阳性比例因国家、季节和年龄组而异，在六个国家中，15岁及以上年龄组的阳性比例往往较高。入住重症监护病房和死亡结局最常出现在年龄大于15岁的流感阳性SARI病例中。对来自三个国家的流感阳性SARI病例的汇总数据进行的探索性分析表明，年龄大于15岁、患有肺、心、肾或肝病以及怀孕与死亡结局独立相关。
东欧国家已能够通过对重症流感的常规监测收集数据，并且关于流感阳性SARI病例严重后果危险因素的结果已确定了几个风险组。鉴于东欧总体疫苗接种率和抗病毒药物使用率较低，这一点尤为重要，因为危险因素信息将有助于确定脆弱人群并对其进行优先排序。
