Vanhems Philippe, Bénet Thomas, Munier-Marion Elodie
aInfection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de LyonbEmerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR 5308, ENS de Lyon, UCBL1cINSERM, F-CRIN, I-REIVAC, Lyon Collaborative Center, Lyon, France.
Curr Opin Infect Dis. 2016 Aug;29(4):366-72. doi: 10.1097/QCO.0000000000000287.
The prevalence and incidence of viral nosocomial influenza infections in healthcare settings are underestimated. Nosocomial influenza outbreaks are frequent, and control remains challenging in acute care and long-term healthcare settings. This review examines recent publications on the determinants of nosocomial influenza prevention and control.
Nosocomial influenza outbreaks occur in various healthcare settings, especially among the frail and elderly. The correct diagnosis is commonly missed because a substantial proportion of asymptomatic cases can transmit infections. Rapid diagnosis will facilitate rapid identification of cases and the implementation of control measures but needs confirmation in some circumstances, such as the description of transmission chains. Links between patients and healthcare personnel (HCP) have been well explored by phylogenetic virus characterization and need additional refinement and study. The preventive role of HCP vaccination in influenza incidence among patients should be investigated further in various settings to take into account different strategies for vaccination (i.e. voluntary or mandatory vaccination policies). Indeed, in Europe, influenza vaccination remains modest, whereas in North America hospitals and some states and provinces are now mandating influenza vaccination among HCP. The variability of vaccine effectiveness by seasonal epidemics is also an important consideration for control strategies.
When influenza cases occur in the community, the risk of transmission and nosocomial cases increase in healthcare settings requiring vigilance among staff. Surveillance and early warning systems should be encouraged. Outbreak control needs appropriate identification of cases and transmission chains, and rapid implementation of control measures. Vaccination policies in conjunction with appropriate infection control measures could reduce virus spreading in hospitals. HCP vaccination coverage must be improved.
医疗机构中病毒引起的医院获得性流感感染的患病率和发病率被低估了。医院获得性流感暴发很常见，在急性护理和长期医疗环境中控制感染仍然具有挑战性。本综述探讨了近期有关医院获得性流感预防和控制决定因素的出版物。
医院获得性流感暴发发生在各种医疗环境中，尤其是在体弱和老年人中。由于相当一部分无症状病例可传播感染，因此通常会漏诊正确诊断。快速诊断将有助于快速识别病例并实施控制措施，但在某些情况下需要确认，例如传播链的描述。通过系统发育病毒特征对患者与医护人员（HCP）之间的联系进行了充分探索，但需要进一步完善和研究。应在各种环境中进一步研究医护人员接种疫苗对患者流感发病率的预防作用，以考虑不同的疫苗接种策略（即自愿或强制接种政策）。事实上，在欧洲，流感疫苗接种率仍然不高，而在北美，医院以及一些州和省现在要求医护人员强制接种流感疫苗。季节性流行导致的疫苗效果差异也是控制策略的一个重要考虑因素。
当社区出现流感病例时，医疗机构中的传播风险和医院获得性病例会增加，这需要工作人员保持警惕。应鼓励建立监测和预警系统。暴发控制需要正确识别病例和传播链，并迅速实施控制措施。疫苗接种政策与适当的感染控制措施相结合可以减少病毒在医院的传播。必须提高医护人员的疫苗接种覆盖率。
