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2012-03-27Zeitschriftenartikel DOI: 10.1186/1471-2458-12-245
Lessons from a one-year hospital-based surveillance of acute respiratory infections in Berlin- comparing case definitions to monitor influenza
dc.contributor.authorNachtnebel, Matthias
dc.contributor.authorGreutélaers, Benedikt
dc.contributor.authorFalkenhorst, Gerhard
dc.contributor.authorJorgensen, Pernille
dc.contributor.authorDehnert, Manuel
dc.contributor.authorSchweiger, Brunhilde
dc.contributor.authorTräder, Christian
dc.contributor.authorBuda, Silke
dc.contributor.authorEckmanns, Tim
dc.contributor.authorWichmann, Ole
dc.contributor.authorHellenbrand, Wiebke
dc.date.accessioned2018-05-07T15:41:15Z
dc.date.available2018-05-07T15:41:15Z
dc.date.created2012-06-06
dc.date.issued2012-03-27none
dc.identifier.otherhttp://edoc.rki.de/oa/articles/reji2Q5KL1fhY/PDF/20k7QdghoXeTg.pdf
dc.identifier.urihttp://edoc.rki.de/176904/1229
dc.description.abstractBackground: Surveillance of severe acute respiratory infections (SARI) in sentinel hospitals is recommended to estimate the burden of severe influenza-cases. Therefore, we monitored patients admitted with respiratory infections (RI) in 9 Berlin hospitals from 7.12.2009 to 12.12.2010 according to different case definitions (CD) and determined the proportion of cases with influenza A(H1N1)pdm09 (pH1N1). We compared the sensitivity and specificity of CD for capturing pandemic pH1N1 cases. Methods: We established an RI-surveillance restricted to adults aged ≤ 65 years within the framework of a pH1N1 vaccine effectiveness study, which required active identification of RI-cases. The hospital information-system was screened daily for newly admitted RI-patients. Nasopharyngeal swabs from consenting patients were tested by PCR for influenza-virus subtypes. Four clinical CD were compared in terms of capturing pH1N1-positives among hospitalized RI-patients by applying sensitivity and specificity analyses. The broadest case definition (CD1) was used for inclusion of RI-cases; the narrowest case definition (CD4) was identical to the SARI case definition recommended by ECDC/WHO. Results: Over the study period, we identified 1,025 RI-cases, of which 283 (28%) met the ECDC/WHO SARI case definition. The percentage of SARI-cases among internal medicine admissions decreased from 3.2% (calendar-week 50-2009) to 0.2% (week 25-2010). Of 354 patients tested by PCR, 20 (6%) were pH1N1-positive. Two case definitions narrower than CD1 but -in contrast to SARI- not requiring shortness of breath yielded the largest areas under the Receiver-Operator-Curve. Heterogeneity of proportions of patients admitted with RI between hospitals was significant. Conclusions: Comprehensive surveillance of RI cases was feasible in a network of community hospitals. In most settings, several hospitals should be included to ensure representativeness. Although misclassification resulting from failure to obtain symptoms in the hospital information-system cannot be ruled out, a high proportion of hospitalized PCR-positive pH1N1-patients (45%) did not fulfil the SARI case-definition that included shortness of breath or difficulty breathing. Thus, to assess influenza-related disease burden in hospitals, broader, alternative case definitions should be considered.eng
dc.language.isoeng
dc.publisherRobert Koch-Institut, Infektionsepidemiologie
dc.subjectAdolescenteng
dc.subjectHumanseng
dc.subjectFemaleeng
dc.subjectPolymerase Chain Reactioneng
dc.subjectMaleeng
dc.subjectMiddle Agedeng
dc.subjectAdulteng
dc.subjectSentinel Surveillanceeng
dc.subjectInfluenza A Viruseng
dc.subjectRespiratory Tract Infections/epidemiologyeng
dc.subjectRespiratory Tract Infections/virologyeng
dc.subjectBerlin/epidemiologyeng
dc.subjectH1N1 Subtype/isolation & purificationeng
dc.subjectHospitalization/statistics & numerical dataeng
dc.subjectInfluenza Human/virologyeng
dc.subjectNasopharynx/virologyeng
dc.subjectInfluenza Human/epidemiologyeng
dc.subjectInfluenza Human/diagnosiseng
dc.subjectIntensive Care Units/statistics & numerical dataeng
dc.subjectInfluenza Vaccines/administration & dosageeng
dc.subjectArea Under Curveeng
dc.subjectConfidence Intervalseng
dc.subjectHospital Information Systemseng
dc.subjectHospitals Communityeng
dc.subjectOutcome Assessment (Health Care)eng
dc.subjectPatient Admission/statistics & numerical dataeng
dc.subjectPatient Admission/trendseng
dc.subjectROC Curveeng
dc.subjectRespiratory Tract Infections/diagnosiseng
dc.subject.ddc610 Medizin
dc.titleLessons from a one-year hospital-based surveillance of acute respiratory infections in Berlin- comparing case definitions to monitor influenza
dc.typeperiodicalPart
dc.identifier.urnurn:nbn:de:0257-10024506
dc.identifier.doi10.1186/1471-2458-12-245
dc.identifier.doihttp://dx.doi.org/10.25646/1154
local.edoc.container-titleBMC Public Health
local.edoc.fp-subtypeArtikel
local.edoc.type-nameZeitschriftenartikel
local.edoc.container-typeperiodical
local.edoc.container-type-nameZeitschrift
local.edoc.container-urlhttp://www.biomedcentral.com/1471-2458/12/245
local.edoc.container-publisher-nameBioMedCentral
local.edoc.container-volume12
local.edoc.container-issue245
local.edoc.container-year2012

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