CJEM Articles: influenza

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  • Predictors of pandemic influenza infection in adults presenting to two urban emergency departments, Toronto, 2009
    January 2011 13 1
    Allison McGeer, Barbara Mater, Kevin Katz, Linda R. Taggart, Todd C. Lee

    Objective: Identifying features that differentiate patients with H1N1 influenza infection from those with other conditions may assist clinical decision making during waves of pandemic influenza activity.
    Methods: From April 27 to June 15, 2009, nasopharyngeal swabs were obtained from all adults presenting to two urban emergency departments (EDs) with illness including fever or respiratory symptoms. H1N1 infection was detected by reverse transcriptase–polymerase chain reaction. Chart review was performed to compare cases of H1N1 influenza (n = 117) to matched controls.
    Results: The median age of cases was 35 years versus 50 years for controls (p < .001). In those with pre-existing conditions, asthma was present in 31% of cases versus 14% of controls (OR 2.6, 95% CI 1.3–5.4). Cough (OR 7.8, 95% CI 3.2–19), fever (OR 3.0, 95% CI 1.7–5.4), headache (OR 2.0, 95% CI 1.2–3.2), and myalgias (OR 1.9, 95% CI 1.2–3.1) were significantly more common in H1N1 cases. The median white blood cell count was 5.7 × 109/mL versus 10.9 × 109/mL (p < .001). The combination of fever and cough had an OR of 5.3. Fever, cough, low white blood cell (WBC) count, and tachycardia had the highest OR at 11. The absence of both fever and cough had a negative predictive value of 99%, but this occurred in only 8% of controls.
    Conclusion: In patients presenting to the ED, the combination of fever, cough, tachycardia, and WBC count < 10 × 109/mL was suggestive of H1N1 influenza infection. However, clinical features could not reliably distinguish influenza from other acute respiratory illnesses in adult ED patients.

  • Successful implementation of a combined pneumococcal and influenza vaccination program in a Canadian emergency department
    November 2005 7 6
    Antoinette Colacone, Eddy Lang, Eleena Pearson, Marc Afilalo, Nadia Farooki

    Objectives: To determine the proportion of patients vaccinated with pneumococcal (PVAX) and influenza (IVAX) vaccines under an emergency department (ED) vaccination program, that would not otherwise have been vaccinated by other primary care resources.
    Methods: This prospective cohort study was performed in a tertiary care academic centre. A questionnaire was administered to all consenting ED patients who met screening eligibility criteria to receive either IVAX or PVAX. Eligible unvaccinated patients who did not plan on receiving vaccination elsewhere were offered one or both of the vaccines and, if agreeable, were immunized in the ED.
    Results: During the 4-week study period, 754 patients (36% of all presenting ED patients) were eligible for vaccination with one or both vaccines. Of these 525 (70%) consented to participate in the study and completed a questionnaire. Of the 525 participants, 289 (55% of IVAX eligible patients; 95% confidence interval [CI], 51%–59%) were unvaccinated against influenza that year and did not plan on being vaccinated elsewhere and 277 (60% of PVAX eligible patients; 95% CI, 56%–64%) were unvaccinated against pneumococcus and did not plan on being vaccinated elsewhere. IVAX was administered to 187 patients (65% penetration; 95% CI, 59%–70%), and PVAX was administered to 165 patients (60% penetration; 95% CI, 54%–65%). Overall vaccine penetration was 46% (95% CI, 42%–50%) in the study participants and 32% (95% CI, 29%–35%) for the entire ED screened and eligible group. Reasons for vaccination refusal included concerns about benefit, side effects, and the desire to discuss vaccination with their primary care physician.
    Conclusions: An ED-based program can result in the vaccination of a significant proportion of patients eligible for IVAX and/or PVAX who would otherwise likely go unprotected.

  • Influenza vaccination rate among emergency department personnel: a survey of four teaching hospitals
    January 2005 7 1
    Inderpal Saluja, Janusz Kaczorowski, Karl D. Theakston

    Objectives: To determine influenza vaccination rates and attitudes toward vaccination among emergency department health care workers at 4 Ontario teaching hospitals.

    Methods: During the influenza season of 1999-2000 a confidential 28-item survey was distributed to emergency physicians and residents, nurses, respiratory therapists, and other allied health care workers at the emergency departments of 4 London, Ontario teaching hospitals.

    Results: Of 426 surveys distributed, 343 were returned, for an overall response rate of 80.5%. The mean age of respondents was 38.5 years (standard deviation = 8.3), 74.3% were female, and 86.6% were non-smokers. The overall vaccination rate was 37.0% (95% confidence interval, 31.9%-42.4%). Vaccination rates were 45.9% for respiratory therapists, 35.3% for emergency physicians and residents, 34.5% for nurses and 27.1% for other allied health care workers (p = 0.083). Multivariate logistic regression analysis revealed that age ≥41 and a chronic medical condition were positively associated with influenza vaccination (p < 0.05). Close to one-third of respondents (28.3%) believed that adverse affects were common, 51.6% believed vaccination was effective, 52% would support a program to improve vaccination rates among emergency department staff, and 24.4% would support mandatory vaccination for this population. Only 26.8% believed that patients were at increased risk of contracting influenza from emergency department staff, but 58.3% perceived that emergency department staff were at increased risk of contracting influenza through exposure to patients.

    Conclusions: In this study, only 37% of emergency department health care workers were immunized against influenza, with chronic illness and older age being the only 2 significant correlates. Strategies to improve emergency department health care worker attitudes toward influenza vaccination for themselves and to increase vaccination rates for this population should be developed.

  • Can a universal influenza immunization program reduce emergency department volume?
    July 2002 4 4
    Bonnie Henry, Dianne Groll

    Objectives: In 2000 the Ontario Minister of Health and Long-Term Care announced a universal influenza immunization program for Ontario, Canada. The 2 objectives of this $38-million program were to decrease seasonal impact of influenza on emergency department (ED) visits and to decrease the number and severity of influenza cases. This paper examines the correlation between population influenza rates and ED visits in 5 tertiary care hospitals in Ontario over a 5-year period (1996-2001).
    Methods: In this retrospective, observational study, we determined the total number of ED visits during the study period, by month, at 5 tertiary care hospitals in 3 Ontario cities Kingston, London and Ottawa). Detailed ED diagnoses were captured for Kingston, and provincial and national population-based influenza rates were obtained from Health Canada for the 5-year study period. Correlation and regression analyses were used to determine the relationship of influenza rates and ED volumes. "Influenza season" is defined in this study as November 1st to March 31st of each year.
    Results: There was no significant correlation between influenza rates and ED volumes, with Pearson correlation coefficients (r) of 0.22 (p = 0.72), 0.33 (p = 0.59) and 0.27 (p = 0.66) at the Kingston, London and Ottawa study sites, respectively. Data from the Kingston hospitals showed that, during influenza season, acute respiratory diagnoses accounted for only 4.4% of ED visits and influenza for only 0.34% of visits. Multiple linear regression analysis showed that the ED diagnosis of influenza was not significantly related to ED volume. During the influenza season after the universal immunization campaign, ED visits increased at all sites.
    Conclusion: Based on this study, a universal influenza immunization campaign is unlikely to affect ED volume.