Influenza and respiratory syncytial virus in the elderly.

Respiratory infections are one of the leading causes of morbidity and mortality worldwide: influenza and respiratory syncytial virus (RSV) are the predominant pathogens responsible. Annual vaccination and the use of antiviral drugs provides both protection and treatment against influenza, particularly protecting those patients most at risk, including the elderly and individuals with chronic comorbidities. Currently, there are extremely limited options in the protection against RSV infection, making those at-risk patients vulnerable to serious disease, complications and death.

Lessons from 40 years' surveillance of influenza in England and Wales.

The influenza virus continues to pose a significant threat to public health throughout the world. Current avian influenza outbreaks in humans have heightened the need for improved surveillance and planning. Despite recent advances in the development of vaccines and antiviral drugs, seasonal epidemics of influenza continue to contribute significantly to general practitioner workloads, emergency hospital admissions, and deaths.

The state of play in the battle against antimicrobial resistance: a general practitioner perspective.

This article summarizes personal reflections from the perspective of general practice on developments with regard to antibiotic resistance and the containment of antibiotic prescribing during the lifetime of the Specialist Advisory Committee on Antimicrobial Resistance in England. These reflections concern the entry of antibiotics into the food chain, recent extensions of prescribing responsibilities and developments towards improved surveillance and reduced antibiotic prescribing. A large gap remains between the scientific appreciation of the risks from antimicrobial resistance and effective means to measure it and thereby hopefully control it.

Skin infections and antibiotic prescribing: a comparison of surveillance and prescribing data.

Background: Reductions in the number of dispensed antibiotics and the incidence of respiratory infections presented to GPs and have been reported. Whether this trend applies to skin infections requires further investigation.

Aim: To examine trends in the incidence of skin infections in relation to trends in dispensed prescriptions for flucloxacillin, topical fusidic acid, mupirocin, and corticosteroids with fusidic acid.

The management of acute bronchitis in children.

Acute bronchitis is one of the most common infections reported in children under 5 years of age, and is a leading cause of hospitalisation. In general practice, confusion surrounds the clinical diagnosis of acute bronchitis, especially when distinguishing it from asthma. The microbiological causes are mostly known, but the contribution of each is much less clear, and they are non-specific in their clinical expression in individual cases.

Morbidity profiles of patients consulting during influenza and respiratory syncytial virus active periods.

We compared the burden of illness due to a spectrum of respiratory diagnostic categories among persons presenting in a sentinel general practice network in England and Wales during periods of influenza and of respiratory syncytial virus (RSV) activity. During all periods of viral activity, incidence rates of influenza-like illness, bronchitis and common cold were elevated compared to those in baseline periods. Excess rates per 100,000 of acute bronchitis were greater in children aged <1 year (median difference 2702, 95% CI 929-4867) and in children aged 1-4 years (994, 95% CI 338-1747) during RSV active periods rather than influenza; estimates for the two viruses were similar in other age groups.

Surveillance of influenza-like illness in England and Wales during 1966-2006.

We report surveillance data collected since 1966 from a general practice database in England and Wales. Incidence rates of influenza-like illness (ILI) peaked during the winter of 1969/70, and were then followed by a decade of heightened activity. There has since been a gradual downward trend of ILI, interspersed with winters of heightened activity; since 1999/2000, the incidence of ILI has been at its lowest for 40 years.

The association between impetigo, insect bites and air temperature: a retrospective 5-year study (1999-2003) using morbidity data collected from a sentinel general practice network database.

Background: Impetigo is one of the commonest childhood skin infections. Insect bites are commonly implicated in the development of impetigo. There are, however, very few data available to describe the seasonal incidences and association between the two conditions.

Estimating the risk population in relation to influenza vaccination policy.

There are many small differences in national influenza vaccination polices, some are age related and others morbidity related. This study examines a large English general practice database for 2003 to estimate the size of the England and Wales population at risk because of co-morbidity and to make recommendations on the choice of morbidity codes for use when estimating demand for vaccine and in auditing medical records to assess vaccination uptake. Morbidity codes relevant to the assessment of risk were defined and the database was analysed to estimate the annual period prevalence of the various diseases and groups of diseases.

The incidence of molluscum contagiosum, scabies and lichen planus.

We aimed to describe the incidence of new episodes of molluscum contagiosum, scabies and lichen planus presenting to general practitioners in England and Wales. We examined data collected in a sentinel practice network (the Weekly Returns Service of the Royal College of General Practitioners) in which about half a million persons were observed each year over the period 1994-2003. The incidence of molluscum contagiosum in males was 243/100,000 person-years and in females 231; of scabies, males 351, females 437; of lichen planus, males 32, females 37.

Mortality in children from influenza and respiratory syncytial virus.

Study Objective: To quantify mortality attributable to influenza and respiratory syncytial virus (RSV) infection in children.

Design And Methods: Comparison of death rates (all cause and certified respiratory) in England over winters 1989/90 to 1999/00 during and outside influenza and RSV circulation periods. Virus active weeks were defined from clinical and virological surveillance data.

The impact of influenza on the health and health care utilisation of elderly people.

Despite intensive research, influenza viruses still present one of the major causes of respiratory disease throughout the world. The elderly population and those individuals considered "at risk" due to presenting co-morbidity are especially vulnerable to influenza infection; this is evident from increased rates of morbidity and mortality in these populations during winter epidemic periods. Successful vaccination campaigns have targeted these groups over the last few years, providing protection to an increasing number of susceptible individuals.

Respiratory illness associated with influenza and respiratory syncytial virus infection.

Aims: To estimate excess morbidity during periods of influenza and respiratory syncytial virus (RSV) activity.

Methods: Retrospective analysis of a sentinel practice network database in active and non-active virus periods.

Main Outcome Measures: clinical diagnoses of new episodes of influenza-like illness (ILI), acute bronchitis, asthma, and otitis media.

Influenza and its relationship to circulatory disorders.

Three sources of data (general practice episode data from the Weekly Returns Service of the Royal College of General Practitioners, national hospital admission data for England and national mortality data by date of death) were examined separately in each winter (1994/1995 to 1999/2000) to investigate the impact of influenza on circulatory disease. Weekly data on incidence (clinical new episodes) hospital emergency admissions and deaths certified to circulatory disorders and to respiratory diseases (chapters VII and VIII of ICD9) during influenza epidemic periods (defined from combined clinical/virological surveillance) were examined in age groups 45-64, 65-74 and > or =75 years. Data collected in the four winters in which there were substantial influenza A epidemics were consolidated for the period 6 weeks before to 6 weeks after each peak of the epidemic, and associations between the variables at different time lags examined by calculating cross-correlation coefficients.

Gender difference in the incidence of shingles.

We investigated age- and gender-specific incidence of shingles reported in a large sentinel practice network monitoring a defined population over the years 1994-2001. In total, 5915 male and 8617 female incident cases were studied. For each age group, we calculated the relative risk of females to males presenting with shingles.

Influenza and adult hospital admissions for respiratory conditions in England 1989-2001.

Influenza is recognised as a major cause of excess hospital admissions during winter months. This study sets out to quantify admissions related to influenza during the last twelve winters and to examine the importance of age. Total admission data for respiratory disorders in adults for England during the years 1989 to 2001 have been used.

The incidence of shingles and its implications for vaccination policy.

A vaccine is now available to prevent varicella-zoster infection, but its place in routine preventive care is not yet determined. The age specific incidence of shingles was examined separately by gender and age groups (15-24, 25-44, 45-64, 65-74 and 75 years and more) over the years 1994-2001. These incidence data were applied to national available data for the UK on current life expectancy to calculate the risk of shingles infections at varying ages.

Zanamivir in the treatment of influenza.

Influenza is a common illness, affecting many people every winter, with a considerable impact on mortality, hospital admissions, healthcare utilisation and sickness absence from work and school. Influenza management is currently focused on annual vaccinations for those in certain risk groups. Risk is determined by age and chronic illness, particularly diabetes, chronic respiratory and cardiac disease, and persons immunocompromised from disease or concomitant therapy.

The evolution of influenza surveillance in Europe and prospects for the next 10 years.

This report traces the evolution of surveillance programmes for influenza in the United Kingdom and countries of western Europe since the World Health Organisation (WHO) resolution to establish an international influenza reference centre in 1947. The introduction of clinical surveillance schemes in the late 1960s and their gradual integration with laboratory-based surveillance is described, with particular emphasis on the need for integrated surveillance based on population-specific denominators. The function of the European Influenza Surveillance Scheme (EISS), its work programme in the last 5 years, and the likely direction of future developments is outlined.

The management of influenza in people of working age.

Influenza is common, causing considerable morbidity and sickness absence from work in most winters. Influenza vaccines have been available for >40 years, but are not extensively used in the workforce (in the UK). Amantadine has been available for 25 years as a treatment and prophylactic against influenza A infection, but has scarcely been used.

Impact of infections on primary care--greater than expected.

Though infection has declined as a cause of death it consumes a major proportion of primary care resources, and because of antibiotic resistance is increasingly important. We examined the burden of illness attributable to infection in primary care by analysing data from the fourth practice-based national morbidity survey which monitored all consultations by diagnosis in 470,000 persons over a 12 month period from September 1991 to August 1992. Rates of persons consulting, new episodes of illness and consultations were calculated according to the list of infections published by Wilson and Bhopal (W&B list), and as amended by the Communicable Disease Surveillance Centre (CDSC list); selected comparisons were made with national data on hospital derived finished consultant episodes and deaths.

Influenza diagnosis and treatment: a view from clinical practice.

Influenza is a descriptive term for respiratory epidemic disease presenting with cough and fever. Influenza viruses are probably the most important of the pathogens that cause this condition. Clinical influenza occurs almost every winter in England and Wales and the outbreaks last 8-10 weeks.

Study of the effectiveness of influenza vaccination in the elderly in the epidemic of 1989-90 using a general practice database.

The effectiveness of influenza vaccination in preventing serious illness and death was determined in an elderly population during the influenza epidemic of was determined in an elderly population during the influenza epidemic of was determined in an elderly population during the influenza epidemic of 1989-90. A retrospective cohort study was carried out using computerized general practitioner records on nearly 10,000 patients aged 55 years and over. After adjustment for potential confounding factors, recent immunization was found to have a protective effect of 75% (95% confidence intervals: 21-92%) against death.