Letter to the Editor
Reply to “Influenza vaccination and critical patient protection: Responsibility of healthcare workers”
En respuesta a «Vacunación antigripal y protección del paciente crítico: responsabilidad de los profesionales sanitarios»
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A. Pre-stenotic axial image showing the esophageal dilatation and aortic dissection. B. Axial image of the compression region (white asterisk). C. Coronal imaging showing progressive esophageal tapering.Ao, aorta with image of aortic flap; LA, left atrium; LV, left ventricle; PA, pulmonary artery; RV, right ventricle. White arrow: pre- and post-stenotic esophageal dilatation. White asterisk: esophageal obstruction region.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Valiente Fernández, J.D. Czapka Mital, J.L. Pérez Vela" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Valiente Fernández" ] 1 => array:2 [ "nombre" => "J.D." "apellidos" => "Czapka Mital" ] 2 => array:2 [ "nombre" => "J.L." 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Marin-Corral, R. Muñoz-Bermúdez, F. Álvarez-Lerma" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Marin-Corral" "email" => array:1 [ 0 => "jmarincorral@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Muñoz-Bermúdez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Álvarez-Lerma" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Investigación en Patología Crítica (GREPAC), Instituto Mar de Investigaciones Médicas (IMIM), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universitat Autònoma de Barcelona (UAB), Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "En respuesta a «Vacunación antigripal y protección del paciente crítico: responsabilidad de los profesionales sanitarios»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the first place, we wish to thank the authors of “Influenza vaccination and critical patient protection: responsibility of healthcare workers” for their interest and for quoting our paper.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Infections caused by influenza virus can be prevented though common vaccination in our setting.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It is a especially effective public health measure capable of preventing the disease, hospital admissions and infection-induced mortality.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although there are not too many studies on this regard, nosocomial or hospital-acquired influenza infections have already been reported. A recent study conducted by our group<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> revealed a 9.3% incidence rate of hospital-acquired influenza A (symptom onset starting on the 7th day of admission) in a cohort of 2421 severe patients admitted to the intensive care unit (ICU). Patients with nosocomial influenza A infections had a clinical profile, showed severity at the ICU admission and different therapeutic requirements compared to patients with community-acquired and in-hospital-acquired infections, which was independently associated with mortality.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This finding stresses the authors’ message shown on the title of their letter. We share their opinion on the importance of vaccinating healthcare providers to avoid transmitting the infection. We agree that the low influenza immunization of healthcare providers, especially at the ICU setting, should be approached by the authorities in charge of the health policies following recommendations of scientific evidence and from the work health and safety committees of each center. In this sense, at our hospital ICU and thanks to the public campaigns run by the work health and safety service, these rates of influenza immunization have grown among healthcare providers, from 29.5% in 2015 to 38.1% in 2017, especially among doctors (72.2%).</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the ICU setting and in all hospitalization units, the recommendations should go far beyond vaccinating healthcare providers. Everybody who is in contact with these patients should be vaccinated, included the families. Preventive measures should include avoiding the contact of visitors and healthcare providers with the patients’ clinical signs, use face masks during the epidemic periods, and follow all hand sanitizing regulations before and after treating the patient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Preventing the transmission of the influenza virus in hospitals, and especially at the ICU setting, should be a priority goal. In this sense, vaccinating healthcare providers is still one of the key strategies. Also, implementing measures that have proven effective increasing the immunization rate of these professionals (obligatory nature or filling out a refusal to vaccinate declaration) could improve the actual situation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marin-Corral J, Muñoz-Bermúdez R, Álvarez-Lerma F. En respuesta a «Vacunación antigripal y protección del paciente crítico: responsabilidad de los profesionales sanitarios». Med Intensiva. 2019;43:585–586.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Fiore AC, Bridges CB, Katz JM, Cox NJ. Inactivated influenza vaccines. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines, 6th ed.; Elsevier: Philadelphia, PA. 2012; p. 257–93." ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Advisory Committee on Immunization Practices; Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60:1–45." ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO Regional Office for Europe. WHO Regional Office for Europe Recommendations on Influenza Vaccination during the 2015/2016 Winter Season. 2015. Available from: <a target="_blank" href="http://www.euro.who.int/en/health-topics/communicable-diseases/influenza/publications/2018/recommendations-on-influenza-vaccination-during-the-20182019-winter-season-2018">http://www.euro.who.int/en/health-topics/communicable-diseases/influenza/publications/2018/recommendations-on-influenza-vaccination-during-the-20182019-winter-season-2018</a> [accessed 26.10.18]." ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of patients with hospital-acquired influenza A (H1N1)pdm09 virus admitted to the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Álvarez-Lerma" 1 => "J. Marin-Corral" 2 => "C. Vilà" 3 => "J.R. Masclans" 4 => "I.M. Loeches" 5 => "S. Barbadillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhin.2016.12.017" "Revista" => array:6 [ "tituloSerie" => "J Hosp Infect" "fecha" => "2016" "volumen" => "95" "paginaInicial" => "200" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28153560" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions to increase seasonal influenza vaccine coverage in healthcare workers: a systematic review and meta-regression analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Lytras" 1 => "F. Kopsachilis" 2 => "E. Mouratidou" 3 => "D. Papamichail" 4 => "S. Bonovas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/21645515.2015.1106656" "Revista" => array:6 [ "tituloSerie" => "Hum Vaccin Immunother" "fecha" => "2016" "volumen" => "12" "paginaInicial" => "671" "paginaFinal" => "681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26619125" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000009/v1_201911280636/S217357271930205X/v1_201911280636/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000009/v1_201911280636/S217357271930205X/v1_201911280636/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271930205X?idApp=WMIE" ]
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