Seasonal influenza affects a considerable proportion of the global population each year. We assessed the association between subnational influenza activity and temperature, specific humidity and rainfall in three Central America countries, i.e. Costa Rica, Honduras and Nicaragua. Using virologic data from each country's national influenza centre, rainfall from the Tropical Rainfall Measuring Mission and air temperature and specific humidity data from the Global Land Data Assimilation System, we applied logistic regression methods for each of the five sub-national locations studied. Influenza activity was represented by the weekly proportion of respiratory specimens that tested positive for influenza. The models were adjusted for the potentially confounding co-circulating respiratory viruses, seasonality and previous weeks' influenza activity. We found that influenza activity was proportionally associated (P<0.05) with specific humidity in all locations [odds ratio (OR) 1.21-1.56 per g/kg], while associations with temperature (OR 0.69-0.81 per °C) and rainfall (OR 1.01-1.06 per mm/day) were location-dependent. Among the meteorological parameters, specific humidity had the highest contribution (~3-15%) to the model in all but one location. As model validation, we estimated influenza activity for periods, in which the data was not used in training the models. The correlation coefficients between the estimates and the observed were ≤0.1 in 2 locations and between 0.6-0.86 in three others. In conclusion, our study revealed a proportional association between influenza activity and specific humidity in selected areas from the three Central America countries.
Evaluating the impact of different social networks on the spread of respiratory diseases has been limited by a lack of detailed data on transmission outside the household setting as well as appropriate statistical methods. Here, from data collected during a H1N1 pandemic (pdm) influenza outbreak that started in an elementary school and spread in a semirural community in Pennsylvania, we quantify how transmission of influenza is affected by social networks. We set up a transmission model for which parameters are estimated from the data via Markov chain Monte Carlo sampling. Sitting next to a case or being the playmate of a case did not significantly increase the risk of infection; but the structuring of the school into classes and grades strongly affected spread. There was evidence that boys were more likely to transmit influenza to other boys than to girls (and vice versa), which mimicked the observed assortative mixing among playmates. We also investigated the presence of abnormally high transmission occurring on specific days of the outbreak. Late closure of the school (i.e., when 27% of students already had symptoms) had no significant impact on spread. School-aged individuals (6–18 y) facilitated the introduction and spread of influenza in households, but only about one in five cases aged >18 y was infected by a school-aged household member. This analysis shows the extent to which clearly defined social networks affect influenza transmission, revealing strong between-place interactions with back-and-forth waves of transmission between the school, the community, and the household.
Retinoblastoma, a neuroblastic tumor, is the most common primary intraocular malignancy of childhood. Patients usually present with leukokoria (white reflex or white pupil), detected in primary care. The mean age at diagnosis is 12 months for bilateral tumors and 24 months for unilateral tumors. If untreated, almost all patients die of intracranial extension and disseminated disease within two years. However, new diagnostic and treatment methods allow for a high cure rate (93 percent five-year survival in the United States), therefore it is important that primary care physicians recognize the manifestations of this malignancy. Diagnosis is primarily by history and complete ophthalmic examination, with studies including ultrasonography of the eye and imaging of the orbits and brain. Treatment modalities include laser thermotherapy, cryotherapy, radioactive plaques, external beam radiotherapy, chemotherapy, and enucleation. Prospective parents with a family history of retinoblastoma should be referred for genetic counseling. Office evaluation for a red reflex in children should be performed until three years of age. If leukokoria is observed, the patient should be examined by an ophthalmologist within one week.
In 2013, the Pan American Health Organization established a multi-site, multi-country network to evaluate influenza vaccine effectiveness (VE). We pooled data from five consecutive seasons in five countries to conduct an analysis of southern hemisphere VE against laboratory-confirmed influenza hospitalizations in young children and older adults.We used a test-negative design to estimate VE against laboratory-confirmed influenza in hospitalized young children (aged 6─24 months) and older adults (aged ≥60 years) in Argentina, Brazil, Chile, Colombia, and Paraguay. Following country-specific influenza surveillance protocol, hospitalized persons with severe acute respiratory infections (SARI) at 48 sentinel hospitals (March 2013-December 2017) were tested for influenza virus infection by rRT-PCR. VE was estimated for young children and older adults using logistic random effects models accounting for cluster (country), adjusting for sex, age (months for children, and age-in-year categories for adults), calendar year, country, preexisting conditions, month of illness onset and prior vaccination as an effect modifier for the analysis in adults.We included 8426 SARI cases (2389 children and 6037 adults) in the VE analyses. Among young children, VE against SARI hospitalization associated with any influenza virus was 43% (95%CI: 33%, 51%) for children who received two doses, but was 20% (95%CI: -16%, 45%) and not statistically significant for those who received one dose in a given season. Among older adults, overall VE against SARI hospitalization associated with any influenza virus was 41% (95%CI: 28%, 52%), 45% (95%CI: 34%, 53%) against A(H3N2), 40% (95%CI: 18%, 56%) against A(H1N1)pdm09, and 20% (95%CI: -40%, 54%) against influenza B viruses.Our results suggest that over the five-year study period, influenza vaccination programs in five South American countries prevented more than one-third of laboratory confirmed influenza-associated hospitalizations in young children receiving the recommended two doses and vaccinated older adults.
Abstract Data needed to guide influenza vaccine policies are lacking in tropical countries. We multiplied the number of severe acute respiratory infections by the proportion testing positive for influenza. There were ≈6,699 influenza hospitalizations and 803 deaths in Costa Rica during 2009–2012, supporting continuation of a national influenza vaccine program.
External quality assessments (EQAs) for the molecular detection of respiratory syncytial virus (RSV) are necessary to ensure the provision of reliable and accurate results. One of the objectives of the pilot of the World Health Organization (WHO) Global RSV Surveillance, 2016-2017, was to evaluate and standardize RSV molecular tests used by participating countries. This paper describes the first WHO RSV EQA for the molecular detection of RSV.The WHO implemented the pilot of Global RSV Surveillance based on the WHO Global Influenza Surveillance and Response System (GISRS) from 2016 to 2018 in 14 countries. To ensure standardization of tests, 13 participating laboratories were required to complete a 12 panel RSV EQA prepared and distributed by the Centers for Disease Control and Prevention (CDC), USA. The 14th laboratory joined the pilot late and participated in a separate EQA. Laboratories evaluated a RSV rRT-PCR assay developed by CDC and compared where applicable, other Laboratory Developed Tests (LDTs) or commercial assays already in use at their laboratories.Laboratories performed well using the CDC RSV rRT-PCR in comparison with LDTs and commercial assays. Using the CDC assay, 11 of 13 laboratories reported correct results. Two laboratories each reported one false-positive finding. Of the laboratories using LDTs or commercial assays, results as assessed by Ct values were 100% correct for 1/5 (20%). With corrective actions, all laboratories achieved satisfactory outputs.These findings indicate that reliable results can be expected from this pilot. Continued participation in EQAs for the molecular detection of RSV is recommended.
Hantaviruses are rodent-borne viruses capable of causing human disease. The Seoul virus is a hantavirus that causes hemorrhagic fever with renal syndrome in East Asia. To our knowledge, we report the first domestically acquired case of hemorrhagic fever with renal syndrome caused by the Seoul virus, confirmed by serology testing, reverse-transcriptase polymerase chain reaction, and nucleotide sequence analysis. The patient presented with myalgias and fever, and developed acute renal failure.
We report shedding duration of 2009 pandemic influenza A (pH1N1) virus from a school-associated outbreak in Pennsylvania during May through June 2009. Outbreak-associated students or household contacts with influenza-like illness (ILI) onset within 7 days of interview were recruited. Nasopharyngeal specimens, collected every 48 hours until 2 consecutive nonpositive tests, underwent real-time reverse transcriptase polymerase chain reaction (rRT-PCR) and culture for pH1N1 virus. Culture-positive specimens underwent virus titrations. Twenty-six (median age, 8 years) rRT-PCR–positive persons, for pH1N1 virus, were included in analysis. Median shedding duration from fever onset by rRT-PCR was 6 days (range, 1–13) and 5 days (range, 1–7) by culture. Following fever resolution virus was isolated for a median of 2 days (range, 0–5). Highest and lowest virus titers detected, 2 and 5 days following fever onset, were 3.2 and 1.2 log10 TCID50/mL respectively. Overall, shedding duration in children and adults were similar to seasonal influenza viruses.
To determine trends in mortality from respiratory disease in several areas of Latin America between 1998 and 2009.The numbers of deaths attributed to respiratory disease between 1998 and 2009 were extracted from mortality data from Argentina, southern Brazil, Chile, Costa Rica, Ecuador, Mexico and Paraguay. Robust linear models were then fitted to the rates of mortality from respiratory disease recorded between 2003 and 2009.Between 1998 and 2008, rates of mortality from respiratory disease gradually decreased in all age groups in most of the study areas. Among children younger than 5 years, for example, the annual rates of such mortality - across all seven study areas - fell from 56.9 deaths per 100,000 in 1998 to 26.6 deaths per 100,000 in 2008. Over this period, rates of mortality from respiratory disease were generally highest among adults older than 65 years and lowest among individuals aged 5 to 49 years. In 2009, mortality from respiratory disease was either similar to that recorded in 2008 or showed an increase - significant increases were seen among children younger than 5 years in Paraguay, among those aged 5 to 49 years in southern Brazil, Mexico and Paraguay and among adults aged 50 to 64 years in Mexico and Paraguay.In much of Latin America, mortality from respiratory disease gradually fell between 1998 and 2008. However, this downward trend came to a halt in 2009, probably as a result of the (H1N1) 2009 pandemic.Déterminer les tendances de la mortalité par maladies respiratoires dans plusieurs régions d'Amérique latine entre 1998 et 2009.Le nombre de décès attribuables aux maladies respiratoires entre 1998 et 2009 a été extrait des données de mortalité d'Argentine, du Sud du Brésil, du Chili, du Costa Rica, d'Équateur, du Mexique et du Paraguay. Des modèles linéaires solides ont ensuite été adaptés aux taux de mortalité par maladies respiratoires enregistrés entre 2003 et 2009.Entre 1998 et 2008, les taux de mortalité par maladies respiratoires ont progressivement diminué dans tous les groupes d'âge, dans la plupart des domaines d'étude. Chez les enfants de moins de 5 ans, par exemple, les taux annuels de mortalité, dans les sept domaines d'étude, ont chuté de 56,9 décès pour 100 000 en 1998, à 26,6 décès pour 100 000 en 2008. Au cours de cette période, les taux de mortalité par maladies respiratoires étaient généralement les plus élevés chez les adultes de plus de 65 ans et les plus faibles chez les individus âgés de 5 à 49 ans. En 2009, la mortalité par maladies respiratoires était similaire à celle enregistrée en 2008 ou en augmentation. Des augmentations importantes ont été observées chez les enfants de moins de 5 ans au Paraguay, chez les personnes âgées de 5 à 49 ans dans le Sud du Brésil, au Mexique et au Paraguay et chez les adultes âgés de 50 à 64 ans au Mexique et au Paraguay.Dans une grande partie de l'Amérique latine, la mortalité par maladies respiratoires a progressivement diminué entre 1998 et 2008. Cependant, cette tendance à la baisse s'est interrompue en 2009, probablement en raison de la pandémie de 2009 (H1N1).Determinar las tendencias de la mortalidad por enfermedades respiratorias en varias zonas de América Latina entre 1998 y 2009.El número de muertes atribuidas a enfermedades respiratorias entre los años 1998 y 2009 se obtuvo de los datos sobre la mortalidad en Argentina, sur de Brasil, Chile, Costa Rica, Ecuador, México y Paraguay y se adaptaron modelos lineales sólidos a las tasas de mortalidad por enfermedades respiratorias registradas entre 2003 y 2009.Entre 1998 y 2008, las tasas de mortalidad por enfermedades respiratorias disminuyeron gradualmente en todos los grupos de edad en la mayoría de las áreas de estudio. Entre los niños menores de 5 años, por ejemplo, las tasas anuales de dicha mortalidad (en las siete áreas de estudio) se redujeron de 56,9 muertes por cada 100 000 habitantes en 1998 a 26,6 muertes por cada 100 000 habitantes en 2008. Durante este período, las tasas de mortalidad por enfermedades respiratorias fueron en general más altas entre los adultos mayores de 65 años y más bajas entre las personas de 5 a 49 años. En 2009, la mortalidad por enfermedades respiratorias fue similar a la registrada en el 2008 o mostró un incremento, pues se observó un aumento significativo entre los niños menores de 5 años en Paraguay, entre individuos de entre 5-49 años de edad en el sur de Brasil, México y Paraguay, así como entre los adultos con edades comprendidas entre 50 y 64 años en México y Paraguay.En gran parte de América Latina, la mortalidad por enfermedades respiratorias se redujo gradualmente entre 1998 y 2008. Sin embargo, esta tendencia a la baja se detuvo en 2009, probablemente como resultado de la pandemia (H1N1) de 2009.تحديد الاتجاهات في معدل الوفيات الناجمة عن الأمراض التنفسية في عدة مناطق في أمريكا اللاتينية في الفترة من 1998 إلى 2009.تم استخلاص أعداد الوفيات التي تُعزى إلى الأمراض التنفسية في الفترة من 1998 إلى 2009 من بيانات الوفيات من الأرجنتين وجنوب البرازيل وشيلي وكوستاريكا والإكوادور والمكسيك وباراغواي. وتم ملاءمة النماذج الخطية القوية بمعدلات الوفيات الناجمة عن الأمراض التنفسية المسجلة في الفترة من 2003 إلى 2009.في الفترة من 1998 إلى 2008، انخفضت معدلات الوفيات الناجمة عن الأمراض التنفسية تدريجياً في جميع الفئات العمرية في معظم مناطق الدراسة. على سبيل المثال، انخفضت المعدلات السنوية لهذه الوفيات بين الأطفال الأقل من 5 سنوات – عبر جميع مناطق الدراسة السبعة – من 56.9 حالة وفاة لكل 100000 في عام 1998 إلى 26.6 حالة وفاة لكل 100000 في عام 2008. وعلى مدار هذه الفترة، كانت معدلات الوفيات الناجمة عن الأمراض التنفسية عموماً هي الأعلى بين البالغين الأكبر من 65 سنة والأقل بين الأفراد الذين تراوحت أعمارهم من 5 إلى 49 سنة. وفي عام 2009، كان معدل الوفيات الناجمة عن الأمراض التنفسية إما مشابهاً لذلك الذي تم تسجيله في عام 2008 أو أظهر ارتفاعاً – لوحظت ارتفاعات كبيرة بين الأطفال الأقل من 5 سنوات في باراغواي، وبين من تراوحت أعمارهم من 5 إلى 49 سنة في جنوب البرازيل والمكسيك وباراغواي وبين البالغين الذين تراوحت أعمارهم من 50 إلى 64 سنة في المكسيك وباراغواي.في معظم مناطق أمريكا اللاتينية، انخفض معدل الوفيات الناجمة عن الأمراض التنفسية تدريجياً في الفترة من 1998 إلى 2008. ومع ذلك، توقف هذا الاتجاه النزولي في عام 2009، على نحو محتمل نتيجة لجائحة (H1N1) لعام 2009.确定1998 年至2009 年之间拉丁美洲数个地区呼吸系统疾病的死亡率趋势。从阿根廷、巴西南部、智利、哥斯达黎加、厄瓜多尔、墨西哥和巴拉圭的死亡数据中提取1998 年至2009 年之间归因于呼吸系统疾病的死亡数。运用稳健线性模型对2003 年至2009 年记录的呼吸系统疾病死亡率进行拟合。。在1998 年至2008 年之间，在大多数研究地区，所有年龄组的呼吸系统疾病死亡率逐步降低。例如，未满5 岁的儿童中，在所有七个研究区域中这种疾病年死亡率从1998 年的每10 万人56.9 例死亡降低为2008 年的每10 万人26.6 例死亡。在此期间，呼吸系统疾病死亡率在65岁以上老年人中普遍最高，在5 至49 岁人群中最低。在2009 年，呼吸系统疾病死亡率或者类似于2008 年的记录，或者出现增加——巴拉圭未满5 岁儿童中和巴西南部、墨西哥及巴拉圭5 至49 岁人群中，以及墨西哥和巴拉圭50 至64 岁人群中出现显著增加。在大多数拉丁美洲，1998 年至2008 年之间呼吸系统疾病死亡率逐渐降低。但是在2009 年，这种趋势停止，这可能是受（H1N1）2009 年大流行的影响。Определить тенденции смертности от респираторных заболеваний в нескольких регионах Латинской Америки в период 1998-2009 гг.Данные по количеству смертей, связанных с респираторными заболеваниями в период 1998-2009 гг., были получены из данных по смертности Аргентины, южной части Бразилии, Чили, Коста-Рики, Эквадора, Мексики и Парагвая. Устойчивые линейные модели затем были приложены к уровням смертности от респираторных заболеваний, зарегистрированных в период 2003-2009 гг.В период 1998-2008 гг. показатели смертности от респираторных заболеваний постепенно снижались во всех возрастных группах в большинстве исследуемых регионов. Среди детей в возрасте до пяти лет, к примеру, годовые показатели подобной смертности (во всех семи исследуемых регионах) снизились с 56,9 смертей на 100 000 в 1998 году до 26,6 смертей на 100 000 в 2008 году. За этот период показатели смертности от респираторных заболеваний были в большинстве случаев высокими у людей старше 65 лет и ниже у людей в возрасте от 5 до 49 лет. В 2009 году смертность от респираторных заболеваний была либо аналогична зарегистрированной в 2008 г., либо выше – значительные повышения наблюдались у детей в возрасте до 5 лет в Парагвае, у людей в возрасте от 5 до 49 лет в южной части Бразилии, Мексике и Парагвае и у пожилых людей в возрасте от 50 до 64 лет в Мексике и Парагвае.В основном в Латинской Америке смертность от респираторных заболеваний постепенно снижалась в 1998-2008 гг. Однако подобная тенденция к снижению была прервана в 2009 году, вероятно, из-за пандемии H1N1-2009.
The formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of the condition involved and improvements in diagnostic testing. Optimal case definitions also need to have a balance of sensitivity and specificity that reflects their intended use. After the 2009-2010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. This prompted improvements in the sensitivity and specificity of the case definition for influenza - i.e. a respiratory disease that lacks uniquely defining symptomology. The revision process not only modified the definition of influenza-like illness, to include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. The new definitions have been found to capture more cases without compromising specificity. Despite the challenge still posed in the clinical separation of influenza from other respiratory infections, the global use of the new WHO case definitions should help determine global trends in the characteristics and transmission of influenza viruses and the associated disease burden.La formulation de définitions précises de cas cliniques fait partie intégrante d'un processus efficace de surveillance de la santé publique. Alors que ces définitions devraient, dans l'idéal, s'appuyer sur un ensemble standardisé et fixe de critères de définition, elles nécessitent souvent une révision pour tenir compte des nouvelles connaissances relatives à la maladie concernée et des améliorations apportées aux tests diagnostiques. Pour être optimales, les définitions de cas doivent aussi établir un équilibre entre sensibilité et spécificité qui reflète leur utilisation aux fins prévues. À la suite de la pandémie de grippe H1N1 de 2009-2010, l'Organisation mondiale de la Santé (OMS) a lancé une consultation technique sur la surveillance mondiale de la grippe. Cela a conduit à des améliorations concernant la sensibilité et la spécificité de la définition de cas pour la grippe – c'est-à-dire une maladie respiratoire dont seule la symptomatologie reste à définir. Le processus de révision n'a pas seulement modifié la définition du syndrome de type grippal pour inclure une liste simplifiée des critères le mieux à même de prédire une infection grippale, il a également permis de clarifier le langage utilisé dans la définition pour en améliorer l'interprétation. Par ailleurs, afin de tenir compte des cas sévères de grippe qui nécessitaient une hospitalisation, une nouvelle définition de cas a été introduite concernant l'infection aigüe sévère des voies respiratoires dans tous les groupes d'âge. Il a été constaté que les nouvelles définitions reflétaient davantage de cas, sans pour autant compromettre la spécificité. S'il est vrai que la distinction clinique de la grippe des autres infections respiratoires continue de poser problème, l'utilisation mondiale des nouvelles définitions de cas de l'OMS devrait permettre de dégager des tendances mondiales concernant les caractéristiques et la transmission des virus grippaux ainsi que la charge de morbidité qui leur est associée.La elaboración de definiciones precisas de los casos clínicos es una parte fundamental de un proceso efectivo de la vigilancia de la salud pública. Aunque tales definiciones deberían, idealmente, estar basadas en una recopilación estandarizada y fija de criterios de definición, a menudo necesitan una revisión para reflejar el nuevo conocimiento de la enfermedad existente y las mejoras en las pruebas de diagnóstico. Las definiciones óptimas de los casos también deben tener un equilibrio entre sensibilidad y especificidad que refleje su uso previsto. Después de la pandemia de gripe H1N1 en 2009-2010, la Organización Mundial de la Salud (OMS) inició una consulta técnica para la vigilancia mundial de la gripe. Esto dio lugar a mejoras en la sensibilidad y la especificidad de las definiciones de los casos de gripe, es decir, una enfermedad respiratoria que carece de una sintomatología definitoria singular. El proceso de revisión no solo modificó la definición de las enfermedades similares a la gripe para incluir una lista simplificada de los criterios que demostraron ser más predictivos de la infección por gripe, sino que también aclaró el lenguaje utilizado para la definición, con el fin de mejorar su interpretación. Para englobar los casos graves de gripe que requirieron hospitalización, también se desarrolló una nueva definición de los casos de la infección respiratoria aguda grave en todos los grupos de edad. Se ha descubierto que las nuevas definiciones engloban más casos sin comprometer la especificidad. A pesar del desafío que todavía plantea la separación clínica de la gripe de otras infecciones respiratorias, el uso global de las nuevas definiciones de los casos de la OMS debería ayudar a determinar las tendencias mundiales en las características y transmisión de los virus de la gripe y la carga de la enfermedad asociada.إن صياغة تعريفات دقيقة للحالات من الناحية العلاجية جزء أساسي من الإجراءات الفعالة لمراقبة الصحة العامة. وبالرغم من أن مثل هذه التعريفات يجب، من الناحية النظرية، أن تقوم على مجموعة منتقاة من المعايير التعريفية الموحدة والثابتة، فغالبًا ما تحتاج تلك التعريفات إلى المراجعة لكي تعكس المعلومات التي تستجد بشأن الحالة المرتبطة بها والتطورات التي تشهدها الاختبارات التشخيصية. وتحتاج أيضًا التعريفات المثالية للحالات إلى الموازنة بين الحساسية والنوعية بما يتفق مع الاستخدام المزمع. وبعد تفشي فيروس الأنفلونزا H1N1 في الفترة ما بين عامي 2009 و2010، بدأت منظمة الصحة العالمية في تقديم المشاورة التقنية بشأن مراقبة الأنفلونزا على المستوى العالمي. وقد شجع ذلك على تحسين الحساسية والنوعية المرتبطة بتعريف حالة الأنفلونزا - بعبارة أخرى، مرض يصيب الجهاز التنفسي يفتقر إلى مجموعة أعراض فريدة تعرّف المرض. وأدت إجراءات المراجعة إلى تعديل تعريف ذلك المرض المشابه للأنفلونزا، إذ شمل التعريف قائمة مبسطة من المعايير التي تبين أنها الأفضل للتنبؤ بعدوى الأنفلونزا، ولم تقتصر النتائج على ذلك فحسب، بل نتج أيضًا عن تلك الإجراءات استخدام لغة أكثر وضوحًا في التعريف، لتحسين القدرة على التأويل. ولتحقيق الدقة في رصد الحالات الحرجة للأنفلونزا والتي تتطلب الإقامة بالمستشفى، تم أيضًا وضع تعريف جديد لحالة العدوى التنفسية الحادة والحرجة لجميع الفئات العمرية. وتبين أن التعريفات الجديدة ترصد بدقة مزيدًا من الحالات دون الإخلال بالنوعية. وبالرغم من أن التحدي لا يزال قائمًا عند التمييز من الناحية العلاجية بين الأنفلونزا وغيرها من أنواع عدوى الجهاز التنفسي، من المفترض أن يساعد الاستخدام العالمي لما توصلت إليه منظمة الصحة العالمية من تعريفات جديدة للحالة على تحديد الاتجاهات العامة فيما يتعلق بخصائص فيروسات الأنفلونزا وطرق انتقال العدوى بها وكذلك عبء المرض المرتبط بها.准确制定临床病例定义是进行有效公共卫生监督进程中的一个组成部分。虽然理论上此类定义应该以标准化和固定收集的定义标准为基础，但是这些定义通常需要进行修订，以反映所涉及的新症状知识，以及诊断测试的进展。最佳病例定义还需要达到反映其预期用途敏感性与特异性的平衡。2009–2010 年 H1N1 流感大流行之后，世界卫生组织发起了一项有关全球流感监测的技术咨询。该咨询提出改进流感定义的敏感性与特异性，即呼吸道疾病缺乏独特定义的症状。修订过程不仅修改流感样疾病定义，以纳入显示最能预测流感病毒感染的简化标准列表，同时明确了定义使用的语言，以增强解释力。为了获取需要住院治疗的严重流感病例，同时为所有年龄段的严重急性呼吸道感染制定了新的病例定义。目前已经发现新定义能够囊括更多案例，并且不会影响特异性。尽管在临床上将流感与其他呼吸道感染区分开来仍然面临挑战，但是统一使用世界卫生组织的新病例定义有助于确定全球流感病毒的特征和传播趋势以及相关的疾病负担。.Формулировка точных определений клинических случаев является неотъемлемой частью эффективного эпиднадзора. Хотя в идеале такие определения должны основываться на стандартизованном и фиксированном наборе определяющих критериев, они часто требуют пересмотра с учетом новых знаний об этих состояниях и улучшениях в диагностическом тестировании. Оптимальные определения случаев также должны иметь баланс чувствительности и специфичности, который отражает их целевое назначение. После пандемии гриппа H1N1 в 2009–2010 годах Всемирная организация здравоохранения (ВОЗ) инициировала техническую консультацию по глобальному эпиднадзору за гриппом. Это привело к улучшению чувствительности и специфичности определения для гриппа, то есть респираторного заболевания, которое не имеет однозначной определяющей симптоматики. Пересмотр привел не только к изменению определения гриппоподобного заболевания, включив в него упрощенный список критериев, показавших, что гриппозная инфекция является наиболее прогностической, но и для улучшения интерпретируемости был сделан более понятным язык, используемый для этого определения. Для выявления тяжелых случаев гриппа, требующих госпитализации, было разработано новое определение для тяжелой острой респираторной инфекции во всех возрастных группах. Было обнаружено, что новые определения охватывают больше случаев без ущерба для специфичности. Несмотря на сложности, которые все еще возникают при дифференциации гриппа от других респираторных инфекций, глобальное использование новых определений ВОЗ должно помочь выявить всеобщие тенденции в характеристиках и передаче вируса гриппа, а также в связанном с ними бремени болезней.
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