The burden of severe cases of Influenza disease: the Friuli Venezia Giulia Region experience

Introduction. Influenza represents a matter of serious concern for clinicians, both for outpatient and in hospital setting. The 2017-18 epidemic represented the highest in terms of severity since 2003-04 worldwide.  Overall,  in Italy 764 cases was classified as “severe form”, with 173 influenza-attributed deaths . The majority of the fatal cases were recorded in the elderly and in patients with multiple comorbidities. However, some sporadic cases were also described in previously healthy people. We report a real-world experience about the management of cases of influenza admitted in a large teaching hospital in the Friuli Venezia Giulia region during the 2017-2018 influenza season. We also provide a practical guide for the management of hospitalized influenza cases.Methods. A retrospective observational analysis wasbconducted among all influenza cases requiring admission in our Center during the 2017-18 season.Results.  Overall, 29 patients were admitted at the University  Hospital of Udine during the 2017-18 season with a diagnosis of influenza.  B virus was responsible for the majority of the cases. More than 65.5% of the subjects presented with a complication. We estimated that 41.4% of the admitted cases were affected by a “severe form”. All these cases required admission in  Intensive Care Unit,  27.6% and 10.3% of them needing Oral-Tracheal Intubation and Extracorporeal Membrane Oxygenation, respectively. Fatality rate was 24.1%. Noteworthy, only 9 subjects of our cohort had received vaccination. On the basis of the experience acquired during the past season, we propose a practical guide  to approach influenza cases in everyday hospital practice.Conclusion. The cornerstones of the management of all hospitalized influenza cases are the rapid identification and treatment of severe forms. Timely and strictly adherence to contact and respiratory precautions are also fundamental to reduce the risk of intra-hospital outbreaks. Despite the improvements of antiviral therapies and supportive measures, influenza-related morbidity and mortality remain high. According to our opinion, a universal vaccination program represents the only safe and effective method to fill the gap.