Scientific letter
Is there a year-round flu?
¿Existe la gripe todo el año?
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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "200" "paginaFinal" => "201" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jordi Reina, Ester del Barrio, Jaume Gimenez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Jordi" "apellidos" => "Reina" "email" => array:1 [ 0 => "jorge.reina@ssib.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ester" "apellidos" => "del Barrio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jaume" "apellidos" => "Gimenez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Epidemiología, Consellería de Salut, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Existe la gripe todo el año?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 946 "Ancho" => 1678 "Tamanyo" => 70177 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cumulative monthly distribution of influenza A and B cases throughout the study period.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Influenza is a viral respiratory disease that can occur generally as an epidemic or seasonally during the winter months, and as a pandemic at any time of the year.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> The impact of influenza on the population and public health determines the existence of an active surveillance through the sentinel networks that deal with community flu and the corresponding hospitals that register serious cases.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The period of active surveillance ranges from week 40 of one year to week 20 of the following year since the flu epidemic occurs between two different years. This is known as the interepidemic period, where sentinel networks do not perform any active search and surveillance is maintained only in the hospital network.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The influenza pandemic that occurred in April 2009 and spread in the following months proved once again the unpredictability of this disease. In this situation, the first epidemic wave occurred during the summer months, an unusual period of time for conventional influenza.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This is why from that year on the flu surveillance is maintained throughout every month of the year. We found it interesting to review the year-round epidemiology of influenza in our autonomous community, to verify if the flu occurs and persists all year round and especially in the summer months.</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the period between January 2013 and December 2017, the cases of influenza detected in every month of the year have been studied prospectively. The diagnosis of influenza was carried out in the respiratory samples of the patients using a real-time RT-PCR type molecular amplification assay (Anyplex<span class="elsevierStyleSup">®</span> RV16, Seegen, South Korea). This assay allows the simultaneous and differential detection of 16 different respiratory viruses and differentiates between the 2 subtypes of influenza A (H3N2) and (H1N1) pdm09.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Throughout the study, 2729 cases of flu were detected, 1982 being influenza A (72.6%) and 747 influenza B (27.2%). The cumulative monthly distribution is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Epidemiological differences have been reported between the 2 types of influenza. Thus, influenza A was predominant in all months except for March, April and May, with detection percentages between 21 and 100%. In the epidemic months of influenza, influenza A accounted for 92.6% of all cases in January and progressively decreased. Then it reached new peaks up to 91.1 and 99.6% in the months of November and December. Influenza B was predominant in the months of March (54.4%), April (66.9%) and May (79%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Cases of influenza have been detected every month of the year, but not every year. Overall influenza cases were detected in 50 (83.3%) of the 60 months studied, ranging from 66.6% (8 months) in 2014 to 100% (12 months) in 2017. 79.8% of all cases (2179) were detected in the first quarter of the year, followed by 7.9% (199 cases) in the second, 0.5% (14 cases) in the third and 12.3% (337 cases) in the last quarter. The month with the highest detection percentage was February with 886 cases (32.4%); being the highest detection for influenza A also in this month (33.4%) and March for influenza B (44.7%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the summer months (June–July–August) a total of 17 flu cases were detected (0.6% of the total) (14 influenza A and 3 influenza B); only in 2014 no influenza viruses were detected in this period. All the cases detected in this period were A (H1N1) pdm09 and corresponded to people who had not previously traveled.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the marked epidemic and seasonal nature of influenza, the possibility of detecting patients with influenza in any month cannot be ruled out. Although the warm months do not seem to be physiologically proper for the spread and transmission of these viruses,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> we have been able to detect 0.6% cases in this time period. None of the patients had traveled or was a tourist, which leads us to think that the spread of these viruses is present, but at a low level and probably imported by tourists from the southern hemisphere where the flu is present all year round.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Knowing the epidemiological patterns of the flu allows us to establish surveillance and alert systems that allow us to prevent or fight against the occurrence of an unexpected epidemic outbreak as soon as possible. The occurrence of influenza cases in the summer period is an unlikely but possible event, and should be part of the potential differential diagnosis in any acute respiratory process.</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: Reina J, del Barrio E, Gimenez J. ¿Existe la gripe todo el año? Med Clin (Barc). 2019;152:200–201.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 946 "Ancho" => 1678 "Tamanyo" => 70177 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cumulative monthly distribution of influenza A and B cases throughout the study period.</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:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global epidemiology of influenza: past and present" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.J. Cox" 1 => "K. 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