The flu epidemic is spreading, and gastroenteritis happens : the Ile-de-France alerts its hospitals

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Published the 29.12.2017 at 13h50
Update the 29.12.2017 at 17h57

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At the edge of the rupture, the doctors and the health care providers of the parisian hospitals need help. Some have even gone on strike, as in the Kremlin-Bicêtre hospital in paris where the staff of pediatric emergencies can no longer “take care properly of the children who come to the emergency room” in a context of epidemic bronchiolitis and influenza.
“Reinforcements replacement personnel (recruitment in progress 4 carers and 2 nurses) have been determined to cope with the increase of came to the emergency room until the end of the winter period “, indicated the direction of the AP-HP.
Who in management has today decided to upgrade to level 2 the plan “epidemics in winter” in all the hospitals of public assistance of the region francilienne, a region where the peak of the epidemic is not yet reached.

The epidemic is strengthened to Paris

With 510 cases of influenza identified for 1000 inhabitants in the Ile-de-France, hospitals, ile-de-france are called upon to strengthen their organisation measures to cope with a new pic of consultations scheduled for this weekend.
“The number of appeals to emergency rooms for influenza-like illness is very high, higher than the one observed at the peak of the epidemic last year, both for adults and pediatrics,” says the AP-HP in a press release.
It is a matter of “deal with the current situation and to continue to organise the reception of patients after the long weekend of Christmas, but above all, it is” anticipating a new peak of activity likely during the weekend of the New Year “.

Level 2 of the “epidemic of winter”

Level 2 of the plan is triggered upon the onset of the first signs of the impact of the epidemic on hospital activity. It allows them to ” strengthen the organisational measures put in place during the winter period, to maintain the maximum capacity “.
In particular, this requires the establishment of crisis cells at the level of the 12 hospital groups and of the general direction of the APHP with daily monitoring of activity indicators and the availability of beds. It also involves a series of gradual measures such as :

• Outputs anticipated for some patients and assistance to remain at home with the support of the teams of the Hospital at Home of AP-HP fully mobilized,
• The deprogramming of some of the scheduled activities, less urgent,
• The grouping of patients with respiratory infections,
• Measures for the “accommodation” in a different specialty, limited in time and organized in terms of medical care,
• The opening of additional beds. This year, as it is usually the case at this time, a little over 80 % of beds medical, surgical and obstetrics are open at the AP-HP this week. Re-openings of beds are planned for the week of January 1 (90%) and the week of January 8, with the end of the school holidays (nearly 100%).

The epidemic reached its peak in the North and extends elsewhere

In the last epidemiological bulletin of Public Health of France, the epidemic threshold is exceeded in the whole of France, outside of Corsica.
Influenza activity is a significant increase compared to previous weeks and the number of patients with influenza is now in excess of 349 patients per 100 000 inhabitants. The clinical pictures reported by Sentinel physicians showed no particular sign of severity.
There were 6213 passages to the urgencies for influenza-like illness of which 522 (8%) hospitalizations. Hospitalizations are mainly the concern of the elderly (33% were over 75 years of age) and children under 5 years of age (22%). On hospitalizations, 203 patients were admitted in the icu since week 45, and 18 of them have died.
Among the patients admitted in the icu, the average age is 57 years and the majority of the risk factors. Among those whose vaccination status was known, 57% were not vaccinated. The actors of the flu think that this epidemic will be larger than last year.

A virus of type H1N1 in metropolis

In week 51, 72% of samples of the network Sentinels are positive, a proportion that is increasing. The majority of virus-type A (79%) of which 56% of H1N1 and 12% for H3N2. The virus of type B represent 21% of the isolated viruses. The proportions are roughly the same in samples and hospital patients admitted in the icu.
The distribution is therefore different from that of last year, where it was the H3N2 that had been responsible for the epidemic : a virus that had led to many complications in the elderly and impaired. The epidemic of 2016-2017 has been the origin of more than 1,500 hospitalizations in intensive care and nearly 14 400 deaths, mainly in people at risk who were not vaccinated.
The epidemic is progressing overseas with a passage in the epidemic in the Antilles and in the pre-epidemic in Guyana. At the Meeting, the flu epidemic is over (southern hemisphere) with a single wave particularly intense.

The epidemic of gastroenteritis happens

If it was only the flu, but France has to face a 2nd outbreak : gastroenteritis happens, as every year, but a little earlier. An overlap which will aggravate the congestion of the emergency and of the entire system of care.
According to Public Health France, the epidemic of gastroenteritis has reached the regions of Grand-est, PACA, Auvergne, Rhone-Alpes, Occitania, and the Hauts-de-France. Normandy, Brittany, Corsica and the Ile-de-France, are they in activity pre-epidemic. This translates into a net increase of visits to the emergency room and general medicine. According to the analysis, a norovirus is involved in half of the cases.

It is possible to protect yourself

During infection, the influenza virus will infect the patient by the respiratory route. Inhaled with the air infected, the virus will be deposited on the cells lining the surface of the respiratory tract : the throat and the bronchi. It will then penetrate and divert the means of production of the cell to his advantage and start to multiply. The release of the virus manufactured in this way leads to the destruction of the cell. For gastroenteritis, it is a contamination that is carried by hands and objects touched by the sick, so disinfection is very important.

Public health France is therefore recommended to wash hands frequently with soap and water or with a solution of hydro-alcoholic, wear a mask when one has a syndrome (influenza-like illness (limiting the spread of the virus when you cough and sneeze, cover your mouth and nose with your elbow or a tissue if coughing and sneezing, using tissues, in single-use paper and throw it away and limiting contact with sick people.

In the case of gastroenteritis, it is necessary to wash hands frequently, before preparing meals, before eating, after going to the toilet…) ; it is necessary to clean surfaces that are frequently touched by everyone such as door handles, phones, toilets, sinks ; hand towels should be regularly changed ; it is necessary to avoid sharing glasses and cutlery at the table ; people who have diarrhea should not be involved in the preparation of the meal.