Portuguese seasonal influenza 2017/2018

(U.S. Navy photo by Mass Communication Specialist Seaman Cole C. Pielop / Released)

Based on the analysis of influenza virus activity in previous seasons, every year WHO launches a recommendation on the strains to be included in the trivalent and quadrivalent influenza virus vaccine (in March for the Northern Hemisphere and September for the Southern Hemisphere). The need to update this vaccine is due to phenomena of antigenic derivation of the virus that, like the previous issue, obliges the annual study of the vaccine that will present greater coverage. Based on circulating types and subtypes, this year a viral strain A (H1N1)pdm09 identical to A/Michigan/45/2015 was recommended for the trivalent vaccine; a virus strain A (H3N2) identical to A/Hong Kong/4801/2014; and a viral strain B (Victoria strain) identical to B/Brisbane/60/2008.

The quadrivalent vaccine contains the three viruses described above, and in addition another strain of virus B/Phuket/3073/2013. (1) Evaluating sentinel sites until December 2017, there was a dominance of virus B circulating in relation to type A. Of the latter, the most prevalent subtype with about 2/3 of detected cases was A (H3N2), and the remaining third H1N1 subtype. In the same surveillance period last year, type A (H3N2) virus circulated almost exclusively, with high immunity expected; however, the presence of emerging sub-strains and variants that were not covered by this year vaccine could be possible the source of suboptimal coverage. Among B viruses, type B/Yamagata was almost exclusive with 85% and the remaining 15%, type B/Victoria. For the 4th consecutive year, the trivalent influenza vaccine does not correspond to the circulating B virus subtypes, since most of the prevalent B virus strains, Yamagata, are antigenic and genetically related to B/Phuket, which is only included in the quadrivalent vaccine. In this sense, and to increase vaccination coverage of the type B virus in the coming years, ECDC advises the use of the quadrivalent vaccine. (2) (3)

Another factor to be discussed that may be among the causes of lower vaccination coverage is due to the use of eggs in vaccines production. This substrate may interact with different groups of aminoacids present and consequently, alter proteins responsible for the antibody receptors, creating minor viral amendments that may change the effectiveness of the vaccine. (4)

Influenza virus vaccine is the most effective prophylactic measure against influenza severity. Thousands of vaccines are distributed in primary health care, completely free of charge to priority groups such as population over 65 years of age, chronic and immunosuppressed patients, pregnant women, health professionals and other caregivers. During flu season and up to the first week of 2018, approximately 478,291 influenza vaccines were administered in Portugal northern health region. Along with this measure, it is also recommended to conduct respiratory etiquette and hand hygiene, as well as the use of appropriate face masks for patients diagnosed or with symptoms suggestive of influenza. (3) (5) (6)



  1. World Health Organization. Recommended composition of influenza virus vaccines for use in the 2017- 2018 northern hemisphere influenza season. http://www.who.int. [Online] Março 2, 2017. http://www.who.int/influenza/vaccines/virus/recommendations/201703_recommendation.pdf?ua=1..
  2. European Centre for Disease Prevention and Control. Risk assessment for seasonal influenza, EU/EEA. Estocolmo, Estocolmo, Suécia : s.n., Dezembro 20, 2017.
  3. Administração Regional de Saúde do Norte, Departamento de Saúde Pública. Gripe sazonal – vigilância epidemiológica – Semana 40 de 2017 a semana de 1 de 2018. ARS Norte. [Online] Outubro-Janeiro 2017-2018. www.arsnorte.min-saude.pt.
  4. Paules, Catharine I, et al. Chasing Seasonal Influenza — The Need for a Universal Influenza Vaccine. N Negl J Med. DOI: 10.1056/NEJMp1714916, 2018, Vols. 378:7-9.
  5. Centro Emergências de Saúde Pública. RONDA número 2. Lisboa : Direção Geral da Saúde, 2018.
  6. Direção Geral da Saúde. Vacinação contra a gripe – Época 2017/2018. Lisboa : s.n., Setembro 26, 2017. Orientação nº 018/2017 de 26/09/2017.


Mariana Perez Duque
Public Health Resident
West Porto Public Health Unit, Portugal

(As published in EuroNews #13)

Make it happen: A very brief note on failure, success and strange August weather


“Make it happen” has been the official slogan for the city of Rotterdam since 2014. So, last August, I made it happen.

Each year, Rotterdam’s Erasmus Medical Centre (MC) and Netherlands Institute for Health Sciences (NIHES) organise the Erasmus Summer Programme (ESP) that “provides hundreds of students, researchers and health professionals with the opportunity to boost their scientific careers. It is a specialized event that offers three weeks of á la carte research training in quantitative medical and health research. The programme provides its participants with a broad range of dynamic courses, both introductory and advanced, and provides the flexibility to mix and match the courses to their own individual programme.” This introductory text does a nice job of explaining the programme and was taken from ESP’s website, which I highly recommend (https://erasmussummerprogramme.nl/), not only because you can find photos of me there.

In 2016, I applied for the Fellowship programme offered by ESP and failed spectacularly to be accepted. Then I consulted my favourite quote-guy, the late and always great F. Scott Fitzgerald for some top quality advice. “Never confuse a single defeat with a final defeat”, he said. Okay, I applied again in 2017 and made it happen this time round.

So why is this ESP thing so special? Amazing programme with a rich selection of courses and topics, able to fill each public health resident’s theoretical and methodological gaps. Smart, motivated and interesting colleagues from all around the world. Literally – Egypt, Colombia, Trinidad, Pakistan, Nigeria and Hong Kong, just to name a few. Top top top professors. Do names like John Ioannidis or Johan Mackenbach ring a bell? If not, ask Pedro Oh yeah – also an ultimately bike-friendly Rotterdam in August.

Any drawbacks? Well, the cost of the courses was an issue, to start with. Also, summer in Rotterdam is not really what I imagine when someone mentions August and weather in the same sentence.

The cost problem, I managed to solve by applying for the Fellowship programme. This took time and stubbornness. It worked out from the second attempt, as I already mentioned. The coldest_and_rainiest_August_of_my_life issue, I simply solved by embracing that it is normal to wear a fleece jacket mid-Summer and get soaking wet riding your bike on odd_date days. That’s how locals do it.

For additional stories (SUP’ing around the channels, free coffee machine, chance encounters with EuroNet’ters…) plus tips&tricks how to apply, feel free to give me a call or shoot me an email.


Damir Ivankovic
Public Health Resident from and in Croatia

Why we need a Public Health professional journal in Slovenia and how we run it

A professional journal is a collection of articles which range from research articles, reports to practical articles applicable to a profession. What separates it from scientific journal is its emphasis on practice. Although professional journals can be a source of research, they primarily address practices with feasible implementation possibilities or practices with important implications to the current state of work.

Public Health is quite a specific field of work with many different stakeholders of diverse professional backgrounds. It is not unusual to see, for example, medical doctors, anthropologists, and economists working on the same public health topic, all employing different theoretical backgrounds, research methodologies, and professional networks to distribute their findings. Public Health is notorious for adopting theories and methods from other, more basic, sciences. Publishing practical and, also, research articles from researchers and practitioners from different fields, all working on health topics, should therefore widen the horizon of readers with interest in public health issues. That is more so the case in countries where (new) Public Health is not yet a universally acknowledged and accepted profession.

Such is the case of Slovenia. Empowered by the idea presented above, we started to work on a journal where professionals working on Public Health issues would be able to publish and read about work being done in their own country. And all of this in their mother tongue, thus maintaining and developing Slovenian Public Health terminology. Apart from research and practical articles, we decided to publish two specific types of articles. In an article type named Perspectives, professionals from different fields of science deconstruct a public health issue and write a short piece on how the issue is dealt within their scientific or professional domain. The main author of the article summarises their perspectives on the issue and reveals possible conflicts or synergies among different professional and scientific fields. The second type of an article is Methodological conversation where a researcher and a methodologist discuss various methodological issues that often arise in Public Health work. The article is written in the form of a dialogue with the purpose of making often confusing statistical and methodological discussions accessible to a wider audience. In the last issue of the journal the topic of Perspectives is alcohol use disorder and Methodological conversation is on the topic of developing a questionnaire for research purposes.

The first meeting of the editorial board of our new journal was held in November 2016. Our first issue was published in October 2017 and the second one in March 2018. As an editor-in-chief I hope our effort will advance the state of the art in Public Health in Slovenia and consequently in the wider European area.


Matej Vinko
National Institute of Public Health, Slovenia

As published in EuroNews 

EuroNet MRPH Newsletter #9

The ninth edition of the EuroNet Newsletter is finally here.

Check it out here to read about:

– the upcoming meeting in Dublin

– the EuroNet MRPH Statement on asylum seeker and refugee health and

Public Health Trainees’ attitudes and their assessment on the Specialty in Spain.

– and much more!

Telemedicine and virtual healthcare in Ireland

While we wait for the new issue of the Newsletter in the making, we bring you an article from the last Euronet Newsletter, about “Telemedicine and virtual healthcare in Ireland”:

Virtual healthcare and telemedicine have burgeoned in Ireland in recent years, with many private companies offering online services including video General Practitioner  (GP) consultations, prescriptions for medications and home testing kits for sexually transmitted infections (STIs). As an example, there are now at least seven different online companies offering STIs testing to individuals in Ireland without the need to see a doctor or health worker. Some of these companies are based in Ireland, others are based in other countries such as the UK.

Health insurance companies have come on board and many now have contracts with online GP consultation services offering video consultations with one of these companies as part of their health insurance package.

So what are the implications for health and health care in Ireland from the advent of such companies? Certainly there are potential benefits to using online platforms in health and health care.

They have the potential to improve access to patients who live in rural or remote areas.  In the area of STIs testing they may increase testing and treatment of STIs particularly in young people. Telemedicine may increase the number of patients who can be seen and treated during a given period of time, important at a time when many GPs in Ireland are emigrating to other countries.

Virtual platforms have been used to improve communication and delivery of healthcare between services. In Ireland, a pilot programme between family doctors and hospital specialists involving an online forum for discussion and advice on cases has been used to reduce admissions to hospital.

However, this new and developing field raises many questions for health and healthcare. Because these are private companies, without an established relationship with patients, the loss of the central pillars of primary care that include continuity of care, the management of multi-morbidities, the doctor-patient relationship and the delivery of a holistic model of care are concerns. Testing for STIs through this system may also affect notification, contact tracing and sexual health promotion. Other questions arise; for example will rates of antibiotic prescribing increase, given that physical examination will not be possible in a video consultation for a respiratory tract infection?

There are many questions to be answered as to how the advent of such systems of delivering healthcare can affect health and healthcare in Ireland, both good and bad. It’s an opportunity for Public Health in Ireland to engage with the issue as it is likely that telemedicine and virtual healthcare will continue to expand both in Ireland and internationally.

Chantal Migone

EuroNet MRPH Ireland


Lies, damned lies, and statistics. Hacking the P-value.

In order to bring more out of the effort that are invested in the EuroNet Newsletters, we will also be featuring articles as blog posts on a regular basis, so that people that don’t read the entire newsletter all at once (there might be a few;)) can still read (most of) it across time.

Also, don’t forget that the next issue is in the making and you can be part of it!

Hoping to inspire you, take a read at Damiano Cerasuolo’s article “Lies, damned lies, and statistics. Hacking the P-value“, from the last Euronet Newsletter:

In chapters from ‘my Autobiography’ Mark Twain says: “there are three kinds of lies: lies, damned lies, and statistics.” [1] Twain’s statement about the use and the misuse of statistics couldn’t have been more farsighted. On February 2016, 177-year-old American Statistical Association (ASA) released a statement [2] (followed by a scientific publication [3]) issuing guidelines of p value to conduct and interpret quantitative science. P-value is misused. P-value is usually used to test (and possibly dismiss) the “null hypothesis”. If the statistical test of two groups or pair of characteristics results in a P-value below 0.05, the null hypothesis is usually dismissed (depending on the level of significance intended): there is a relationship between the two groups (or the two characteristics) that is not attributable to mere chance. On more practical basis, we want to test the association between two factors, for example age and injectable drug use in two comparable groups issued from a specific population. If our statistical test results in a p-value of less than 0.05, the association between the two factors is usually statistically significant. However, a significant P-value doesn’t provide any information about the strength of the relationship between the two factors, neither about its direction. Criticism of the p-value is not new. On February 25th, 2015, the journal Basic and Applied Social Psychology issued an editorial [4] banning P-values and confidence intervals from all future papers. Undoubtedly these drastic steps could seem counterproductive but they have the merit to start the debate. Without proposing a ban of P-value results, the American Statistical Association observes “good statistical practice is an essential component of good scientific practice”. Meanwhile its executive director, Ron Wasserstein, explains that “wellreasoned statistical arguments contain much more than the value of a single number and whether that number exceeds an arbitrary threshold. The ASA statement is intended to steer research into a ‘post p<0.05 era’”. In other words, P-value should not substitute scientific reasoning but it should come together with numerical and graphical summaries of data, interpretation and understanding of the phenomenon under study and its results in context. Wrong P-value reporting is helping “bad” science being published: without information and with only P-value results, nonsignificant data can easily make its way through publication. Stanford metaresearcher John Ioannidis and colleagues found an increasing number of articles reporting P-values over time[5]. Almost all articles and abstracts with P-values reported statistically significant results while confidence intervals, Bayes factors, or effect sizes were rarely mentioned. The explanation to this phenomenon has already its own name: publication bias (for statistical significance). Daniël Lakens in a 2015 paper published by PeerJ [6] defines publication bias as ‘tendency to publish statistical significant results, both because authors are more likely to submit these results and reviewers and editors to evaluate more positively these manuscripts’. In the way publication bias sacrifices reproducibility (the ability to recompute results) and replicability (the chances other experimenters will achieve a consistent result) to publication itself[7], addressing this issue is urgent. Statistics are a core part of Public Health and although P-value debate could be perceived as “pure statistics”, it is not. Public Health ranges from epidemiology to hygiene, from biostatistics to health promotion. It is not a unitary, monolithic discipline and it requires a multidisciplinary approach to the “P-value gate”, in order to provide the best answers to each subdiscipline. Specialists in public health should join the debate, proposing solutions.

Damiano Cerasuolo

Euronet France


[ 1 ] https://en.wikipedia.org/wiki/Lies,_damned_lies,_and_statistics

[2] http://www.amstat.org/newsroom/pressreleases/P-ValueStatement.pdf

[3] Ronald L. Wasserstein , Nicole A. Lazar. The ASA’s statement on p-values: context, process, and purpose. The American Statistician. http://d x.doi.org/10.1080/00031305.2016.1154108

[4] David Trafimow & Michael Marks (2015) Editorial, Basic and Applied Social Psychology, 37:1, 1-2, DOI: 10.1080/01973533.2015.1012991

[5] Chavalarias D, Wallach J, Li A, Ioannidis JA. Evolution of Reporting P Values in the Biomedical Literature, 1990-2015. JAMA. 2016;315(11):1141-1148. doi:10.1001/jama.2016.1952.

[6] Lakens D. (2015) On the challenges of drawing conclusions from p-values just below 0.05. PeerJ3:e1142 https://doi.org/10.7717/peerj.1142

[7] Jeffrey T. Leek and Roger D. Peng Opinion: Reproducible research can still be wrong: Adopting a prevention approach. PNAS 2015 112 (6) 1645-1646; doi:10.1073/pnas.1421412111

blog picture from:http://emcrit.org/pulmcrit/demystifying-the-p-value/


The EuroNews MRPH N°5 of 2014 is now available online! We invite you to discover:

  • The editorial of our President, Rocío Zurriaga Carda
  • An overview of the seminar held in Palermo (Italy) on International opportunities for Public Health training, by Guido Maringhini
  • A summary on the New Health Law project in France, by Anca Vasiliu
  • The UK Ebola response and screening at Ports of Entry, by Rebecca Nunn
  • An article about the Residency in Public Health Croatia, by Vesna Stefancic and Maja Vajagic
  • Info about the next EuroNet MRPH Meeting that will be hold in Milan (Italy) on 20-21 March 2015
  • The “all you need to know about EuroNet MRPH” section
  • And many other very interesting articles and short news from the member countries of EuroNet MRPH !!!

The newsletter could be download here EuroNews MRPH – 5_Winter_2014  in PDF format is readable with Adobe Reader or others PDF readers.

This last issue was edited by Salvo Parisi and EuroNet MRPH Italy.

We hope you will enjoy the reading and we thank you for your support!


The fourth Newsletter of Euronet MRPH is now online!

Summary :

  • An editorial from Rocio Zurriaga Carda and Guido Maringhini
  • An overview of our last meeting in London
  • Resident Experiences, resident and tutor experience in Spain
  • News around Europe
  • An article about the Ebola outbreak in Western Africa
  • And much more !!



The newsletter could be Download here (2.0 Mo, PDF). PDF format is readable with Adobe Reader or others PDF readers.

Enjoy the reading !