Month: April 2018

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)

_________________________

References

  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
matej.vinko@nijz.si

As published in EuroNews 

Story from Nancy

Shortly after I joined France’s Public Health team in October, I heard about Euronet mainly through CLISP (National Public Health Resident Association in France), and I was quite curious about European Public health Association.

My name is Manon Burgat, I live in Dijon and I am a French resident.
At the beginning, my main interest in Euronet meeting was to do a training course in a European Country and to improve my English vocabulary.
But it turned out to be more than that. Euronet leaves its marks, physically (probably just the Nancy’s one) and in your heart.
Nancy’s meeting occurred in March, from the 8th to the 10th. It’s a beautiful city, known for “La place Stanislas”, listed in the UNESCO world heritage and also for ”macarons” French biscuits. Moreover it’s not far from Dijon. (173 kilometres to be precise)

I am not going to write about the food poisoning, the disease we’ve all survived, the amazing people I met, the 2018 women’s day, the general assembly or the crazy nights we’ve spent. I just want to write you about Public health promotion.

Public health promotion was the title of one of the working groups we had during Thursday morning. It was led by Damir, a Croatian resident. Only French people attended this working group, supposing public health had a poor reputation among French students.

A lot of ideas were developed. We began our work with the premise that there is no common definition of“Public health”. What is it? What is the daily routine of a public health doctor? Do you define public health by quoting the different possibilities of work?
In France for example, students don’t choose medical studies to be a public health doctor. They choose it to cure, to save, and to help patients. To study clinic’s. (Public spirit 🙂 ). The speciality is not well known, and it is just at the end of the medical school that French students start to think about choosing public health speciality. Furthermore, there is no public health work experience during the first years. And at the final exam, public health is one of the last specialty chosen.

After this analysis, what can we do to make public health more glamourous or attractive?
We can take for example a look at what they did in the United States. They had a  campaign “this is public health “ created by the Association of Schools and Programs of Public Health in order to “brand public health and raise awareness of how public health affects individuals, families, communities, and populations”. In the US, public health is very attractive among students!
From there, we talked mainly about having “public health promoter” in cities who can talk about public health, in conferences for example. We can do European leaflets with a cool headline, distribute them in each country. We could have a reference website, where public health work is described…

We are at the beginning of the working group and there is so much left to do to promote public health. And not only in France! All your ideas are welcome! Go to Valencia and share them with us! 🙂

_________________________

Manon Burgat
Public Health Resident, Dijon

Euronet MRPH Spring Meeting in Nancy

Almost one year on from the Strasbourg meeting, EuroNet MRPH is back in France! The 2018 Spring meeting (occurring disturbingly early in March, from 7th to 10th) was hosted by the beautiful city of Nancy. It was excellently organised by a Nancy local, Hélène Rossinot and the French EuroNet MRPH National Commission, on the theme of prevention and health promotion.
The meeting was hosted in the Nancy Museum Aquarium, a natural history museum including over 60 aquariums and a zoology gallery. But, to avoid any fishy business, the sessions were held in the Lucien Cuénot amphitheatre, originally created in 1933 and beautifully restored with the original furniture in 2013.

1st day

The morning session of the meeting’s first day was dedicated to EuroNet working groups. After an the motivating opening welcome message by our President, Alberto Mateo, the participants split in four working groups. “Promoting Public Health as a career choice” working group was led by Damir Ivankovic. It was mostly a brainstorming exercise on how to promote Public Health among medical students, delightfully sprinkled with philosophical insights. Further discussion is needed to determine what role EuroNet could play in this matter, and if this should be formalized with a permanent working group. A second group was led by Matej Vinko, EuroNet MRPH Vice-President, aiming to edit the position paper “On the future of Public Health in the European Union”, as the deadline was that same day. We are proud to say that this was a success. A third group was the “LGBT+ Residents’ Health and working environment” working group, led by Damiano Cerasuolo. It carried on the work already started in Lisbon, during the Euronet winter meeting, by reviewing a questionnaire medical and Public Health residents concerned by this subject across Europe. The last group, led by our communication lead, Gloria Raguzzoni, set up a plan to improve the way we promote our internships and discussed innovative ways of improving our communication channels.

The afternoon session commenced with the official inauguration of the meeting, in the presence of local authority head figures. The welcome speech was given by André Rossinot, president of Grand Nancy Metropole, Laurent Hénart, mayor of Nancy, Bruno Boyer from the Conseil National de l’ordre des médecins (National Board of Doctors), Auldric Ratajczak from the Agence Régionale de Santé Grand Est and François Werner who is in charge of the coordination of European policies in the Grand-Est region and vice president of Nancy Metropole.

Then followed the round table “Local prevention policies” that saw the participation of François Werner, Auldric Ratajczak and Marie Catherine Tallot deputy mayor of Nancy in charge of health. The talk focused on the strategies set up by the ARS (the local health agency) and the local institutions to promote health projects, addressing main issues and needs of the population.

2nd day

The theme of the second day of the meeting was prevention in hospitals. First, we had the presentation of the “Health Promotion Corner in the Hospital”. Le cercle sens & santé is a “think-to-do-tank”, created in 2014 as an ideas generator and processor. Its goal is to develop better hospitals of the future (www.cerclesensetsante.com). Prevention actor club is an association created in 2014 whose main goal is to transform waiting times in hospitals into recreational time and provide opportunities to promote healthy lifestyles, providing “Health for all” in the hallway. Example of activities included Zumba; yoga and cooking classes in hospitals; monthly activity program; leaflets; a photo booth with the prevention slogan; banners for public health campaign promotion, to name just a few. This project is undergoing a trial phase and will be launched in May at Paris HealthCare Week. We then had a round table with a hospital infection control committee responsible officer, occupational health physician and Nancy’s Hospital manager to discuss the risks of occupational diseases in hospitals and preventive measures.

The afternoon was dedicated to the traditional assembly of the association. Lois Murray, from the UK, presented a possible EuroNet partnership with EuroNGOs for sexual and reproductive health and rights advocacy opportunities. It is an organization in which she worked and proposed to be the liaison lead. We then shared ideas for EuroNet participation in World Health Day. Finally, the climax of the meeting was the presentation of the candidacy of Valencia to host the 2018 summer meeting. It was thoroughly prepared by Julio Muñoz, and although he was not present, it is safe to say this performance will be remembered for decades and will inspire future generations of EuroNeters.

Social events

As part of the social programme, we had the chance to explore the beautiful city of Nancy and discover a bit of its rich history. The main square is the famous Place Stanislas, sometimes humbly referred to as “the most beautiful square in the world”. It is named after Stanisław I Leszczyński, former Ruler of Polish-Lithuanian Commonwealth (and father-in-law to King Louis XV of France), who acquired the Duchy of Upper Lorraine, of which Nancy was the capital, after the War of the Polish Succession in 1737.

On the first evening, we were invited to a typical French restaurant called “Vins et tartines”. We tasted different kinds of toasts and local wine. We were also encouraged to taste some local whisky, and a liquor of a fruit called “Mirabelle” (which literally means “beautiful to see” by the way). Damir pointed out that this schnappsy liquor with a fancy name is basically what they call šljivovica in the Balkans, which is not considered fancy at all. After that, the whisky/liquor-resilient comrades went to wander around to experience Nancy by night.

The second evening took place in another typical French restaurant, where we had the chance to taste some fine cuisine. Despite a poultry problem, it was a very nice experience. As the night was still young, most of us went out once again to enjoy Nancy by night. There was music, there was fire, and people danced like they got out of jail, together in a beautiful communion of the nations!

To conclude, it was once again a wonderful meeting, thanks to Hélène and the French National Commission, for all the organisational efforts, thanks to the welcoming people of Nancy and thanks to the wonderful residents who attended it!

Damiano Cerasuolo, Damir Ivankovic, Gisela Leiras, Clément Massonnaud, Lois Murray