The influenza epidemic, more intense than last year, is now spread all over Europe. It has reached its peak in the Haut-de-France and hospitals in the Paris region are overwhelmed ... while the epidemic of gastroenteritis is coming.
With saturated emergencies, doctors and hospital caregivers need help. In Paris, the Department of Public Assistance has reinforced at Level 2 the plan "winter epidemics" in all public assistance hospitals in the Paris region, a region where the peak of the influenza epidemic is not yet reached, but where gastroenteritis arrives.
In Europe, all countries are affected, but the epidemic predominates in the West. The main influenza virus, A (H1N1) virus coexists with other viruses A and B that are included in the current vaccine. Despite many hospitalizations, no over-mortality related to the flu compared to last year.
The epidemic is growing in Paris
With 510 reported influenza cases per 1000 inhabitants in Ile-de-France, hospitals in the Paris region are expected to strengthen their organizational measures to cope with a new peak of consultations scheduled this weekend.
"The number of recourse to emergencies for ILI is very high, higher than that observed at the peak of the epidemic last year, both for adults and pediatrics," said the AP-HP in a statement.
It is about "coping with the current situation and continuing to organize the reception of patients after the long Christmas weekend", but above all, it is "to anticipate a new peak of activity. likely during the New Year weekend.
Level 2 of the "winter epidemic" plan
Level 2 of the plan is triggered as soon as the first signs of an epidemic impact on the hospital activity appear. It makes it possible to "reinforce the organizational measures put in place in winter to maintain maximum capacity".
This includes setting up crisis rooms at the level of the 12 hospital groups and the general management of the APHP with daily monitoring of activity indicators and availability of beds. This also involves a series of graduated measures such as:
- Early exits of some patients and help with home support with the support of AP-HP's home hospitalization teams fully mobilized,
- Deprogramming of certain less urgent scheduled activities,
- Grouping of patients with respiratory infections,
- "Accommodation" measures in a different specialty service, limited in time and organized in terms of medical care,
- The additional opening of beds. This year, as is usually the case at this time, just over 80% of the medicine-surgery-obstetrics beds are open at AP-HP this week. Reopening of beds are planned for the week of January 1st (90%) and the week of January 8th with the end of the school holidays (almost 100%).
Epidemic peaks in the North and extends elsewhere
In the latest epidemiological bulletin of Public Health France, the epidemic threshold is exceeded throughout France, outside Corsica.
Influenza activity has risen sharply compared to previous weeks and the number of infected patients now exceeds 349 patients per 100 000 inhabitants. The clinical pictures reported by the Sentinel physicians did not show any particular sign of severity.
There were 6213 emergency room visits for influenza-like illness, including 522 (8%) hospitalizations. The hospitalizations mainly concern the elderly (33% are over 75) and children under 5 (22%). Of the hospitalizations, 203 patients were admitted to intensive care since week 45 and 18 of them died.
Among patients admitted to intensive care, the average age is 57 and the majority have risk factors. Of those with known vaccination status, 57% are not vaccinated. Influenza stakeholders believe this epidemic will be bigger than last year.
A H1N1 virus A in France
In week 51, 72% of Sentinel network samples are positive, a proportion that is increasing. Most of these are type A viruses (79%), 56% H1N1 and 12% H3N2. Type B viruses account for 21% of isolated viruses. The proportions are generally the same in hospital samples and in patients admitted to intensive care.
The distribution is therefore different from that of last year when it was the H3N2 that was responsible for the epidemic: a virus that had caused many complications in the elderly and weakened. The 2016-2017 epidemic resulted in more than 1,500 ICU hospitalizations and nearly 14,400 deaths, mostly among people at risk who were not vaccinated.
The epidemic is spreading overseas with an outbreak in the West Indies and pre-epidemic phase in French Guiana. In Reunion, the flu epidemic is over (southern hemisphere) with only one particularly intense wave.
The outbreak of gastroenteritis is coming
If it was only the flu, but France must face a 2e epidemic: gastroenteritis happens, like every year, but a little earlier. An overlap that will worsen the congestion of emergencies and the entire care system.
According to Santé Publique France, the gastroenteritis epidemic has reached the Grand-Est, PACA, Auvergne-Rhone-Alpes, Occitanie and Hauts-de-France regions. Normandy, Brittany, Corsica and Ile-de-France are they in pre-epidemic activity. This results in a significant increase in emergency room and general medicine consultations. According to the analyzes, a norovirus is involved in half of the cases.
It is possible to protect yourself
During an infection, influenza viruses will contaminate the patient by the respiratory route. Inhaled with infected air, the viruses will be deposited on the cells that line the surface of the airways: the throat and the bronchi. It will then penetrate and divert the means of production of the cell to his advantage to multiply. The release of the viruses thus produced results in the destruction of the cell. For gastroenteritis, this is a contamination that is carried by the hands and objects affected by the patients so disinfection is very important.
Public Health France therefore recommends washing your hands frequently with soap and water or with a hydro-alcoholic solution, wearing a mask when you have an ILI (limit the spread of the virus during coughing and sneezing) , cover your mouth and nose with your elbow or handkerchief in case of coughing and sneezing, use disposable paper tissues and discard them and limit contact with sick people.
In case of gastroenteritis, wash hands frequently (before preparing meals, before eating, after using the toilet ...); surfaces that are commonly touched by everyone, such as door handles, telephone, toilets, sinks, should be cleaned; the towels must be changed regularly; avoid sharing glasses and cutlery at the table; people who have diarrhea should not intervene in the preparation of meals.