Definición de caso de Gripe. Las decisiones de las altas instancias también pueden ser erróneas

"También hay tonterías elegantes, como hay tontos bien vestidos". Nicolás Chamfort 1741-1794

Después de llevar varias semanas atendiendo multitud de casos compatibles con lo que hemos llamado siempre un síndrome catarral, nuestras autoridades no envían un mensaje "muy importante" para mantenernos actualizados en el manejo de la Gripe A, donde nos informan que desde la semana 40 se adopta la definición de caso de gripe del ECDC (European Centre for Diseases Prevention and Control).

Con esta definición, desaparecen todas las infecciones respiratorias de cualquier virus para ser denominadas todas: casos de gripe. Si leemos literalmente la definición, incluso enfermedades no infecciosas: juntamos la cefalea y el dolor de garganta y ya tenemos gripe. Clásicamente, necesitábamos una fiebre elevada junto a síntomas respiratorios y un claro predominio de la afectación general: cefalea, dolor generalizado, postración... para hablar de síndrome gripal. Se acabó. Por Real Decreto de la Europa Unida en la Ciencia y en la Razón, gripe es casi todo lo que pasa por las vías aéreas.

La referencia por la que adjudican el caso de gripe de 2008, está en una resolución amplia donde se citan criterios para muchas enfermedades y literalmente dicen en inglés:

2008/426/EC: Commission Decision of 28 April 2008 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document number C(2008) 1589) (Text with EEA relevance)

INFLUENZA

(influenza virus)

Clinical criteria

Any person with at least one of the following clinical forms:

Influenza-like illness (ILI)

- Sudden onset of symptoms

AND

- at least one of the following four systemic symptoms:

- Fever or feverishness

- Malaise

- Headache

- Myalgia

AND

- at least one of the following three respiratory symptoms:

- Cough

- Sore throat

- Shortness of breath

Acute respiratory infection (ARI)

- Sudden onset of symptoms

AND

- At least one of the following four respiratory symptoms:

- Cough

- Sore throat

- Shortness of breath

- Coryza

AND

- A clinician's judgement that the illness is due to an infection

Laboratory criteria

At least one the following four:

- Isolation of influenza virus from a clinical specimen

- Detection of influenza virus nucleic acid in a clinical specimen

- Identification of influenza virus antigen by DFA test in a clinical specimen

- Influenza specific antibody response

Sub typing of the influenza isolate should be performed, if possible

Epidemiological criteria

An epidemiological link by human to human transmission

Case classification

A. Possible case

Any person meeting the clinical criteria (ILI or ARI)

B. Probable case

Any person meeting the clinical criteria (ILI or ARI) and with an epidemiological link

C. Confirmed case

Any person meeting the clinical (ILI or ARI) and the laboratory criteria

Sin embargo, hay una resolución del 30 de Abril de 2009 que establece la definición de caso ligado al virus A/H1N1 2009 más acorde a lo que debemos valorar ahora:

2009/363/EC: Commission Decision of 30 April 2009 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council (notified under document number C(2009) 3517) (Text with EEA relevance)

"NOVEL INFLUENZA VIRUS A(H1N1) (THE SO-CALLED SWINE INFLUENZA VIRUS A(H1N1) AND MEXICAN INFLUENZA VIRUS) [1]

Clinical criteria

Any person with one of the following three:

- fever > 38 °C AND signs and symptoms of acute respiratory infection,

- pneumonia (severe respiratory illness),

- death from an unexplained acute respiratory illness.

Laboratory criteria

At least one of the following tests:

- RT-PCR,

- viral culture (requiring BSL 3 facilities),

- four-fold rise in novel influenza virus A(H1N1) specific neutralising antibodies (implies the need for paired sera, from acute phase illness and then at convalescent stage 10-14 days later minimum).

Epidemiological criteria

At least one of the following three in the seven days before disease onset:

- a person who was a close contact to a confirmed case of novel influenza A(H1N1) virus infection while the case was ill,

- a person who has travelled to an area where sustained human-to-human transmission of novel influenza A(H1N1) is documented,

- a person working in a laboratory where samples of the novel influenza A(H1N1) virus are tested.

Case classification

A. Case under investigation

Any person meeting the clinical and epidemiological criteria.

B. Probable case

Any person meeting the clinical AND epidemiological criteria AND with a laboratory result showing positive influenza A infection of an unsubtypable type.

C. Confirmed case

Any person meeting the laboratory criteria for confirmation.

¿A qué viene volver a una definición tan mal hecha como la de 2008? ¿Por qué se decide que las redes de vigilancia del espacio europeo cambien su reciente definición de caso de 2009 por una de 2008? ¿Qué pretenden demostrar, que hay 200 millones de casos de gripe en Europa?.