1
|
Umbreen G, Rehman A, Avais M, Jabeen C, Sadiq S, Maqsood R, Rashid HB, Afzal S, Chaudhry M. Burden of influenza A (H1N1)pdm09 infection among tuberculosis patients: a prospective cohort study. BMC Infect Dis 2023; 23:526. [PMID: 37563563 PMCID: PMC10413717 DOI: 10.1186/s12879-023-08441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Influenza and tuberculosis both cause significant morbidity and mortality worldwide. Therefore, this study aimed to estimate the burden of influenza A (H1N1)pdm09 virus infection among human tuberculosis patients and the general population. METHODS A prospective cohort study was conducted among a cohort group (TB positive patients) as exposed and a comparison group (general population) as non-exposed. A total of 304 participants were recruited in both groups and followed for a period of 12 weeks. Of the 304 concurrently enrolled individuals, 152 were TB-positive patients (cohort group) and 152 were from the general population (comparison group).To calculate the sample size, the power of study was kept at 80% for detecting a difference at 5% alpha level assuming the 25% prevalence of respiratory viruses in cohort group compared to 12.5% in general population. An oropharyngeal swab was taken from a participant with symptoms of influenza-like illness (ILI). Samples were tested by conventional reverse transcription polymerase chain reaction (RT-PCR) for the detection of influenza A (H1N1)pdm09. All statistical analyses were conducted using R software. RESULTS A total of 95 participants developed influenza-like illness (ILI) symptoms. Among these, 64 tested positive for influenza A(H1N1)pdm09, of which 39 were from the exposed group and 25 were from the non-exposed group. During the 12-week period of follow-up, the influenza A (H1N1)pdm09 incidence rate was 20 per 1000 people. The risk of testing positive for influenza A (H1N1)pdm09 was 1.66 times higher in the exposed group compared to the non-exposed group. The cumulative incidence indicated that 25% of the TB cohort and 16% of the comparison group were at risk of getting influenza A (H1N1)pdm09 during the 12 weeks of follow-up. CONCLUSION Participants from the TB cohort had a higher incidence of influenza A (H1N1)pdm09 than the general population suggesting that they should be prioritized for influenza vaccination.
Collapse
Affiliation(s)
- Gulshan Umbreen
- Department of Epidemiology & Public Health, University of veterinary and Animal Sciences, Lahore, Pakistan
| | - Abdul Rehman
- Department of Epidemiology & Public Health, University of veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Avais
- Department of Veterinary Medicine, University of veterinary and Animal Sciences, Lahore, Pakistan
| | - Chanda Jabeen
- Department of Epidemiology & Public Health, University of veterinary and Animal Sciences, Lahore, Pakistan
| | - Shakera Sadiq
- Department of Epidemiology & Public Health, University of veterinary and Animal Sciences, Lahore, Pakistan
| | - Rubab Maqsood
- Department of Epidemiology & Public Health, University of veterinary and Animal Sciences, Lahore, Pakistan
| | - Hamad Bin Rashid
- Department of Veterinary Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Saira Afzal
- Department of Community Medicine, King Edward Medical University, Lahore, Pakistan
| | - Mamoona Chaudhry
- Department of Epidemiology & Public Health, University of veterinary and Animal Sciences, Lahore, Pakistan.
| |
Collapse
|
2
|
Komada MT, Lee JS, Watanabe E, Nakazawa E, Mori K, Akabayashi A. Factors of influenza vaccine inoculation and non-inoculation behavior of community-dwelling residents in Japan: suggestions for vaccine policy and public health ethics after COVID-19. Vaccine X 2022; 13:100245. [PMCID: PMC9744486 DOI: 10.1016/j.jvacx.2022.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
The aim of this study is to provide basic information that contributes to vaccine inoculation policy after COVID-19. We used the secondary data of the influenza vaccine inoculation behavior survey for community-dwelling adults conducted in 2011, before the COVID-19 pandemic, but after the 2009 novel influenza A (H1N1) pdm 09 pandemic. All factors such as socio-demographic characteristics, health-related behaviors, family environment, physical and social environment, and area of residence were adjusted, and factors related to vaccine inoculation behavior were analyzed. Those living with pregnant women had a significantly higher odds ratio of inoculation; this was self-evident in that those people considered infection to their family. Regarding the social environment, those aged 20–64 years with a significantly higher adjusted odds ratio of inoculation were those with “at least five people with which they interacted in the neighborhood”. This result can be interpreted in two ways relating to altruism in Japan. Finally, we indicated the importance of learning from the past, including the case of 2009.
Collapse
Affiliation(s)
- Mayuko T. Komada
- Division of Nursing, Higashigaoka Faculty of Nursing, Tokyo Healthcare University, 2-5-1, Higashigaoka, Meguro-ku, Tokyo 152-8558, Japan
| | - Jung Su Lee
- Postgraduate School of Healthcare, Tokyo Healthcare University 4-1-17 Higashigotanda, Shinagawa-ku, Tokyo 141-8648, Japan
| | - Etsuko Watanabe
- Postgraduate School of Healthcare, Tokyo Healthcare University 4-1-17 Higashigotanda, Shinagawa-ku, Tokyo 141-8648, Japan
| | - Eisuke Nakazawa
- Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Katsumi Mori
- Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Akira Akabayashi
- Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Division of Medical Ethics, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA
- Corresponding author at: Department of Biomedical Ethics, University of Tokyo Faculty of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| |
Collapse
|
3
|
Khajehkazemi R, Baneshi MR, Iuliano AD, Roguski KM, Sharifi H, Bresee J, Haghdoost A. Estimated mortality due to seasonal influenza in southeast of Iran, 2006/2007 to 2011/2012 influenza seasons. Influenza Other Respir Viruses 2022; 17:e13061. [PMID: 36285808 PMCID: PMC9835411 DOI: 10.1111/irv.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Global estimates showed an estimate of up to 650,000 seasonal influenza-associated respiratory deaths annually. However, the mortality rate of seasonal influenza is unknown for most countries in the WHO Eastern Mediterranean Region, including Iran. We aimed to estimate the excess mortality attributable to seasonal influenza in Kerman province, southeast Iran for the influenza seasons 2006/2007-2011/2012. METHODS We applied a Serfling model to the weekly total pneumonia and influenza (PI) mortality rate during winter to define the epidemic periods and to the weekly age-specific PI, respiratory, circulatory, and all-cause deaths during non-epidemic periods to estimate baseline mortality. The excess mortality was calculated as the difference between observed and predicted mortality. Country estimates were obtained by multiplying the estimated annual excess death rates by the populations of Iran. RESULTS We estimated an annual average excess of 40 PI, 100 respiratory, 94 circulatory, and 306 all-cause deaths attributable to seasonal influenza in Kerman; corresponding to annual rates of 1.4 (95% confidence interval [CI] 1.1-1.8) PI, 3.6 (95% CI 2.6-4.8) respiratory, 3.4 (95% CI 2.1-5.2) circulatory, and 11.0 (95% CI 7.3-15.6) all-cause deaths per 100,000 population. Adults ≥75 years accounted for 56% and 53% of all excess respiratory and circulatory deaths, respectively. At country level, we would expect an annual of 1119 PI to 8792 all-cause deaths attributable to seasonal influenza. CONCLUSIONS Our findings help to define the mortality burden of seasonal influenza, most of which affects adults aged ≥75 years. This study supports influenza prevention and vaccination programs in older adults.
Collapse
Affiliation(s)
- Razieh Khajehkazemi
- Modeling in Health Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Mohammad Reza Baneshi
- Social Determinants of Health Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Angela Danielle Iuliano
- Influenza DivisionNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Katherine M. Roguski
- Influenza DivisionNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Joseph Bresee
- Influenza DivisionNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| |
Collapse
|
4
|
Prevalence and Characteristics of Malaria and Influenza Co-Infection in Febrile Patients: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7080168. [PMID: 36006260 PMCID: PMC9413030 DOI: 10.3390/tropicalmed7080168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Malaria and influenza are co-endemic in several geographical areas, and differentiation of their clinical features is difficult. The present study aimed to qualitatively and quantitatively analyze the prevalence and characteristics of malaria and influenza co-infection in febrile patients. The systematic review was registered at PROSPERO (CRD42021264525). Relevant literature that reported malaria and influenza co-infection in febrile patients were searched in PubMed, Web of Science, and Scopus from 20 June to 27 June 2021 and the risk of bias for each study was assessed. Quantitative analysis included pooled prevalence, and the odds of malaria and influenza virus co-infection among febrile patients were estimated using a random-effects model. Subgroup analyses were performed to summarize the effect estimate for each group. Funnel plot, Egger’s test, and contour-enhanced funnel plot were used to demonstrate any publication bias among outcomes of included studies. Among 4253 studies retrieved, 10 studies that enrolled 22,066 febrile patients with 650 co-infected patients were included for qualitative and quantitative syntheses. The pooled prevalence of malaria and influenza virus co-infection among febrile patients was 31.0% in Nigeria, 1.0% in Tanzania, 1.0% in Uganda, 1.0% in Malawi, 1.0% in Ghana, 0% in Cambodia, 7.0% in the Central African Republic, and 7.0% in Kenya. Meta-analysis also showed co-infection occurrence by chance (p = 0.097, odds ratio 0.54, 95% CI 0.26–1.12, I2 94.9%). The prevalence of malaria and influenza virus co-infection among febrile patients was heterogeneous by country, characteristics of febrile participants, and diagnostic tests for influenza virus. Further studies should investigate severe clinical manifestations or differentiate clinical outcomes between mono-infected or co-infected individuals, whether the co-infection leads to severe disease outcome.
Collapse
|
5
|
Zhang Y, Chang HH, Iuliano AD, Reed C. Application of Bayesian spatial-temporal models for estimating unrecognized COVID-19 deaths in the United States. SPATIAL STATISTICS 2022; 50:100584. [PMID: 35013705 PMCID: PMC8730676 DOI: 10.1016/j.spasta.2021.100584] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 05/10/2023]
Abstract
In the United States, COVID-19 has become a leading cause of death since 2020. However, the number of COVID-19 deaths reported from death certificates is likely to represent an underestimate of the total deaths related to SARS-CoV-2 infections. Estimating those deaths not captured through death certificates is important to understanding the full burden of COVID-19 on mortality. In this work, we explored enhancements to an existing approach by employing Bayesian hierarchical models to estimate unrecognized deaths attributed to COVID-19 using weekly state-level COVID-19 viral surveillance and mortality data in the United States from March 2020 to April 2021. We demonstrated our model using those aged ≥ 85 years who died. First, we used a spatial-temporal binomial regression model to estimate the percent of positive SARS-CoV-2 test results. A spatial-temporal negative-binomial model was then used to estimate unrecognized COVID-19 deaths by exploiting the spatial-temporal association between SARS-CoV-2 percent positive and all-cause mortality counts using an excess mortality approach. Computationally efficient Bayesian inference was accomplished via the Polya-Gamma representation of the binomial and negative-binomial models. Among those aged ≥ 85 years, we estimated 58,200 (95% CI: 51,300, 64,900) unrecognized COVID-19 deaths, which accounts for 26% (95% CI: 24%, 29%) of total COVID-19 deaths in this age group. Our modeling results suggest that COVID-19 mortality and the proportion of unrecognized deaths among deaths attributed to COVID-19 vary by time and across states.
Collapse
Affiliation(s)
- Yuzi Zhang
- Department of Biostatistics and Bioinformatics, The Rollins School of Public Health of Emory University, 1518 Clifton Rd. N.E., Atlanta, GA 30322, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, The Rollins School of Public Health of Emory University, 1518 Clifton Rd. N.E., Atlanta, GA 30322, USA
| | - A Danielle Iuliano
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
6
|
Lemaitre M, Fouad F, Carrat F, Crépey P, Gaillat J, Gavazzi G, Launay O, Mosnier A, Levant MC, Uhart M. Estimating the burden of influenza-related and associated hospitalizations and deaths in France: An eight-season data study, 2010-2018. Influenza Other Respir Viruses 2022; 16:717-725. [PMID: 35014194 PMCID: PMC9178052 DOI: 10.1111/irv.12962] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background In France, each year, influenza viruses are responsible for seasonal epidemics leading to 2–6 million cases. Influenza can cause severe disease that may lead to hospitalization or death. As severe disease may be due to the virus itself or to disease complications, estimating the burden of severe influenza is complex. The present study aimed at estimating the epidemiological and economic burden of severe influenza in France during eight consecutive influenza seasons (2010–2018). Methods Influenza‐related hospitalization and mortality data and patient characteristics were taken from the French hospital information database, PMSI. An ecological approach using cyclic regression models integrating the incidence of influenza syndrome from the Sentinelles network supplemented the PMSI data analysis in estimating excess hospitalization and mortality (CépiDc—2010–2015) and medical costs. Results Each season, the average number of influenza‐related hospitalizations was 18,979 (range: 8627–44,024), with an average length of stay of 8 days. The average number of respiratory hospitalizations indirectly related with influenza (i.e., influenza associated) was 31,490 (95% confidence interval [CI]: 24,542–39,012), with an average cost of €141 million (range: 54–217); 70% of these hospitalizations and 77% of their costs concerned individuals ≥65 years of age (65+). More than 90% of excess mortality was in 65+ subjects. Conclusions The combination of two complementary approaches allowed estimation of both influenza‐related and associated hospitalizations and deaths and their burden in France, showing the substantial impact of complications. The present study highlighted the major public health burden of influenza and its severe complications, especially in 65+ subjects.
Collapse
Affiliation(s)
| | | | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (Inserm), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Pascal Crépey
- Université de Rennes, EHESP, REPERES-EA 7449, Rennes, France
| | | | - Gaëtan Gavazzi
- CHU Grenoble Alpes, Clinique Universitaire de Gériatrie, Pavillon Elisée-Chatin, and GREPI EA 7408, Université Grenoble Alpes, Grenoble, France
| | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.,Inserm, CIC 1417, F-CRIN I-REIVAC, Assistance Publique-Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
| | | | | | | |
Collapse
|
7
|
Loevinsohn G, Hamahuwa M, Sinywimaanzi P, Fenstermacher KZJ, Shaw-Saliba K, Pekosz A, Monze M, Rothman RE, Simulundu E, Thuma PE, Sutcliffe CG. Facility-based surveillance for influenza and respiratory syncytial virus in rural Zambia. BMC Infect Dis 2021; 21:986. [PMID: 34548020 PMCID: PMC8453466 DOI: 10.1186/s12879-021-06677-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While southern Africa experiences among the highest mortality rates from respiratory infections, the burden of influenza and respiratory syncytial virus (RSV) in rural areas is poorly understood. METHODS We implemented facility-based surveillance in Macha, Zambia. Outpatients and inpatients presenting with influenza-like illness (ILI) underwent testing for influenza A, influenza B, and RSV and were prospectively followed for 3 to 5 weeks to assess clinical course. Log-binomial models assessed correlates of infection and clinical severity. RESULTS Between December 2018 and December 2019, 17% of all outpatients presented with ILI and 16% of inpatients were admitted with an acute respiratory complaint. Influenza viruses and RSV were detected in 17% and 11% of outpatient participants with ILI, and 23% and 16% of inpatient participants with ILI, respectively. Influenza (July-September) and RSV (January-April) prevalence peaks were temporally distinct. RSV (relative risk [RR]: 1.78; 95% confidence interval [CI] 1.51-2.11), but not influenza, infection was associated with severe disease among patients with ILI. Underweight patients with ILI were more likely to be infected with influenza A (prevalence ratio [PR]: 1.72; 95% CI 1.04-2.87) and to have severe influenza A infections (RR: 2.49; 95% CI 1.57-3.93). CONCLUSIONS Populations in rural Zambia bear a sizeable burden of viral respiratory infections and severe disease. The epidemiology of infections in this rural area differs from that reported from urban areas in Zambia.
Collapse
Affiliation(s)
- Gideon Loevinsohn
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mwaka Monze
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Philip E Thuma
- Macha Research Trust, Macha, Choma, Zambia
- Department of Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD, 21205, USA.
| |
Collapse
|
8
|
Gómez-Gómez A, Sánchez-Ramos EL, Noyola DE. Diabetes is a major cause of influenza-associated mortality in Mexico. Rev Epidemiol Sante Publique 2021; 69:205-213. [PMID: 34023186 DOI: 10.1016/j.respe.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Influenza is a major cause of mortality worldwide. Most influenza-associated deaths are associated with cardiovascular or respiratory disorders. However, a large proportion of influenza-associated deaths do not have respiratory or cardiovascular disorders declared as the underlying cause of death. Diabetic individuals are at increased risk for influenza-mortality. In this study, we assessed the contribution of diabetes to influenza-associated mortality in Mexico. METHODS Diabetes influenza-associated mortality was estimated for the Mexican population using National Mortality Databases from the Mexican Ministry of Health from 1998 through 2015. Diabetes influenza-associated mortality was calculated applying Serfling cyclical regression models to weekly mortality rates for persons 20-59 years, 60 and more years, and all ages, and by sex. RESULTS There was a high correlation between weekly pneumonia and influenza mortality and diabetes-related mortality. Yearly influenza-associated diabetes mortality rates varied between 2.0 and 5.9/100,000. Up until the 2005-2006 season, diabetes-associated mortality rates were higher in females, while after that season rates were higher in males. Yearly influenza-associated diabetes mortality rates for adults 20-59 years of age ranged between 1.7 and 3.4/100,000, while estimates for adults 60 years and older ranged between 16.3 and 46.1/100,000. Approximately one third of estimated diabetes influenza-associated deaths occurred in adults 20-59 years of age. On average, diabetes deaths accounted for 19.6% of estimated influenza-associated all-cause mortality. CONCLUSION Diabetes is a major cause of estimated influenza-associated mortality in Mexico. Health-care authorities and professionals in countries with high diabetes prevalence should be aware of the potential impact of influenza in individuals with this condition.
Collapse
Affiliation(s)
- A Gómez-Gómez
- Internal Medicine Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - D E Noyola
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Avenida Venustiano Carranza 2405, 78210 San Luis Potosí, Mexico.
| |
Collapse
|
9
|
Kraigsley AM, Moore KA, Bolster A, Peters M, Richardson D, Arpey M, Sonnenberger M, McCarron M, Lambach P, Maltezou HC, Bresee JS. Barriers and activities to implementing or expanding influenza vaccination programs in low- and middle-income countries: A global survey. Vaccine 2021; 39:3419-3427. [PMID: 33992439 DOI: 10.1016/j.vaccine.2021.04.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/02/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Despite considerable global burden of influenza, few low- and middle-income countries (LMICs) have national influenza vaccination programs. This report provides a systematic assessment of barriers to and activities that support initiating or expanding influenza vaccination programs from the perspective of in-country public health officials. METHODS Public health officials in LMICs were sent a web-based survey to provide information on barriers and activities to initiating, expanding, or maintaining national influenza vaccination programs. The survey primarily included Likert-scale questions asking respondents to rank barriers and activities in five categories. RESULTS Of 109 eligible countries, 62% participated. Barriers to influenza vaccination programs included lack of data on cost-effectiveness of influenza vaccination programs (87%) and on influenza disease burden (84%), competing health priorities (80%), lack of public perceived risk from influenza (79%), need for better risk communication tools (77%), lack of financial support for influenza vaccine programs (75%), a requirement to use only WHO-prequalified vaccines (62%), and young children require two vaccine doses (60%). Activities for advancing influenza vaccination programs included educating healthcare workers (97%) and decision-makers (91%) on the benefits of influenza vaccination, better estimates of influenza disease burden (91%) and cost of influenza vaccination programs (89%), simplifying vaccine introduction by focusing on selected high-risk groups (82%), developing tools to prioritize target populations (80%), improving availability of influenza diagnostic testing (79%), and developing collaborations with neighboring countries for vaccine procurement (74%) and regulatory approval (73%). Responses varied by country region and income status. CONCLUSIONS Local governments and key international stakeholders can use the results of this survey to improve influenza vaccination programs in LMICs, which is a critical component of global pandemic preparedness for influenza and other pathogens such as coronaviruses. Additionally, strategies to improve global influenza vaccination coverage should be tailored to country income level and geographic location.
Collapse
Affiliation(s)
- Alison M Kraigsley
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA.
| | - Kristine A Moore
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA
| | | | - Maya Peters
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA
| | | | - Meredith Arpey
- Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, Minneapolis, MN, USA
| | - Michelle Sonnenberger
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Joseph S Bresee
- The Task Force for Global Health, Atlanta, GA, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
10
|
Kocabiyik O, Cagno V, Silva PJ, Zhu Y, Sedano L, Bhide Y, Mettier J, Medaglia C, Da Costa B, Constant S, Huang S, Kaiser L, Hinrichs WLJ, Huckriede A, Le Goffic R, Tapparel C, Stellacci F. Non-Toxic Virucidal Macromolecules Show High Efficacy Against Influenza Virus Ex Vivo and In Vivo. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:2001012. [PMID: 33552848 PMCID: PMC7856883 DOI: 10.1002/advs.202001012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/07/2020] [Indexed: 06/12/2023]
Abstract
Influenza is one of the most widespread viral infections worldwide and represents a major public health problem. The risk that one of the next pandemics is caused by an influenza strain is high. It is important to develop broad-spectrum influenza antivirals to be ready for any possible vaccine shortcomings. Anti-influenza drugs are available but they are far from ideal. Arguably, an ideal antiviral should target conserved viral domains and be virucidal, that is, irreversibly inhibit viral infectivity. Here, a new class of broad-spectrum anti-influenza macromolecules is described that meets these criteria and display exceedingly low toxicity. These compounds are based on a cyclodextrin core modified on its primary face with long hydrophobic linkers terminated either in 6'sialyl-N-acetyllactosamine (6'SLN) or in 3'SLN. SLN enables nanomolar inhibition of the viruses while the hydrophobic linkers confer irreversibility to the inhibition. The combination of these two properties allows for efficacy in vitro against several human or avian influenza strains, as well as against a 2009 pandemic influenza strain ex vivo. Importantly, it is shown that, in mice, one of the compounds provides therapeutic efficacy when administered 24 h post-infection allowing 90% survival as opposed to no survival for the placebo and oseltamivir.
Collapse
Affiliation(s)
- Ozgun Kocabiyik
- Insitute of MaterialsÉcole Polytechnique Fédérale de LausanneStation 12Lausanne1015Switzerland
| | - Valeria Cagno
- Insitute of MaterialsÉcole Polytechnique Fédérale de LausanneStation 12Lausanne1015Switzerland
- Department of Microbiology and Molecular MedicineUniversity of GenevaRue Michel Servet 1Geneva1205Switzerland
| | - Paulo Jacob Silva
- Insitute of MaterialsÉcole Polytechnique Fédérale de LausanneStation 12Lausanne1015Switzerland
| | - Yong Zhu
- Insitute of MaterialsÉcole Polytechnique Fédérale de LausanneStation 12Lausanne1015Switzerland
| | - Laura Sedano
- Virologie et Immunologie MoleculaireInstitut National Recherche AgronomiqueUniversité Paris‐SaclayJouy en Josas78350France
| | - Yoshita Bhide
- Department of Pharmaceutical Technology and BiopharmacyUniversity of GroningenGroningen9713GZThe Netherlands
- University Medical Center GroningenDepartment of Medical Microbiology and Infection Prevention (internal postcode EB88)University of GroningenHanzeplein 1Groningen9713GZThe Netherlands
| | - Joelle Mettier
- Virologie et Immunologie MoleculaireInstitut National Recherche AgronomiqueUniversité Paris‐SaclayJouy en Josas78350France
| | - Chiara Medaglia
- Department of Microbiology and Molecular MedicineUniversity of GenevaRue Michel Servet 1Geneva1205Switzerland
| | - Bruno Da Costa
- Virologie et Immunologie MoleculaireInstitut National Recherche AgronomiqueUniversité Paris‐SaclayJouy en Josas78350France
| | | | - Song Huang
- Epithelix SasChemin des Aulx 18Geneva1228Switzerland
| | - Laurent Kaiser
- Hopital Universitaire de GenèveRue Gabrielle Perret Gentil 4Geneva1205Switzerland
| | - Wouter L. J. Hinrichs
- Department of Pharmaceutical Technology and BiopharmacyUniversity of GroningenGroningen9713GZThe Netherlands
| | - Anke Huckriede
- University Medical Center GroningenDepartment of Medical Microbiology and Infection Prevention (internal postcode EB88)University of GroningenHanzeplein 1Groningen9713GZThe Netherlands
| | - Ronan Le Goffic
- Virologie et Immunologie MoleculaireInstitut National Recherche AgronomiqueUniversité Paris‐SaclayJouy en Josas78350France
| | - Caroline Tapparel
- Department of Microbiology and Molecular MedicineUniversity of GenevaRue Michel Servet 1Geneva1205Switzerland
| | - Francesco Stellacci
- Insitute of MaterialsÉcole Polytechnique Fédérale de LausanneStation 12Lausanne1015Switzerland
- Bioengineering InstituteEcole Polytechnique Fédérale de LausanneStation 12Lausanne1015Switzerland
| |
Collapse
|
11
|
Walaza S, Cohen C, Tempia S, Moyes J, Nguweneza A, Madhi SA, McMorrow M, Cohen AL. Influenza and tuberculosis co-infection: A systematic review. Influenza Other Respir Viruses 2019; 14:77-91. [PMID: 31568678 PMCID: PMC6928059 DOI: 10.1111/irv.12670] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction There are limited data on risk of severe disease or outcomes in patients with influenza and pulmonary tuberculosis (PTB) co‐infection compared to those with single infection. Methods We conducted a systematic review of published literature on the interaction of influenza viruses and PTB. Studies were eligible for inclusion if they presented data on prevalence, disease association, presentation or severity of laboratory‐confirmed influenza among clinically diagnosed or laboratory‐confirmed PTB cases. We searched eight databases from inception until December 2018. Summary characteristics of each study were extracted, and a narrative summary was presented. Cohort or case‐control studies were assessed for potential bias using the Newcastle‐Ottawa scale. Results We assessed 5154 abstracts, reviewed 146 manuscripts and included 19 studies fulfilling selection criteria (13 human and six animal). Of seven studies reporting on the possible effect of the underlying PTB disease in patients with influenza, three of four analytical studies reported no association with disease severity of influenza infection in those with PTB, whilst one study reported PTB as a risk factor for influenza‐associated hospitalization. An association between influenza infection and PTB disease was found in three of five analytical studies; whereas the two other studies reported a high frequency of PTB disease progression and complications among patients with seasonal influenza co‐infection. Conclusion Human analytical studies of an association between co‐infection and severe influenza‐ or PTB‐associated disease or increased prevalence of influenza co‐infection in individuals' hospitalized for PTB were not conclusive. Data are limited from large, high‐quality, analytical epidemiological studies with laboratory‐confirmed endpoints.
Collapse
Affiliation(s)
- Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Athermon Nguweneza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,U.S. Public Health Service, Rockville, MD, USA
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Global Immunization Monitoring and Surveillance, Expanded Programme on Immunization Department of Immunization, Vaccines and Biologicals World Health Organization, Geneva, Switzerland
| |
Collapse
|
12
|
Bresee JS, Lafond KE, McCarron M, Azziz-Baumgartner E, Chu SY, Ebama M, Hinman AR, Xeuatvongsa A, Bino S, Richardson D, Porter RM, Moen A, McKinlay M. The partnership for influenza vaccine introduction (PIVI): Supporting influenza vaccine program development in low and middle-income countries through public-private partnerships. Vaccine 2019; 37:5089-5095. [PMID: 31288998 PMCID: PMC6685526 DOI: 10.1016/j.vaccine.2019.06.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 01/15/2023]
Abstract
Influenza vaccination remains the most effective tool for reducing seasonal influenza disease burden. Few Low and Middle-Income Countries (LMICs) have robust, sustainable annual influenza national vaccination programs. The Partnership for Influenza Vaccine Introduction (PIVI) was developed as a public-private partnership to support LMICs to develop and sustain national vaccination programs through time-limited vaccine donations and technical support. We review the first 5 years of experience with PIVI, including the concept, country progress toward sustainability, and lesson learned. Between 2013 and 2018, PIVI worked with Ministries of Health in 17 countries. Eight countries have received donated vaccines and technical support; of these, two have transitioned to sustained national support of influenza vaccination and six are increasing national support of the vaccine programs towards full transition to local vaccine program support by 2023. Nine additional countries have received technical support for building the evidence base for national policy development and/or program evaluation. PIVI has resulted in increased use of vaccines in partner countries, and early countries have demonstrated progress towards sustainability, suggesting that a model of vaccine and technical support can work in LMICs. PIVI expects to add new country partners as current countries transition to self-reliance.
Collapse
Affiliation(s)
- Joseph S Bresee
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, USA.
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret McCarron
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Y Chu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Malembe Ebama
- Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, USA
| | - Alan R Hinman
- Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, USA
| | - Anonh Xeuatvongsa
- Ministry of Health, Lao Peoples Democratic Republic, Vientiane, Laos
| | | | - Dominique Richardson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Moen
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark McKinlay
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
13
|
Bacurau AGDM, Ferraz RDO, Donalisio MR, Francisco PMSB. Trend of mortality from ischemic heart disease and influenza vaccination in older adults in São Paulo. CIENCIA & SAUDE COLETIVA 2019; 24:2971-2982. [DOI: 10.1590/1413-81232018248.25472017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of the present study was to analyze the mortality trend due to ischemic heart disease (IHD) among older adults, identify changes in the trend and determine the correlation with influenza vaccine coverage (2000 to 2012) in the state of São Paulo between 1980 and 2012. An ecological time series study was conducted involving secondary data from Brazilian information systems. Linear and polynomial regression models as well as joinpoint regression were used to estimate the trends. Pearson’s correlation coefficient was used to evaluate the correlation between age-standardized mortality coefficients and vaccine coverage. A decreasing tendency in mortality due to IHD occurred in both sexes, higher mortality rates were found for males and greater reductions were found in the period after the vaccination campaigns. However, no statistically significant changes occurred in the year coinciding with or near the onset of the campaigns. In the overall sample, no evidence of a linear correlation was found between the mortality coefficients and vaccination coverage. Other factors directly associated with morbidity and mortality due to ischemic heart disease may have influenced the trend.
Collapse
|
14
|
Phiri M, Gooding K, Peterson I, Mambule I, Nundwe S, McMorrow M, Desmond N. Dust or disease? Perceptions of influenza in rural Southern Malawi. PLoS One 2019; 14:e0208155. [PMID: 31009480 PMCID: PMC6476467 DOI: 10.1371/journal.pone.0208155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/05/2019] [Indexed: 01/10/2023] Open
Abstract
Influenza virus infections cause between 291 243 and 645 832 deaths annually, with the highest burden in low-income settings. Research in high-income countries has examined public understanding of influenza, but there is little information on views and behaviours about influenza in low-income countries. We explored communities' ideas about the severity, causes, prevention and treatment of influenza in Chikwawa district, Malawi. We conducted 64 in-depth interviews with parents of children aged <5 years, and 7 focus groups with community health workers, parents, and traditional healers. Data were analysed thematically and using a framework matrix to compare views between groups. Respondents held varied ideas about influenza, and many were uncertain about its causes and treatment. Some parents, traditional healers and health workers thought influenza was not severe because they felt it did not cause death or limit activities, but others disagreed. Many saw influenza as a symptom of other conditions, especially malaria and pneumonia, rather than as a disease of its own. Most mentioned dust as the main cause of influenza and believed influenza could be prevented by cleaning the home thoroughly. Treatment seeking for influenza followed different stages, usually starting with home remedies followed by purchasing drugs from groceries and then visiting a health centre. Seeking a clinician tended to be triggered by severe symptoms like high fever or difficulty breathing, and suspicions of malaria or pneumonia. Community health workers provide health education for communities, but some lacked understanding of influenza. Our findings suggest uncertainty about the causes and control of influenza among parents and varied levels of understanding among health providers. Strengthening the capacity of community health workers to provide relevant information about influenza prevention and treatment could address parents' interest in further information and support informed health seeking and engagement with future influenza interventions.
Collapse
Affiliation(s)
- Mackwellings Phiri
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
| | - Kate Gooding
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Ingrid Peterson
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Ivan Mambule
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Spencer Nundwe
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- U.S. Public Health Service, Rockville, Maryland, United States of America
| | - Nicola Desmond
- Malawi Liverpool Welcome Trust Clinical Research Programme, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| |
Collapse
|
15
|
Bresee J, Fitzner J, Campbell H, Cohen C, Cozza V, Jara J, Krishnan A, Lee V. Progress and Remaining Gaps in Estimating the Global Disease Burden of Influenza. Emerg Infect Dis 2019; 24:1173-1177. [PMID: 29912681 PMCID: PMC6038739 DOI: 10.3201/eid2407.171270] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Influenza has long been a global public health priority because of the threat of another global pandemic. Although data are available for the annual burden of seasonal influenza in many developed countries, fewer disease burden data are available for low-income and tropical countries. In recent years, however, the surveillance systems created as part of national pandemic preparedness efforts have produced substantial data on the epidemiology and impact of influenza in countries where data were sparse. These data are leading to greater interest in seasonal influenza, including implementation of vaccination programs. However, a lack of quality data on severe influenza, nonrespiratory outcomes, and high-risk groups, as well as a need for better mathematical models and economic evaluations, are some of the major gaps that remain. These gaps are the focus of multilateral research and surveillance efforts that will strengthen global efforts in influenza control in the future.
Collapse
|
16
|
Walaza S, Tempia S, Dawood H, Variava E, Wolter N, Dreyer A, Moyes J, Von Mollendorf C, McMorrow M, Von Gottberg A, Haffejee S, Venter M, Treurnicht FK, Hellferscee O, Martinson NA, Ismail N, Cohen C. The Impact of Influenza and Tuberculosis Interaction on Mortality Among Individuals Aged ≥15 Years Hospitalized With Severe Respiratory Illness in South Africa, 2010-2016. Open Forum Infect Dis 2019; 6:ofz020. [PMID: 30906797 PMCID: PMC6424478 DOI: 10.1093/ofid/ofz020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/22/2019] [Indexed: 11/12/2022] Open
Abstract
Background Data on the prevalence and impact of influenza–tuberculosis coinfection on clinical outcomes from high–HIV and –tuberculosis burden settings are limited. We explored the impact of influenza and tuberculosis coinfection on mortality among hospitalized adults with lower respiratory tract infection (LRTI). Methods We enrolled patients aged ≥15 years admitted with physician-diagnosed LRTI or suspected tuberculosis at 2 hospitals in South Africa from 2010 to 2016. Combined nasopharyngeal and oropharyngeal swabs were tested for influenza and 8 other respiratory viruses. Tuberculosis testing of sputum included smear microscopy, culture, and/or Xpert MTB/Rif. Results Among 6228 enrolled individuals, 4253 (68%) were tested for both influenza and tuberculosis. Of these, the detection rate was 6% (239/4253) for influenza, 26% (1092/4253) for tuberculosis, and 77% (3113/4053) for HIV. One percent (42/4253) tested positive for both influenza and tuberculosis. On multivariable analysis, among tuberculosis-positive patients, factors independently associated with death were age group ≥65 years compared with 15–24 years (adjusted odds ratio [aOR], 3.6; 95% confidence interval [CI], 1.2–11.0) and influenza coinfection (aOR, 2.3; 95% CI, 1.02–5.2). Among influenza-positive patients, laboratory-confirmed tuberculosis was associated with an increased risk of death (aOR, 4.5; 95% CI, 1.5–13.3). Coinfection with other respiratory viruses was not associated with increased mortality in patients positive for tuberculosis (OR, 0.7; 95% CI, 0.4–1.1) or influenza (OR, 1.6; 95% CI, 0.4–5.6). Conclusions Tuberculosis coinfection is associated with increased mortality in individuals with influenza, and influenza coinfection is associated with increased mortality in individuals with tuberculosis. These data may inform prioritization of influenza vaccines or antivirals for tuberculosis patients and inform tuberculosis testing guidelines for patients with influenza.
Collapse
Affiliation(s)
- Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Halima Dawood
- Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp Tshepong Hospital, North West Province.,School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andries Dreyer
- Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Claire Von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Division of Global Health Protection, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Anne Von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sumayya Haffejee
- Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal, South Africa
| | - Marietje Venter
- Zoonosis Research Program, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB.,DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, Maryland
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
17
|
Bacurau AGDM, Ferraz RDO, Donalisio MR, Francisco PMSB. [Mortality due to cerebrovascular disease among the elderly and vaccination against influenza: São Paulo State, Brazil, 1980-2012]. CAD SAUDE PUBLICA 2019; 35:e00145117. [PMID: 30785490 DOI: 10.1590/0102-311x00145117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/25/2018] [Indexed: 05/30/2023] Open
Abstract
This study describes the trend of the coefficients of mortality due to cerebrovascular diseases (CbVD) among the elderly in São Paulo State, Brazil, from 1980 to 2012, before and after influenza vaccination campaigns, and identifies change points. It is an ecological, time-series study carried out with death data from the Health Ministry's Mortality Information System and population data from the Brazilian Institute of Geography and Statistics. We used linear, polynomial and joinpoint regression models in the data analysis. Between 1980 and 2012, there were 480,955 deaths due to CbVD. The mean mortality coefficients decreased for both sexes in all age groups we analyzed, with the greatest reduction in the older ages and male sex. We observed a significant reduction in the mortality trend in 1998 for male sex in the age group 60-69 years (annual percent change - APC = -3%, 95%CI: -4.3; -1.6) and for all elderly (APC = -3.8%, 95%CI: -4.4; -3.1). Considering the period as a whole, we did not observe change points for the age group 70-79 (average annual percent change - AAPC = -3.3%, 95%CI: -3.5; -3.1) and, for male sex, for the group ≥ 80 years (AAPC = -2.9%, 95%CI: -3.1; -2.6). For all elderly, the mean percentage reduction was of 3.1% per year (AAPC = -3.1%, 95%CI: -3.5; -2.7). Results show a reduction in the mortality due to CbVD in the period, with different percentage variations in coefficient reduction. The study's findings add information to the debate regarding possible effects of vaccination campaigns in reducing mortality due to CbVD among the elderly.
Collapse
Affiliation(s)
| | | | - Maria Rita Donalisio
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil
| | | |
Collapse
|
18
|
Solanki G, Cornell M, Lalloo R. Uptake and cost of influenza vaccines in a private health insured South African population. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1504532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Geetesh Solanki
- Health System Research Unit, Medical Research Council of South Africa, Cape Town, South Africa
- Health Economics Unit, Department of Public Health, University of Cape Town, South Africa
- Towers Watson, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
19
|
Solanki G, Cornell M, Lalloo R. Uptake and cost of influenza vaccines in a private health insured South African population. S Afr J Infect Dis 2018; 33. [PMID: 32051821 PMCID: PMC7015168 DOI: 10.4102/sajid.v33i5.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Influenza vaccination is regarded as the most effective form of prevention and is particularly recommended for individuals at increased risk of developing severe influenza. Data on uptake (coverage) and costs in South Africa are limited. Methods This study examined influenza vaccination uptake amongst South African private health insurance scheme members. All claims received for services rendered in 2015 were collated at an individual level and the claims related to the provision of influenza vaccines were analysed. Results Of the almost 520 000 members, overall 5.0% (95% CI 4.9%; 5.1%) received the influenza vaccine in 2015. Priority risk groups such as pregnant women, older adults and those with a medical condition were significantly more likely to be vaccinated, as were members belonging to insurance schemes that offered a specific influenza vaccine benefit. The average cost of providing the vaccination was R350. Conclusions Influenza vaccination coverage was low in this privately insured population. There were more members vaccinated in the priority risk groups. There is an urgent need to implement strategies to increase this coverage in privately insured South Africans.
Collapse
Affiliation(s)
- Geetesh Solanki
- Health System Research Unit, Medical Research Council of South Africa, Cape Town, South Africa.,Health Economics Unit, Department of Public Health, University of Cape Town, South Africa.,Towers Watson, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
20
|
Abstract
Pandemic influenza remains the single greatest threat to global heath security. Efforts to increase our preparedness, by improving predictions of viral emergence, spread and disease severity, by targeting reduced transmission and improved vaccination and by mitigating health impacts in low- and middle-income countries, should receive renewed urgency.
Collapse
Affiliation(s)
- Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
- International Severe Acute Respiratory and Emerging Infections Consortium, Oxford, UK.
| |
Collapse
|
21
|
Orsi A, Colomba GME, Pojero F, Calamusa G, Alicino C, Trucchi C, Canepa P, Ansaldi F, Vitale F, Tramuto F. Trends of influenza B during the 2010-2016 seasons in 2 regions of north and south Italy: The impact of the vaccine mismatch on influenza immunisation strategy. Hum Vaccin Immunother 2018; 14:523-531. [PMID: 28708953 PMCID: PMC5861802 DOI: 10.1080/21645515.2017.1342907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/22/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022] Open
Abstract
Influenza A and B viruses are responsible for respiratory infections, representing globally seasonal threats to human health. The 2 viral types often co-circulate and influenza B plays an important role in the spread of infection. A 6-year retrospective surveillance study was conducted between 2010 and 2016 in 2 large administrative regions of Italy, located in the north (Liguria) and in the south (Sicily) of the country, to describe the burden and epidemiology of both B/Victoria and B/Yamagata lineages in different healthcare settings. Influenza B viruses were detected in 5 of 6 seasonal outbreaks, exceeding influenza A during the season 2012-2013. Most of influenza B infections were found in children aged ≤ 14 y and significant differences were observed in the age-groups infected by the different lineages. B/Victoria strains prevailed in younger population than B/Yamagata, but also were more frequently found in the community setting. Conversely, B/Yamagata viruses were prevalent among hospitalized cases suggesting their potential role in the development of more severe disease. The relative proportions of viral lineages varied from year to year, resulting in different lineage-level mismatch for the B component of trivalent influenza vaccine. Our findings confirmed the need for continuous virological surveillance of seasonal epidemics and bring attention to the adoption of universal influenza immunization program in the childhood. The use of tetravalent vaccine formulations may be useful to improve the prevention and control of the influenza burden in general population.
Collapse
Affiliation(s)
- Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital “San Martino” - IST National Institute for Cancer Research, Genoa, Italy
| | - Giuseppina Maria Elena Colomba
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Fanny Pojero
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Giuseppe Calamusa
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | | | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paola Canepa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital “San Martino” - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| |
Collapse
|
22
|
Li L, Wong JY, Wu P, Bond HS, Lau EHY, Sullivan SG, Cowling BJ. Heterogeneity in Estimates of the Impact of Influenza on Population Mortality: A Systematic Review. Am J Epidemiol 2018; 187:378-388. [PMID: 28679157 PMCID: PMC5860627 DOI: 10.1093/aje/kwx270] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022] Open
Abstract
Influenza viruses are associated with a substantial global burden of morbidity and mortality every year. Estimates of influenza-associated mortality often vary between studies due to differences in study settings, methods, and measurement of outcomes. We reviewed 103 published articles assessing population-based influenza-associated mortality through searches of PubMed and Embase, and we identified considerable variation in the statistical methods used across studies. Studies using regression models with an influenza activity proxy applied 4 approaches to estimate influenza-associated mortality. The estimates increased with age and ranged widely, from -0.3-1.3 and 0.6-8.3 respiratory deaths per 100,000 population for children and adults, respectively, to 4-119 respiratory deaths per 100,000 population for older adults. Meta-regression analysis identified that study design features were associated with the observed variation in estimates. The estimates increased with broader cause-of-death classification and were higher for older adults than for children. The multiplier methods tended to produce lower estimates, while Serfling-type models were associated with higher estimates than other methods. No "average" estimate of excess mortality could reliably be made due to the substantial variability of the estimates, partially attributable to methodological differences in the studies. Standardization of methodology in estimation of influenza-associated mortality would permit improved comparisons in the future.
Collapse
Affiliation(s)
- Li Li
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
- WHO Collaborating Center for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Jessica Y Wong
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Helen S Bond
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sheena G Sullivan
- WHO Collaborating Center for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Benjamin J Cowling
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
23
|
Epidemiologic and Spatiotemporal Characterization of Influenza and Severe Acute Respiratory Infection in Uganda, 2010-2015. Ann Am Thorac Soc 2018; 13:2159-2168. [PMID: 27612095 DOI: 10.1513/annalsats.201607-561oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Little is known about the epidemiology of severe acute respiratory infection (SARI) or influenza in sub-Saharan Africa. Characterization of influenza transmission dynamics and risk factors for severe disease and mortality is critical to inform prevention and mitigation strategies. OBJECTIVES To characterize the epidemiology and transmission dynamics of influenza and risk factors for influenza-associated severe respiratory infection in Uganda. METHODS Clinicians at 12 sentinel surveillance sites prospectively collected clinical data and upper respiratory tract samples from consecutive patients who met criteria for SARI and influenza-like illness (ILI). Samples were tested for influenza A and B viruses using real-time reverse transcription-polymerase chain reaction. Spatial and spatiotemporal cluster modeling was performed to identify loci of increased influenza transmission. Morbidity and mortality were assessed through chart review in a defined subset of patients. Univariable and multivariable analyses were used to identify risk factors for severe respiratory infection, prolonged hospitalization, and in-hospital mortality. MEASUREMENTS AND MAIN RESULTS From October 2010 to June 2015, 9,978 patients met case definitions for SARI and ILI and had samples tested for influenza A and B. Of the 9,978 patient samples tested, 1,113 (11.2%) were positive for influenza. Among 6,057 patients with ILI, 778 samples (12.8%) were positive, and among 3,921 patients with SARI, 335 samples (8.5%) were positive. Significant clustering of influenza cases was observed in urban and periurban areas and during rainy seasons. Among 1,405 cases of SARI with available outcome data, in-hospital mortality was 1.6%. Infection with the 2009 pandemic A/H1N1 subtype and prolonged time to presentation were independently associated with SARI among influenza cases. CONCLUSIONS Influenza is associated with a substantial proportion of acute respiratory infection in Uganda. As influenza vaccination programs are developed in East Africa, timing campaigns to confer protection during rainy seasons should be considered, particularly among high-risk urban populations.
Collapse
|
24
|
Cohen C, Walaza S, Treurnicht FK, McMorrow M, Madhi SA, McAnerney JM, Tempia S. In- and Out-of-hospital Mortality Associated with Seasonal and Pandemic Influenza and Respiratory Syncytial Virus in South Africa, 2009-2013. Clin Infect Dis 2018; 66:95-103. [PMID: 29040527 PMCID: PMC5813484 DOI: 10.1093/cid/cix740] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
Background Estimates of influenza- and respiratory syncytial virus (RSV)-associated mortality burden are important to guide policy for control. Data are limited on the contribution of out-of-hospital deaths to this mortality. Methods We modeled excess mortality attributable to influenza and RSV infection by applying regression models to weekly deaths from national vital statistics from 2009 through 2013, using influenza and RSV laboratory surveillance data as covariates. We fitted separate models for in- and out-of-hospital deaths. Results There were 509791 average annual deaths in South Africa, of which 44% (95% confidence interval [CI] 43%-45%) occurred out-of-hospital. Seasonal influenza and RSV all-cause mortality rates were 23.0 (95% CI 11.0-30.6) and 13.2 (95% CI 6.4-33.8) per 100000 population annually (2.3% [95%CI 2.3%-2.4%] and 1.3% [95% CI 1.2%-1.4%] of all deaths respectively). The peak mortality rate was in individuals aged ≥75 years (386.0; 95% CI 176.5-466.3) for influenza and in infants (143.4; 95% CI 0-194.8) for RSV. Overall, 63% (95% CI 62%--65%) of seasonal influenza and 48% (95% CI 47%-49%) of RSV-associated deaths occurred out-of-hospital. Among children aged <5 years, RSV-associated deaths were more likely to occur in-hospital, whereas influenza-associated deaths were more likely to occur out-of-hospital. The mortality rate was 6.7 (95% CI 6.4-33.8) in the first influenza A(H1N1)pdm09 wave in 2009 and 20.9 (95% CI 6.4-33.8) in the second wave in 2011, with 30% (95% CI 29%-32%) of A(H1N1)pdm09-associated deaths in 2009 occurring out-of-hospital. Discussion More than 45% of seasonal influenza- and RSV-associated deaths occur out-of-hospital in South Africa. These data suggest that hospital-based studies may substantially underestimate mortality burden.
Collapse
Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- US Public Health Service, Rockville, Maryland
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| |
Collapse
|
25
|
Lee VJ, Ho ZJM, Goh EH, Campbell H, Cohen C, Cozza V, Fitzner J, Jara J, Krishnan A, Bresee J. Advances in measuring influenza burden of disease. Influenza Other Respir Viruses 2018; 12:3-9. [PMID: 29460425 PMCID: PMC5818353 DOI: 10.1111/irv.12533] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Vernon J. Lee
- Ministry of HealthSingaporeSingapore
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | | | | | - Harry Campbell
- Centre for Global Health ResearchUsher Institute of Population Health SciencesUniversity of EdinburghEdinburghUK
| | - Cheryl Cohen
- Division of the National Laboratory ServiceCentre for Respiratory Diseases and MeningitisNational Institute for Communicable DiseasesJohannesburgSouth Africa
- Wits School of Public HealthUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Vanessa Cozza
- Global Influenza ProgrammeWorld Health OrganizationGenevaSwitzerland
| | - Julia Fitzner
- Global Influenza ProgrammeWorld Health OrganizationGenevaSwitzerland
| | - Jorge Jara
- Center for Health Studies, Research InstituteUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Anand Krishnan
- Centre for Community MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Joseph Bresee
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGAUSA
| | | |
Collapse
|
26
|
McMorrow ML, Emukule GO, Obor D, Nyawanda B, Otieno NA, Makokha C, Mott JA, Bresee JS, Reed C. Maternal influenza vaccine strategies in Kenya: Which approach would have the greatest impact on disease burden in pregnant women and young infants? PLoS One 2017; 12:e0189623. [PMID: 29283997 PMCID: PMC5746219 DOI: 10.1371/journal.pone.0189623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent influenza surveillance data from Africa suggest an important burden of influenza-associated morbidity and mortality. In tropical countries where influenza virus transmission may not be confined to a single season alternative strategies for vaccine distribution via antenatal care (ANC) or semiannual campaigns should be considered. Methods Using data on monthly influenza disease burden in women of child-bearing age and infants aged 0–5 months in Kenya from 2010–2014, we estimated the number of outcomes (illnesses, medical visits, hospitalizations, and deaths) that occurred and that may have been averted through influenza vaccination of pregnant women using: 1) a year-round immunization strategy through ANC, 2) annual vaccination campaigns, and 3) semiannual vaccination campaigns. Results During 2010–2014, influenza resulted in an estimated 279,047 illnesses, 36,276 medical visits, 1612 hospitalizations and 243 deaths in pregnant women and 157,053 illnesses, 65,177 medical visits, 4197 hospitalizations, and 755 deaths in infants aged 0–5 months in Kenya. Depending on the mode of distribution and the vaccine coverage achieved, 12.8–31.4% of influenza-associated disease in pregnant women and 11.6–22.1% in infants aged 0–5 months might have been prevented through maternal influenza immunization. In this model, point estimates for influenza-associated disease averted through maternal vaccination delivered year-round in ANC or semiannually in campaigns were higher than vaccination delivered in a single annual campaign, but confidence intervals overlapped. Conclusions Vaccinating pregnant women against influenza can reduce the burden of influenza-associated illness, hospitalization and death in both pregnant women and their young infants. Alternative immunization strategies may avert more influenza-associated disease in countries where influenza virus transmission occurs throughout the year.
Collapse
Affiliation(s)
- Meredith L. McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Gideon O. Emukule
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - David Obor
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | | | | | - Joshua A. Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
| | - Joseph S. Bresee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| |
Collapse
|
27
|
Goyal S, Prasert K, Praphasiri P, Chittaganpitch M, Waicharoen S, Ditsungnoen D, Jaichuang S, Lindblade KA. The acceptability and validity of self-collected nasal swabs for detection of influenza virus infection among older adults in Thailand. Influenza Other Respir Viruses 2017; 11:412-417. [PMID: 28741903 PMCID: PMC5596524 DOI: 10.1111/irv.12471] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Self-collection of nasal swabs could improve the timeliness of influenza virus detection in older adults. OBJECTIVES Measure the acceptability, adequacy, timeliness, and validity of self-collected nasal swabs among adults >65 years in Thailand. METHODS Our evaluation consisted of two parts: a one-month study among randomly selected, community-dwelling older adults to simulate community-based surveillance for acute respiratory infections (ARI); and a clinic study of older adults with ARI to evaluate the sensitivity and specificity of self-collected nasal swabs for influenza virus infection compared with healthcare worker (HCW)-collected nasal and nasopharyngeal swabs. RESULTS In the community study, 24% of participants experienced an ARI during the observation period. All (100%) participants with an ARI self-collected nasal swabs within 72 hours of symptom onset of which 92% were considered adequate samples. In the clinic study, 45% of patients with ARI presented within 72 hours of symptom onset. The sensitivity of self-collected nasal swabs for detection of influenza virus infection was 78% (95% CI 40-97) compared to nasopharyngeal and 88% (95% CI 47-100) compared to nasal swabs collected by HCWs. Specificity was 100% (95% CI 97-100) compared to both methods. Self-collection of nasal swabs was found acceptable by 99% of participants in both studies. CONCLUSIONS Self-collection of nasal swabs was acceptable to older adults in Thailand who were able to take adequate samples. Self-collection of nasal swabs may improve the timeliness of sample collection but lower sensitivity will need to be considered.
Collapse
Affiliation(s)
- Sonal Goyal
- ASPPH/CDC Allan Rosenfield Global Health Fellow, Atlanta, GA, USA.,Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Prabda Praphasiri
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | - Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Kim A Lindblade
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
28
|
Wu P, Presanis AM, Bond HS, Lau EHY, Fang VJ, Cowling BJ. A joint analysis of influenza-associated hospitalizations and mortality in Hong Kong, 1998-2013. Sci Rep 2017; 7:929. [PMID: 28428558 PMCID: PMC5430505 DOI: 10.1038/s41598-017-01021-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 03/23/2017] [Indexed: 12/02/2022] Open
Abstract
Influenza viruses may cause severe human infections leading to hospitalization or death. Linear regression models were fitted to population-based data on hospitalizations and deaths. Surveillance data on influenza virus activity permitted inference on influenza-associated hospitalizations and deaths. The ratios of these estimates were used as a potential indicator of severity. Influenza was associated with 431 (95% CrI: 358–503) respiratory deaths and 12,700 (95% CrI: 11,700–13,700) respiratory hospitalizations per year. Majority of the excess deaths occurred in persons ≥65 y of age. The ratios of deaths to hospitalizations in adults ≥65 y were significantly higher for influenza A(H1N1) and A(H1N1)pdm09 compared to A(H3N2) and B. Substantial disease burden associated with influenza viruses were estimated in Hong Kong particularly among children and elderly in 1998–2013. Infections with influenza A(H1N1) was suggested to be more serious than A(H3N2) in older adults.
Collapse
Affiliation(s)
- Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Anne M Presanis
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Helen S Bond
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vicky J Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| |
Collapse
|
29
|
McAnerney JM, Walaza S, Tempia S, Blumberg L, Treurnicht FK, Madhi SA, Valley-Omar Z, Cohen C. Estimating vaccine effectiveness in preventing laboratory-confirmed influenza in outpatient settings in South Africa, 2015. Influenza Other Respir Viruses 2016; 11:177-181. [PMID: 27865064 PMCID: PMC5304569 DOI: 10.1111/irv.12436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2016] [Indexed: 11/29/2022] Open
Abstract
Trivalent seasonal influenza vaccine effectiveness during the 2015 season in South Africa was assessed using a test‐negative case control study design. Influenza A(H1N1)pdm09 was the dominant circulating strain. Overall influenza vaccine coverage was 3.2% (29/899). The vaccine effectiveness estimate, against any influenza virus infection, adjusted for age, underlying conditions and timing within season was 46.2% (95% CI: −23.5 to 76.5), and 53.6% (95% CI: −62.6 to 80.3) against influenza A(H1N1)pdm09.
Collapse
Affiliation(s)
- Johanna M McAnerney
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Sibongile Walaza
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Stefano Tempia
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Lucille Blumberg
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Florette K Treurnicht
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Shabir A Madhi
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Faculty of Health Sciences, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Valley-Omar
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Division of Medical Virology, Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- National Health Laboratory Services (NHLS), National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| |
Collapse
|
30
|
Wong KK, Cohen AL, Norris SA, Martinson NA, von Mollendorf C, Tempia S, Walaza S, Madhi SA, McMorrow ML, Variava E, Motlhaoleng KM, Cohen C. Knowledge, attitudes, and practices about influenza illness and vaccination: a cross-sectional survey in two South African communities. Influenza Other Respir Viruses 2016; 10:421-8. [PMID: 26987756 PMCID: PMC4947943 DOI: 10.1111/irv.12388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Understanding knowledge and sentiment toward influenza and vaccination is important for effective health messages and prevention strategies. We aimed to characterize knowledge, attitudes, and practices surrounding influenza illness and vaccination in two South African communities and explore reasons for vaccine hesitancy. METHODS Household primary caregivers in Soweto and Klerksdorp townships were interviewed about knowledge of influenza and intention to receive an influenza vaccine using a structured questionnaire. Factors associated with unwillingness to receive vaccine were explored using multivariable regression. RESULTS We interviewed representatives of 973 households in Soweto and 1,442 in Klerksdorp. Most respondents in Soweto (692, 71%) and Klerksdorp (1247, 87%) thought weather or cold caused influenza. While most would get a free influenza vaccine, those unwilling to receive vaccine had concerns about efficacy (Soweto: 19%; Klerksdorp: 19%) and safety (Soweto: 17%; Klerksdorp: 10%). In Soweto, females (aRR 2·0, 95% CI 1·3-3·2) and those with higher household income (aRR 1·8, 95% CI 1·2-2·7) were less willing to receive vaccine. In Klerksdorp, more educated respondents (aRR 1·6, 95% CI 1·1-2·4) were less willing to receive vaccine; households reporting an HIV-positive member were more willing to receive vaccine (aRR 0·3, 95% CI 0·1-0·8). CONCLUSIONS Although findings suggest most community participants were amenable to influenza vaccination, knowledge gaps were present. Emphasizing the importance of influenza as a health problem and addressing vaccine safety and efficacy concerns may improve uptake. Populations less amenable to vaccination, including those with higher education and income, may benefit from targeted messaging efforts.
Collapse
Affiliation(s)
- Karen K. Wong
- Centers for Disease ControlAtlantaGAUSA
- United States Public Health ServiceAtlantaGAUSA
| | - Adam L. Cohen
- Centers for Disease ControlAtlantaGAUSA
- United States Public Health ServiceAtlantaGAUSA
| | | | - Neil A. Martinson
- MRC Developmental Pathways for Health Research UnitUniversity of WitwatersrandJohannesburgSouth Africa
- Johns Hopkins UniversityBaltimoreMDUSA
| | - Claire von Mollendorf
- University of WitwatersrandJohannesburgSouth Africa
- National Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Stefano Tempia
- Centers for Disease ControlAtlantaGAUSA
- National Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Sibongile Walaza
- National Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Shabir A. Madhi
- University of WitwatersrandJohannesburgSouth Africa
- National Institute for Communicable DiseasesJohannesburgSouth Africa
| | - Meredith L. McMorrow
- Centers for Disease ControlAtlantaGAUSA
- United States Public Health ServiceAtlantaGAUSA
| | - Ebrahim Variava
- University of WitwatersrandJohannesburgSouth Africa
- Klerksdorp‐Tshepong Hospital ComplexKlerksdorpSouth Africa
| | | | - Cheryl Cohen
- University of WitwatersrandJohannesburgSouth Africa
- National Institute for Communicable DiseasesJohannesburgSouth Africa
| |
Collapse
|
31
|
Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions. Cochrane Database Syst Rev 2016; 2016:CD005187. [PMID: 27251461 PMCID: PMC8504984 DOI: 10.1002/14651858.cd005187.pub5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A systematic review found that 3% of working adults who had received influenza vaccine and 5% of those who were unvaccinated had laboratory-proven influenza per season; in healthcare workers (HCWs) these percentages were 5% and 8% respectively. Healthcare workers may transmit influenza to patients. OBJECTIVES To identify all randomised controlled trials (RCTs) and non-RCTs assessing the effects of vaccinating healthcare workers on the incidence of laboratory-proven influenza, pneumonia, death from pneumonia and admission to hospital for respiratory illness in those aged 60 years or older resident in long-term care institutions (LTCIs). SEARCH METHODS We searched CENTRAL (2015, Issue 9), MEDLINE (1966 to October week 3, 2015), EMBASE (1974 to October 2015) and Web of Science (2006 to October 2015), but Biological Abstracts only from 1969 to March 2013 and Science Citation Index-Expanded from 1974 to March 2013 due to lack of institutional access in 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) and non-RCTs of influenza vaccination of healthcare workers caring for individuals aged 60 years or older in LTCIs and the incidence of laboratory-proven influenza and its complications (lower respiratory tract infection, or hospitalisation or death due to lower respiratory tract infection) in individuals aged 60 years or older in LTCIs. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed risk of bias. Effects on dichotomous outcomes were measured as risk differences (RDs) with 95% confidence intervals (CIs). We assessed the quality of evidence with GRADE. MAIN RESULTS We identified four cluster-RCTs and one cohort study (n = 12,742) of influenza vaccination for HCWs caring for individuals ≥ 60 years in LTCIs. Four cluster RCTs (5896 residents) provided outcome data that addressed the objectives of our review. The studies were comparable in their study populations, intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition, lack of blinding, contamination in the control groups and low rates of vaccination coverage in the intervention arms, leading us to downgrade the quality of evidence for all outcomes due to serious risk of bias.Offering influenza vaccination to HCWs based in long term care homes may have little or no effect on the number of residents who develop laboratory-proven influenza compared with those living in care homes where no vaccination is offered (RD 0 (95% CI -0.03 to 0.03), two studies with samples taken from 752 participants; low quality evidence). HCW vaccination probably leads to a reduction in lower respiratory tract infection in residents from 6% to 4% (RD -0.02 (95% CI -0.04 to 0.01), one study of 3400 people; moderate quality evidence). HCW vaccination programmes may have little or no effect on the number of residents admitted to hospital for respiratory illness (RD 0 (95% CI -0.02 to 0.02, one study of 1059 people; low quality evidence). We decided not to combine data on deaths from lower respiratory tract infection (two studies of 4459 people) or all cause deaths (four studies of 8468 people). The direction and size of difference in risk varied between the studies. We are uncertain as to the effect of vaccination on these outcomes due to the very low quality of evidence. Adjusted analyses, which took into account the cluster design, did not differ substantively from the pooled analysis with unadjusted data. AUTHORS' CONCLUSIONS Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions. This review did not find information on co-interventions with healthcare worker vaccination: hand-washing, face masks, early detection of laboratory-proven influenza, quarantine, avoiding admissions, antivirals and asking healthcare workers with influenza or influenza-like illness (ILI) not to work. This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs. High quality RCTs are required to avoid the risks of bias in methodology and conduct identified by this review and to test further these interventions in combination.
Collapse
Affiliation(s)
- Roger E Thomas
- University of CalgaryDepartment of Family Medicine, Faculty of MedicineHealth Sciences Centre3330 Hospital Drive NWCalgaryABCanadaT2N 4N1
| | | | - Toby J Lasserson
- Cochrane Central ExecutiveCochrane Editorial UnitSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | | |
Collapse
|
32
|
Cheng PY, Palekar R, Azziz-Baumgartner E, Iuliano D, Alencar AP, Bresee J, Oliva O, de Souza MDFM, Widdowson MA. Burden of influenza-associated deaths in the Americas, 2002-2008. Influenza Other Respir Viruses 2016; 9 Suppl 1:13-21. [PMID: 26256291 PMCID: PMC4549098 DOI: 10.1111/irv.12317] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Influenza disease is a vaccine-preventable cause of morbidity and mortality. The Pan American Health Organization (PAHO) region has invested in influenza vaccines, but few estimates of influenza burden exist to justify these investments. We estimated influenza-associated deaths for 35 PAHO countries during 2002-2008. METHODS Annually, PAHO countries report registered deaths. We used respiratory and circulatory (R&C) codes from seven countries with distinct influenza seasonality and high-quality mortality data to estimate influenza-associated mortality rates by age group (0-64, 65-74, and ≥ 75 years) with a Serfling regression model or a negative binomial model. We calculated the percent of all R&C deaths attributable to influenza by age group in these countries (etiologic fraction) and applied it to the age-specific mortality in 13 countries with good mortality data but poorly defined seasonality. Lastly, we grouped the remaining 15 countries into WHO mortality strata and applied the age and mortality stratum-specific rate of influenza mortality calculated from the 20 countries. We summed each country's estimate to arrive at an average total annual number and rate of influenza deaths in the Americas. RESULTS For the 35 PAHO countries, we estimated an annual mean influenza-associated mortality rate of 2·1/100,000 among <65-year olds, 31·9/100 000 among those 65-74 years, and 161·8/100,000 among those ≥ 75 years. We estimated that annually between 40,880 and 160,270 persons (mean, 85,100) die of influenza illness in the PAHO region. CONCLUSION Influenza remains an important cause of mortality in the Americas.
Collapse
Affiliation(s)
- Po-Yung Cheng
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rakhee Palekar
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA.,Pan American Health Organization, Washington, DC, USA
| | | | - Danielle Iuliano
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Airlane P Alencar
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Joseph Bresee
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Otavio Oliva
- Pan American Health Organization, Washington, DC, USA
| | | | - Marc-Alain Widdowson
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
33
|
Park M, Wu P, Goldstein E, Joo Kim W, Cowling BJ. Influenza-Associated Excess Mortality in South Korea. Am J Prev Med 2016; 50:e111-e119. [PMID: 26610897 PMCID: PMC4805525 DOI: 10.1016/j.amepre.2015.09.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION It is important to determine the health impact of influenza in order to calibrate public health measures. The objective of this study was to estimate excess mortality associated with influenza in Korea in 2003-2013. METHODS The authors constructed multiple linear regression models in 2014 with weekly mortality rates stratified by age, region, and cause of death against weekly surveillance data on influenza virus collected in 2003-2013. Excess mortality rates were estimated using the difference between predicted mortality rates from the fitted model versus predicted mortality rates with the influenza covariate for each strain set to 0. RESULTS During the study period, influenza was associated with an average of 2,900 excess deaths per year. The impact of influenza on mortality was significantly higher in older people; the overall all-cause excess annual mortality rate per 100,000 people was 5.97 (95% CI=4.89, 7.19), whereas it was 46.98 (95% CI=36.40, 55.82) for adults aged ≥65 years. It also greatly varied from year to year, ranging from 2.04 in 2009-2010 to 18.76 in 2011-2012. CONCLUSIONS The impact of influenza on mortality in Korea is substantial, particularly among the elderly and the rural population. More-comprehensive studies may be needed to estimate the full impact of influenza.
Collapse
Affiliation(s)
- Minah Park
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Transgovernmental Enterprise for Pandemic Influenza in Korea (TEPIK), Seoul, Republic of Korea
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
34
|
Milne GJ, Halder N, Kelso JK, Barr IG, Moyes J, Kahn K, Twine R, Cohen C. Trivalent and quadrivalent influenza vaccination effectiveness in Australia and South Africa: results from a modelling study. Influenza Other Respir Viruses 2016; 10:324-32. [PMID: 26663701 PMCID: PMC4910176 DOI: 10.1111/irv.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A modelling study was conducted to determine the effectiveness of trivalent (TIV) and quadrivalent (QIV) vaccination in South Africa and Australia. OBJECTIVES This study aimed to determine the potential benefits of alternative vaccination strategies which may depend on community-specific demographic and health characteristics. METHODS Two influenza A and two influenza B strains were simulated using individual-based simulation models representing specific communities in South Africa and Australia over 11 years. Scenarios using TIV or QIV, with alternative prioritisation strategies and vaccine coverage levels, were evaluated using a country-specific health outcomes process. RESULTS In South Africa, approximately 18% fewer deaths and hospitalisations would be expected to result from the use of QIV compared to TIV over the 11 modelled years (P = 0·031). In Australia, only 2% (P = 0·30) fewer deaths and hospitalisations would result. Vaccinating 2%, 5%, 15% or 20% of the population with TIV using a strategy of prioritising vulnerable age groups, including HIV-positive individuals, resulted in reductions in hospitalisations and mortality of at least 7%, 18%, 57% and 66%, respectively, in both communities. CONCLUSIONS The degree to which QIV can reduce health burden compared to TIV is strongly dependent on the number of years in which the influenza B lineage in the TIV matches the circulating B lineages. Assuming a moderate level of B cross-strain protection, TIV may be as effective as QIV. The choice of vaccination prioritisation has a greater impact than the QIV/TIV choice, with strategies targeting those most responsible for transmission being most effective.
Collapse
Affiliation(s)
- George J Milne
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia
| | - Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia
| | - Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia
| | - Ian G Barr
- World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, Melbourne, Vic., Australia
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
35
|
Pretorius MA, Tempia S, Walaza S, Cohen AL, Moyes J, Variava E, Dawood H, Seleka M, Hellferscee O, Treurnicht F, Cohen C, Venter M. The role of influenza, RSV and other common respiratory viruses in severe acute respiratory infections and influenza-like illness in a population with a high HIV sero-prevalence, South Africa 2012-2015. J Clin Virol 2015; 75:21-6. [PMID: 26741826 DOI: 10.1016/j.jcv.2015.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Viruses detected in patients with acute respiratory infections may be the cause of illness or asymptomatic shedding. OBJECTIVE To estimate the attributable fraction (AF) and the detection rate attributable to illness for each of the different respiratory viruses STUDY DESIGN We compared the prevalence of 10 common respiratory viruses (influenza A and B viruses, parainfluenza virus 1-3; respiratory syncytial virus (RSV); adenovirus, rhinovirus, human metapneumovirus (hMPV) and enterovirus) in both HIV positive and negative patients hospitalized with severe acute respiratory illness (SARI), outpatients with influenza-like illness (ILI), and control subjects who did not report any febrile, respiratory or gastrointestinal illness during 2012-2015 in South Africa. RESULTS We enrolled 1959 SARI, 3784 ILI and 1793 controls with a HIV sero-prevalence of 26%, 30% and 43%, respectively. Influenza virus (AF: 86.3%; 95%CI: 77.7-91.6%), hMPV (AF: 85.6%; 95%CI: 72.0-92.6%), and RSV (AF: 83.7%; 95%CI: 77.5-88.2%) infections were associated with severe disease., while rhinovirus (AF: 46.9%; 95%CI: 37.6-56.5%) and adenovirus (AF: 36.4%; 95%CI: 20.6-49.0%) were only moderately associated. CONCLUSIONS Influenza, RSV and hMPV can be considered pathogens if detected in ILI and SARI while rhinovirus and adenovirus were commonly identified in controls suggesting that they may cause only a proportion of clinical disease observed in positive patients. Nonetheless, they may be important contributors to disease.
Collapse
Affiliation(s)
- Marthi A Pretorius
- National Health Laboratory Service, Tshwane Academic Division, South Africa; Department of Medical Virology, University of Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp Tshepong Hospital, Klerksdorp, South Africa; Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital, Pietermaritzburg, South Africa; Department of Medicine, University of KwaZulu Natal, South Africa
| | - Mpho Seleka
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Florette Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, South Africa; Global Disease Detection, Centers for Disease Control and Prevention, Pretoria, South Africa
| |
Collapse
|
36
|
Tempia S, Walaza S, Viboud C, Cohen AL, Madhi SA, Venter M, von Mollendorf C, Moyes J, McAnerney JM, Cohen C. Deaths associated with respiratory syncytial and influenza viruses among persons ≥5 years of age in HIV-prevalent area, South Africa, 1998-2009(1). Emerg Infect Dis 2015; 21:600-8. [PMID: 25811455 PMCID: PMC4378466 DOI: 10.3201/eid2104.141033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We estimated deaths attributable to influenza and respiratory syncytial virus (RSV) among persons >5 years of age in South Africa during 1998-2009 by applying regression models to monthly deaths and laboratory surveillance data. Rates were expressed per 100,000 person-years. The mean annual number of seasonal influenza-associated deaths was 9,093 (rate 21.6). Persons >65 years of age and HIV-positive persons accounted for 50% (n = 4,552) and 28% (n = 2,564) of overall seasonal influenza-associated deaths, respectively. In 2009, we estimated 4,113 (rate 9.2) influenza A(H1N1)pdm09-associated deaths. The mean of annual RSV-associated deaths during the study period was 511 (rate 1.2); no RSV-associated deaths were estimated in persons >45 years of age. Our findings support the recommendation for influenza vaccination of older persons and HIV-positive persons. Surveillance for RSV should be strengthened to clarify the public health implications and severity of illness associated with RSV infection in South Africa.
Collapse
|
37
|
McMorrow ML, Wemakoy EO, Tshilobo JK, Emukule GO, Mott JA, Njuguna H, Waiboci L, Heraud JM, Rajatonirina S, Razanajatovo NH, Chilombe M, Everett D, Heyderman RS, Barakat A, Nyatanyi T, Rukelibuga J, Cohen AL, Cohen C, Tempia S, Thomas J, Venter M, Mwakapeje E, Mponela M, Lutwama J, Duque J, Lafond K, Nzussouo NT, Williams T, Widdowson MA. Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries. J Infect Dis 2015; 212:853-60. [PMID: 25712970 PMCID: PMC4826902 DOI: 10.1093/infdis/jiv100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Data on causes of death due to respiratory illness in Africa are limited. METHODS From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)-associated deaths identified from influenza surveillance during 2009-2012. RESULTS Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%-25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%-5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus-negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0-4 years, 462 (43.1%) involved people aged 5-49 years, and 209 (19.5%) involved people aged ≥50 years. CONCLUSIONS Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.
Collapse
Affiliation(s)
- Meredith L. McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
- US Public Health Service, Rockville, Maryland
| | | | | | | | - Joshua A. Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
- US Public Health Service, Rockville, Maryland
- Centers for Disease Control and Prevention–Kenya, Nairobi
| | - Henry Njuguna
- Centers for Disease Control and Prevention–Kenya, Nairobi
| | - Lilian Waiboci
- Centers for Disease Control and Prevention–Kenya, Nairobi
| | | | | | | | - Moses Chilombe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Robert S. Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | | | - Thierry Nyatanyi
- Division of Epidemic Infectious Diseases, Rwanda Biomedical Center
| | | | - Adam L. Cohen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
- US Public Health Service, Rockville, Maryland
- Centers for Disease Control and Prevention–South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
- Centers for Disease Control and Prevention–South Africa
| | - Juno Thomas
- Outbreak Response Unit, National Institute for Communicable Diseases
| | - Marietjie Venter
- Centers for Disease Control and Prevention–South Africa
- Zoonoses Research Unit, Department of Medical Virology, University of Pretoria
- Centre for Respiratory Diseases and Meningitis
| | - Elibariki Mwakapeje
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Ministry of Health and Social Welfare–Tanzania
| | - Marcelina Mponela
- Ministry of Health and Social Welfare–Tanzania
- Centers for Disease Control and Prevention–Tanzania, Dar es Salaam
| | - Julius Lutwama
- Centers for Disease Control and Prevention–Tanzania, Dar es Salaam
- Uganda Virus Research Institute, Entebbe
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
- Battelle, Atlanta, Georgia
| | - Kathryn Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Thelma Williams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
| |
Collapse
|
38
|
Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999-2009. PLoS One 2015; 10:e0129173. [PMID: 26076197 PMCID: PMC4467974 DOI: 10.1371/journal.pone.0129173] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/05/2015] [Indexed: 11/25/2022] Open
Abstract
Background Published data on the interaction between influenza and pulmonary tuberculosis (PTB) are limited. We aimed to estimate the influenza-associated mortality among individuals with PTB in South Africa from 1999–2009. Methods We modelled the excess influenza-associated mortality by applying Poisson regression models to monthly PTB and non-tuberculosis respiratory deaths, using laboratory-confirmed influenza as a covariate. Results PTB deaths increased each winter, coinciding with influenza virus circulation. Among individuals of any age, mean annual influenza-associated PTB mortality rate was 164/100,000 person-years (n = 439). The rate of non-tuberculosis respiratory deaths was 27/100,000 (n = 1125) for HIV-infected and 5/100,000 (n = 2367) for HIV-uninfected individuals of all ages. Among individuals aged <65 years, influenza-associated PTB mortality risk was elevated compared to influenza-associated non-tuberculosis respiratory deaths in HIV-infected (relative risk (RR): 5.2; 95% CI: 4.6–5.9) and HIV-uninfected individuals (RR: 61.0; CI: 41.4–91.0). Among individuals aged ≥65 years, influenza-associated PTB mortality risk was elevated compared to influenza-associated non-tuberculosis respiratory deaths in HIV-uninfected individuals (RR: 13.0; 95% CI: 12.0–14.0). Conclusion We observed an increased risk of influenza-associated mortality in persons with PTB compared to non-tuberculosis respiratory deaths. If confirmed in other settings, our findings may support recommendations for active inclusion of patients with TB for influenza vaccination and empiric influenza anti-viral treatment of patients with TB during influenza epidemics.
Collapse
|
39
|
Foppa IM, Cheng PY, Reynolds SB, Shay DK, Carias C, Bresee JS, Kim IK, Gambhir M, Fry AM. Deaths averted by influenza vaccination in the U.S. during the seasons 2005/06 through 2013/14. Vaccine 2015; 33:3003-9. [PMID: 25812842 PMCID: PMC4834450 DOI: 10.1016/j.vaccine.2015.02.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Excess mortality due to seasonal influenza is substantial, yet quantitative estimates of the benefit of annual vaccination programs on influenza-associated mortality are lacking. METHODS We estimated the numbers of deaths averted by vaccination in four age groups (0.5 to 4, 5 to 19, 20 to 64 and ≥65 yrs.) for the nine influenza seasons from 2005/6 through 2013/14. These estimates were obtained using a Monte Carlo approach applied to weekly U.S. age group-specific estimates of influenza-associated excess mortality, monthly vaccination coverage estimates and summary seasonal influenza vaccine effectiveness estimates to obtain estimates of the number of deaths averted by vaccination. The estimates are conservative as they do not include indirect vaccination effects. RESULTS From August, 2005 through June, 2014, we estimated that 40,127 (95% confidence interval [CI] 25,694 to 59,210) deaths were averted by influenza vaccination. We found that of all studied seasons the most deaths were averted by influenza vaccination during the 2012/13 season (9398; 95% CI 2,386 to 19,897) and the fewest during the 2009/10 pandemic (222; 95% CI 79 to 347). Of all influenza-associated deaths averted, 88.9% (95% CI 83 to 92.5%) were in people ≥65 yrs. old. CONCLUSIONS The estimated number of deaths averted by the US annual influenza vaccination program is considerable, especially among elderly adults and even when vaccine effectiveness is modest, such as in the 2012/13 season. As indirect effects ("herd immunity") of vaccination are ignored, these estimates represent lower bound estimates and are thus conservative given valid excess mortality estimates.
Collapse
Affiliation(s)
- Ivo M Foppa
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA; Battelle Memorial Institute, Atlanta, GA, USA.
| | - Po-Yung Cheng
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA; Battelle Memorial Institute, Atlanta, GA, USA
| | - Sue B Reynolds
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA; Atlanta Research and Education Foundation, GA, USA
| | - David K Shay
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA
| | - Cristina Carias
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; IHRC.Inc, Atlanta, GA, USA
| | - Joseph S Bresee
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA
| | - Inkyu K Kim
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA; Battelle Memorial Institute, Atlanta, GA, USA
| | - Manoj Gambhir
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-20, Atlanta, 30333 GA, USA
| |
Collapse
|
40
|
Cooper BS, Kotirum S, Kulpeng W, Praditsitthikorn N, Chittaganpitch M, Limmathurotsakul D, Day NPJ, Coker R, Teerawattananon Y, Meeyai A. Mortality attributable to seasonal influenza A and B infections in Thailand, 2005-2009: a longitudinal study. Am J Epidemiol 2015; 181:898-907. [PMID: 25899091 PMCID: PMC4445392 DOI: 10.1093/aje/kwu360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022] Open
Abstract
Influenza epidemiology differs substantially in tropical and temperate zones, but estimates of seasonal influenza mortality in developing countries in the tropics are lacking. We aimed to quantify mortality due to seasonal influenza in Thailand, a tropical middle-income country. Time series of polymerase chain reaction–confirmed influenza infections between 2005 and 2009 were constructed from a sentinel surveillance network. These were combined with influenza-like illness data to derive measures of influenza activity and relationships to mortality by using a Bayesian regression framework. We estimated 6.1 (95% credible interval: 0.5, 12.4) annual deaths per 100,000 population attributable to influenza A and B, predominantly in those aged ≥60 years, with the largest contribution from influenza A(H1N1) in 3 out of 4 years. For A(H3N2), the relationship between influenza activity and mortality varied over time. Influenza was associated with increases in deaths classified as resulting from respiratory disease (posterior probability of positive association, 99.8%), cancer (98.6%), renal disease (98.0%), and liver disease (99.2%). No association with circulatory disease mortality was found. Seasonal influenza infections are associated with substantial mortality in Thailand, but evidence for the strong relationship between influenza activity and circulatory disease mortality reported in temperate countries is lacking.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Aronrag Meeyai
- Correspondence to Dr. Aronrag Meeyai, Department of Epidemiology, Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Road, Bangkok 10400, Thailand (e-mail: )
| |
Collapse
|
41
|
Budgell E, Cohen AL, McAnerney J, Walaza S, Madhi SA, Blumberg L, Dawood H, Kahn K, Tempia S, Venter M, Cohen C. Evaluation of two influenza surveillance systems in South Africa. PLoS One 2015; 10:e0120226. [PMID: 25822719 PMCID: PMC4379032 DOI: 10.1371/journal.pone.0120226] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organisation recommends outpatient influenza-like illness (ILI) and inpatient severe acute respiratory illness (SARI) surveillance. We evaluated two influenza surveillance systems in South Africa: one for ILI and another for SARI. METHODOLOGY The Viral Watch (VW) programme has collected virological influenza surveillance data voluntarily from patients with ILI since 1984 in private and public clinics in all 9 South African provinces. The SARI surveillance programme has collected epidemiological and virological influenza surveillance data since 2009 in public hospitals in 4 provinces by dedicated personnel. We compared nine surveillance system attributes from 2009-2012. RESULTS We analysed data from 18,293 SARI patients and 9,104 ILI patients. The annual proportion of samples testing positive for influenza was higher for VW (mean 41%) than SARI (mean 8%) and generally exceeded the seasonal threshold from May to September (VW: weeks 21-40; SARI: weeks 23-39). Data quality was a major strength of SARI (most data completion measures >90%; adherence to definitions: 88-89%) and a relative weakness of the VW programme (62% of forms complete, with limited epidemiologic data collected; adherence to definitions: 65-82%). Timeliness was a relative strength of both systems (e.g. both collected >93% of all respiratory specimens within 7 days of symptom onset). ILI surveillance was more nationally representative, financially sustainable and expandable than the SARI system. Though the SARI programme is not nationally representative, the high quality and detail of SARI data collection sheds light on the local burden and epidemiology of severe influenza-associated disease. CONCLUSIONS To best monitor influenza in South Africa, we propose that both ILI and SARI should be under surveillance. Improving ILI surveillance will require better quality and more systematic data collection, and SARI surveillance should be expanded to be more nationally representative, even if this requires scaling back on information gathered.
Collapse
Affiliation(s)
- Eric Budgell
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States and Influenza Program, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Jo McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Shabir A. Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine-Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucille Blumberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital Complex and University of KwaZulu Natal, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, United States and Influenza Program, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
- CTS Global, Inc., Los Angeles, United States of America
| | - Marietjie Venter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- Zoonoses Research Unit, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
- Schools of Public Health and Pathology, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
42
|
Cohen C, Moyes J, Tempia S, Groome M, Walaza S, Pretorius M, Dawood H, Chhagan M, Haffejee S, Variava E, Kahn K, von Gottberg A, Wolter N, Cohen AL, Malope-Kgokong B, Venter M, Madhi SA. Mortality amongst patients with influenza-associated severe acute respiratory illness, South Africa, 2009-2013. PLoS One 2015; 10:e0118884. [PMID: 25786103 PMCID: PMC4365037 DOI: 10.1371/journal.pone.0118884] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths. METHODS Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009-2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population. RESULTS We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45-64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01-16.3) and ≥65 years (OR 6.5, 95%CI 1.2-34.3) compared to 1-4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1-7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2-7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5-11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1-31.3) and adults aged 45-64 years (10.4, 95%CI 8.4-12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0-27.8) higher in HIV-infected individuals than HIV-uninfected individuals. CONCLUSION Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
Collapse
Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Michelle Groome
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand; Johannesburg; South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marthi Pretorius
- Zoonosis Research Unit, Department of Medical Virology, University of Pretoria
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital, Pietermaritzburg, South Africa
- Department of Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Meera Chhagan
- Department of Paediatrics, University of KwaZulu Natal, Durban, South Africa
| | - Summaya Haffejee
- School of Pathology, University of KwaZulu Natal, Durban, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp Tshepong Hospital
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Babatyi Malope-Kgokong
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marietjie Venter
- Zoonosis Research Unit, Department of Medical Virology, University of Pretoria
- Global Disease Detection, United States Centers for Disease Control and Prevention—South Africa, Pretoria, South Africa
| | - Shabir A. Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; University of the Witwatersrand; Johannesburg; South Africa
| |
Collapse
|
43
|
Cohen AL, Hellferscee O, Pretorius M, Treurnicht F, Walaza S, Madhi S, Groome M, Dawood H, Variava E, Kahn K, Wolter N, von Gottberg A, Tempia S, Venter M, Cohen C. Epidemiology of influenza virus types and subtypes in South Africa, 2009-2012. Emerg Infect Dis 2015; 20:1162-9. [PMID: 24960314 PMCID: PMC4073865 DOI: 10.3201/eid2007.131869] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patient age and co-infections, but not disease severity, were associated with virus
type and subtype. To determine clinical and epidemiologic differences between influenza caused by
different virus types and subtypes, we identified patients and tested specimens.
Patients were children and adults hospitalized with confirmed influenza and severe
acute respiratory illness (SARI) identified through active, prospective,
hospital-based surveillance from 2009–2012 in South Africa. Respiratory
specimens were tested, typed, and subtyped for influenza virus by PCR. Of 16,005 SARI
patients tested, 1,239 (8%) were positive for influenza virus. Patient age and
co-infections varied according to virus type and subtype, but disease severity did
not. Case-patients with influenza B were more likely than patients with influenza A
to be HIV infected. A higher proportion of case-patients infected during the first
wave of the 2009 influenza pandemic were 5–24 years of age (19%) than were
patients infected during the second wave (9%). Although clinical differences exist,
treatment recommendations do not differ according to subtype; prevention through
vaccination is recommended.
Collapse
|
44
|
Ortiz JR, Neuzil KM, Cooke CR, Neradilek MB, Goss CH, Shay DK. Influenza pneumonia surveillance among hospitalized adults may underestimate the burden of severe influenza disease. PLoS One 2014; 9:e113903. [PMID: 25423025 PMCID: PMC4244176 DOI: 10.1371/journal.pone.0113903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/02/2014] [Indexed: 01/10/2023] Open
Abstract
Background Studies seeking to estimate the burden of influenza among hospitalized adults often use case definitions that require presence of pneumonia. The goal of this study was to assess the extent to which restricting influenza testing to adults hospitalized with pneumonia could underestimate the total burden of hospitalized influenza disease. Methods We conducted a modelling study using the complete State Inpatient Databases from Arizona, California, and Washington and regional influenza surveillance data acquired from CDC from January 2003 through March 2009. The exposures of interest were positive laboratory tests for influenza A (H1N1), influenza A (H3N2), and influenza B from two contiguous US Federal Regions encompassing the study area. We identified the two outcomes of interest by ICD-9-CM code: respiratory and circulatory hospitalizations, as well as critical illness hospitalizations (acute respiratory failure, severe sepsis, and in-hospital death). We linked the hospitalization datasets with the virus surveillance datasets by geographic region and month of hospitalization. We used negative binomial regression models to estimate the number of influenza-associated events for the outcomes of interest. We sub-categorized these events to include all outcomes with or without pneumonia diagnosis codes. Results We estimated that there were 80,834 (95% CI 29,214–174,033) influenza-associated respiratory and circulatory hospitalizations and 26,760 (95% CI 14,541–47,464) influenza-associated critical illness hospitalizations. When a pneumonia diagnosis was excluded, the estimated number of influenza-associated respiratory and circulatory hospitalizations was 24,816 (95% CI 6,342–92,624). The estimated number of influenza-associated critical illness hospitalizations was 8,213 (95% CI 3,764–20,799). Around 30% of both influenza-associated respiratory and circulatory hospitalizations, as well as influenza-associated critical illness hospitalizations did not have pneumonia diagnosis codes. Conclusions Surveillance studies which only consider hospitalizations that include a diagnosis of pneumonia may underestimate the total burden of influenza hospitalizations.
Collapse
Affiliation(s)
- Justin R. Ortiz
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Vaccine Access and Delivery Global Program, PATH, Seattle, Washington, United States of America
- * E-mail:
| | - Kathleen M. Neuzil
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Vaccine Access and Delivery Global Program, PATH, Seattle, Washington, United States of America
| | - Colin R. Cooke
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, Seattle, Washington, United States of America
| | - Christopher H. Goss
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - David K. Shay
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
45
|
Are influenza-associated morbidity and mortality estimates for those ≥ 65 in statistical databases accurate, and an appropriate test of influenza vaccine effectiveness? Vaccine 2014; 32:6884-6901. [PMID: 25454864 DOI: 10.1016/j.vaccine.2014.08.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/14/2014] [Accepted: 08/27/2014] [Indexed: 11/22/2022]
Abstract
PURPOSES To assess the accuracy of estimates using statistical databases of influenza-associated morbidity and mortality, and precisely measure influenza vaccine effectiveness. PRINCIPAL RESULTS Laboratory testing of influenza is incomplete. Death certificates under-report influenza. Statistical database models are used as an alternative to randomised controlled trials (RCTs) to assess influenza vaccine effectiveness. Evidence of the accuracy of influenza morbidity and mortality estimates was sought from: (1) Studies comparing statistical models. For four studies Poisson and ARIMA models produced higher estimates than Serfling, and Serfling higher than GLM. Which model is more accurate is unknown. (2) Studies controlling confounders. Fourteen studies mostly controlled one confounder (one controlled comorbidities), and limited control of confounders limits accuracy. EVIDENCE FOR VACCINE EFFECTIVENESS WAS SOUGHT FROM (1) Studies of regions with increasing vaccination rates. Of five studies two controlled for confounders and one found a positive vaccination effect. Three studies did not control confounders and two found no effect of vaccination. (2) Studies controlling multiple confounders. Of thirteen studies only two found a positive vaccine effect and no mortality differences between vaccinees and non-vaccinees in non-influenza seasons, showing confounders were controlled. Key problems are insufficient testing for influenza, using influenza-like illness, heterogeneity of seasonal and pandemic influenza, population aging, and incomplete confounder control (co-morbidities, frailty, vaccination history) and failure to demonstrate control of confounders by proving no mortality differences between vaccinees and non-vaccinees in non-influenza seasons. MAJOR CONCLUSIONS Improving model accuracy requires proof of no mortality differences in pre-influenza periods between the vaccinated and non-vaccinated groups, and reduction in influenza morbidity and mortality in seasons with a good vaccine match, more virulent strains, in the younger elderly with less immune senescence, and specific outcomes (laboratory-confirmed outcomes, pneumonia deaths). Proving influenza vaccine effectiveness requires appropriately powered RCTs, testing participants with RT-PCR tests, and comprehensively monitoring morbidity and mortality.
Collapse
|
46
|
Widdowson MA, Iuliano AD, Dawood FS. Challenges to global pandemic mortality estimation. THE LANCET. INFECTIOUS DISEASES 2014; 14:670-672. [PMID: 25056013 DOI: 10.1016/s1473-3099(14)70835-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, 30333 GA, USA.
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, 30333 GA, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, 30333 GA, USA
| |
Collapse
|
47
|
Ortiz JR, Jacob ST, West TE. Clinical care for severe influenza and other severe illness in resource-limited settings: the need for evidence and guidelines. Influenza Other Respir Viruses 2014; 7 Suppl 2:87-92. [PMID: 24034491 PMCID: PMC5909399 DOI: 10.1111/irv.12086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The 2009 influenza A (H1N1) pandemic highlighted the importance of quality hospital care of the severely ill, yet there is evidence that the impact of the 2009 pandemic was highest in low‐ and middle‐income countries with fewer resources. Recent data indicate that death and suffering from seasonal influenza and severe illness in general are increased in resource‐limited settings. However, there are limited clinical data and guidelines for the management of influenza and other severe illness in these settings. Life‐saving supportive care through syndromic case management is used successfully in high‐resource intensive care units and in global programs such as the Integrated Management of Childhood Illness (IMCI). While there are a variety of challenges to the management of the severely ill in resource‐limited settings, several new international initiatives have begun to develop syndromic management strategies for these environments, including the World Health Organization's Integrated Management of Adult and Adolescent Illness Program. These standardized clinical guidelines emphasize syndromic case management and do not require high‐resource intensive care units. These efforts must be enhanced by quality clinical research to provide missing evidence and to refine recommendations, which must be carefully integrated into existing healthcare systems. Realizing a sustainable, global impact on death and suffering due to severe influenza and other severe illness necessitates an ongoing and concerted international effort to iteratively generate, implement, and evaluate best‐practice management guidelines for use in resource‐limited settings.
Collapse
Affiliation(s)
- Justin R Ortiz
- International Respiratory and Severe Illness Center (INTERSECT), University of Washington, Seattle, WA, USA
| | | | | |
Collapse
|
48
|
Tempia S, Walaza S, Viboud C, Cohen AL, Madhi SA, Venter M, McAnerney JM, Cohen C. Mortality associated with seasonal and pandemic influenza and respiratory syncytial virus among children <5 years of age in a high HIV prevalence setting--South Africa, 1998-2009. Clin Infect Dis 2014; 58:1241-9. [PMID: 24567249 DOI: 10.1093/cid/ciu095] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There are few published data describing the mortality burden associated with influenza and respiratory syncytial virus (RSV) infection in children in low- and middle-income countries and particularly from Africa and settings with high prevalence of human immunodeficiency virus (HIV). METHODS We modeled the excess mortality attributable to influenza (seasonal and pandemic) and RSV infection by applying Poisson regression models to monthly all-respiratory and pneumonia and influenza deaths, using national influenza and RSV laboratory surveillance data as covariates. In addition, we estimated the seasonal influenza- and RSV-associated deaths among HIV-infected and -uninfected children using Poisson regression models that incorporated HIV prevalence and highly active antiretroviral therapy coverage as covariates. RESULTS In children <5 years of age, the mean annual numbers of seasonal influenza- and RSV-associated all-respiratory deaths were 452 (8 per 100 000 person-years [PY]) and 546 (10 per 100 000 PY), respectively. Infants <1 year of age experienced higher mortality rates compared with children 1-4 years of age for both influenza (22 vs 5 per 100 000 PY) and RSV (35 vs 4 per 100 000 PY). HIV-infected compared with HIV-uninfected children <5 years of age were at increased risk of death associated with influenza (age-adjusted relative risk [aRR], 11.5; 95% confidence interval [CI], 9.6-12.6) and RSV (aRR, 8.1; 95% CI, 6.9-9.3) infection. In 2009, we estimated 549 (11 per 100 000 PY) all-respiratory influenza A(H1N1)pdm09-associated deaths among children aged <5 years. CONCLUSIONS Our findings support increased research efforts to guide and prioritize interventions such as influenza vaccination and HIV prevention in low- and middle-income countries with high HIV prevalence such as South Africa.
Collapse
Affiliation(s)
- Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Duque J, McMorrow ML, Cohen AL. Influenza vaccines and influenza antiviral drugs in Africa: are they available and do guidelines for their use exist? BMC Public Health 2014; 14:41. [PMID: 24433304 PMCID: PMC3898391 DOI: 10.1186/1471-2458-14-41] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/08/2014] [Indexed: 11/25/2022] Open
Abstract
Background Influenza viruses cause significant morbidity and mortality in Africa, particularly among high-risk groups, but influenza vaccines and antiviral drugs may not be commonly available and used. The main aim of this study was to determine the availability and use of influenza vaccines and antiviral drugs as well as to describe existing related guidelines and policies in Africa. Methods A self-administered survey was distributed among key influenza experts in 40 African countries. Results Of the 40 countries surveyed, 31 (78%) responded; 14/31 (45%) reported availability of seasonal influenza vaccine, and 19/31 (65%) reported availability of antiviral drugs for the treatment of influenza. Vaccine coverage data were only available for 4/14 (29%) countries that reported availability of seasonal influenza vaccine and ranged from <0.5% to 2% of the population. Conclusions Influenza vaccines and antiviral drugs are available in many countries in Africa but coverage estimates are low and remain largely unknown. Describing the local burden of disease and identifying funding are essential to encourage countries to use influenza vaccine more widely.
Collapse
Affiliation(s)
- Jazmin Duque
- International Epidemiology and Research Team, Epidemiology Branch, Influenza Division, U,S, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS-A32, Atlanta, GA 30333, USA.
| | | | | |
Collapse
|
50
|
Wang H, Fu C, Li K, Lu J, Chen Y, Lu E, Xiao X, Di B, Liu H, Yang Z, Wang M. Influenza associated mortality in Southern China, 2010-2012. Vaccine 2013; 32:973-8. [PMID: 24370709 DOI: 10.1016/j.vaccine.2013.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/04/2013] [Accepted: 12/10/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Influenza caused substantial morbidity and mortality worldwide. The mortality burden caused by influenza has been under evaluation; however, data assessing this burden have been relatively sparse in tropical or subtropical regions. We estimated influenza-associated mortality in Guangzhou, China and assessed the excess mortality due to different influenza virus subtypes. METHODS We estimated influenza-associated excess mortality due to all-cause, pneumonia and influenza, cardiorespiratory disease and other influenza-associated diagnoses from weekly numbers of deaths and influenza surveillance data through negative binomial regression model during 2010-2012. RESULTS Estimates derived from the model indicated that influenza resulted in 14.72 (95% confidence interval (CI), 12.12-17.31) deaths per 100,000 population per year from all-cause death among all ages group. Most deaths (84.2%) occurred among people aged ≥65 years. B virus caused 5.84 (95%CI, 4.10-7.58) deaths per 100,000 population for all-cause death, which was higher than A (H3N2) (4.89, 95%CI, 3.19-6.59) or A(H1N1)pdm09 (3.99, 95%CI, 2.32-5.66). CONCLUSIONS Influenza is responsible for a substantial mortality especially among people aged ≥65 years and influenza B virus caused the highest influenza-associated mortality. The results highlight the need for seasonal influenza vaccination programs in subtropical areas to decrease excess mortality.
Collapse
Affiliation(s)
- Hui Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Chuanxi Fu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Kuibiao Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jianyun Lu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yiyun Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Enjie Lu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Xincai Xiao
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Biao Di
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huazhang Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Ming Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
| |
Collapse
|