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Wan Puteh SE, Aazmi MS, Aziz MN, Kamarudin N‘A, Sam JIC, Thayan R, Wan Mahiyuddin WR, Wan Mohamed Noor WN, Cheong A, El Guerche-Séblain C, Khor J, Zamri EN, Lam JY, Sekawi Z. Cross-sectional study of influenza trends and costs in Malaysia between 2016 and 2018. PLoS One 2024; 19:e0301068. [PMID: 38517867 PMCID: PMC10959333 DOI: 10.1371/journal.pone.0301068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES While influenza circulates year-round in Malaysia, research data on its incidence is scarce. Yet, this information is vital to the improvement of public health through evidence-based policies. In this cross-sectional study, we aimed to determine the trends and financial costs of influenza. METHODS Data for the years 2016 through 2018 were gathered retrospectively from several sources. These were existing Ministry of Health (MOH) influenza sentinel sites data, two teaching hospitals, and two private medical institutions in the Klang Valley, Malaysia. Expert consensus determined the final estimates of burden for laboratory-confirmed influenza-like illness (ILI) and severe acute respiratory infection (SARI). Economic burden was estimated separately using secondary data supplemented by MOH casemix costing. RESULTS Altogether, data for 11,652 cases of ILI and 5,764 cases of SARI were extracted. The influenza B subtype was found to be predominant in 2016, while influenza A was more prevalent in 2017 and 2018. The distribution timeline revealed that the highest frequency of cases occurred in March and April of all three years. The costs of influenza amounted to MYR 310.9 million over the full three-year period. CONCLUSIONS The study provides valuable insights into the dynamic landscape of influenza in Malaysia. The findings reveal a consistent year-round presence of influenza with irregular seasonal peaks, including a notable influenza A epidemic in 2017 and consistent surges in influenza B incidence during March across three years. These findings underscore the significance of continuous monitoring influenza subtypes for informed healthcare strategies as well as advocate for the integration of influenza vaccination into Malaysia's national immunization program, enhancing overall pandemic preparedness.
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Affiliation(s)
- Sharifa Ezat Wan Puteh
- Department of Community Health, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Shafiq Aazmi
- School of Biology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | | | - Noor ‘Adilah Kamarudin
- Department of Community Health, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jamal I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ravindran Thayan
- Infectious Disease Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Wan Rozita Wan Mahiyuddin
- Environmental Health Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | | | | | - Jean Khor
- Medical Department, Sanofi, Petaling Jaya, Malaysia
| | - Eva Nabiha Zamri
- Infectious Disease Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Jia-Yong Lam
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zamberi Sekawi
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Rachmat A, Kelly GC, Tran LK, Christy N, Supaprom C, Heang V, Dul S, Garcia-Rivera JA, Prom S, Sopheab H, Brooks JS, Sutherland IJ, Corson KS, Letizia AG. Clinical Presentation, Risk Factors, and Comparison of Laboratory Diagnostics for Seasonal Influenza Virus Among Cambodians From 2007 to 2020. Open Forum Infect Dis 2024; 11:ofae062. [PMID: 38524221 PMCID: PMC10960604 DOI: 10.1093/ofid/ofae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background Despite its global significance, challenges associated with understanding the epidemiology and accurately detecting, measuring, and characterizing the true burden of seasonal influenza remain in many resource-poor settings. Methods A prospective observational study was conducted in Cambodia at 28 health facilities between 2007 and 2020 utilizing passive surveillance data of patients presenting with acute undifferentiated febrile illness (AUFI) to describe the prevalence of influenza A and B and characterize associated risk factors and symptoms using a questionnaire. A comparison of rapid influenza diagnostic tests (RIDTs) and real-time reverse transcription polymerase chain reaction (rRT-PCR) results was also conducted. Results Of 30 586 total participants, 5634 (18.4%) tested positive for either influenza A or B, with 3557 (11.6%) positive for influenza A and 2288 (7.5%) positive for influenza B during the study. Influenza A and B were strongly associated with the rainy season (odds ratio [OR], 2.30; P < .001) and being from an urban area (OR, 1.45; P < .001). Analysis of individual symptoms identified cough (OR, 2.8; P < .001), chills (OR, 1.4; P < .001), and sore throat (OR, 1.4; P < .001) as having the strongest positive associations with influenza among patients with AUFI. Analysis comparing RIDTs and rRT-PCR calculated the overall sensitivity of rapid tests to be 0.492 (95% CI, 0.479-0.505) and specificity to be 0.993 (95% CI, 0.992-0.994) for both influenza type A and B. Conclusions Findings from this 14-year study include describing the epidemiology of seasonal influenza over a prolonged time period and identifying key risk factors and clinical symptoms associated with infection; we also demonstrate the poor sensitivity of RIDTs in Cambodia.
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Affiliation(s)
- Agus Rachmat
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | | | | | | | - Chonthida Supaprom
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | - Vireak Heang
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | - Sokha Dul
- AC Investment Co, contractor for NAMRU INDO PACIFIC, Phnom Penh, Cambodia
| | | | - Satharath Prom
- Department of Health, Ministry of National Defense, Phnom Penh, Cambodia
| | - Heng Sopheab
- National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
| | - John S Brooks
- US Naval Medical Research Unit INDO PACIFIC, Cambodia
| | | | - Karen S Corson
- US Naval Medical Research Unit INDO PACIFIC, Singapore
- US Naval Medical Research Unit INDO PACIFIC, Cambodia
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Mad Tahir NS, Ismail A, Aljunid SM, Abdul Aziz AF, Azzeri A, Alkhodary AA. Estimating the economic burden of influenza on the older population in Malaysia. PLoS One 2023; 18:e0294260. [PMID: 37971972 PMCID: PMC10653489 DOI: 10.1371/journal.pone.0294260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Influenza is a contagious respiratory illness that can cause life-threatening complications among high-risk groups. Estimating the economic burden of influenza is essential to guide policy-making on influenza vaccination programmes, especially in resource-limited settings. This study aimed to estimate the economic burden of influenza on older adults (those aged ≥60 years) in Malaysia from the provider's perspective. METHODS The main data source in this study was the MY-DRG Casemix database of a teaching hospital in Malaysia. Cases with principal and secondary diagnoses coded in the International Classification of Diseases version 10 (ICD-10) as J09, J10.0, J10.1, J10.8, J11.0, J11.1, J11.8, J12.8, and J12.9, which represent influenza and its complications, were included in the study. The direct cost of influenza at all severity levels was calculated from the casemix data and guided by a clinical pathway developed by experts. The effect of the variations in costs and incidence rate of influenza for both the casemix and clinical pathway costing approaches was assessed with sensitivity analysis. RESULTS A total of 1,599 inpatient and 407 outpatient influenza cases were identified from the MY-DRG Casemix database. Most hospitalised cases were aged <18 years (90.6%), while 77 cases (4.8%) involved older people. Mild, moderate, and severe cases comprised 56.5%, 35.1%, and 8.4% of cases, respectively. The estimated average annual direct costs for managing mild, moderate, and severe influenza were RM2,435 (USD579), RM6,504 (USD1,549), and RM13,282 (USD3,163), respectively. The estimated total annual economic burden of influenza on older adults in Malaysia was RM3.28 billion (USD782 million), which was equivalent to 10.7% of the Ministry of Health Malaysia budget for 2020. The sensitivity analysis indicated that the influenza incidence rate and cost of managing severe influenza were the most important factors influencing the total economic burden. CONCLUSIONS Overall, our results demonstrated that influenza imposes a substantial economic burden on the older Malaysian population. The high cost of influenza suggested that further efforts are required to implement a preventive programme, such as immunisation for older people, to reduce the disease and economic burdens.
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Affiliation(s)
- Nur Syazana Mad Tahir
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Aniza Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Department of Public Health and Community Medicine, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Amirah Azzeri
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia
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Ranjan Wijesinghe P, Sharma D, Vaishnav B, Mukherjee R, Pawar P, Mohapatra A, Buddha N, Ceniza Salvador E, Kakkar M. An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region. Front Public Health 2023; 11:1127891. [PMID: 37139386 PMCID: PMC10149947 DOI: 10.3389/fpubh.2023.1127891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research. Methods We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer. Findings We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization. Interpretation While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.
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Affiliation(s)
- Pushpa Ranjan Wijesinghe
- World Health Organization, Regional Office for South-East Asia, World Health House, New Delhi, India
| | - Divita Sharma
- Executive Office, Generating Research Insights for Development Council (GRID Council), Noida, Uttar Pradesh, India
| | - Bharathi Vaishnav
- Executive Office, Generating Research Insights for Development Council (GRID Council), Noida, Uttar Pradesh, India
| | - Ritika Mukherjee
- Executive Office, Generating Research Insights for Development Council (GRID Council), Noida, Uttar Pradesh, India
| | - Priyanka Pawar
- Executive Office, Generating Research Insights for Development Council (GRID Council), Noida, Uttar Pradesh, India
| | - Archisman Mohapatra
- Executive Office, Generating Research Insights for Development Council (GRID Council), Noida, Uttar Pradesh, India
| | - Nilesh Buddha
- World Health Organization, Regional Office for South-East Asia, World Health House, New Delhi, India
| | - Edwin Ceniza Salvador
- World Health Organization, Regional Office for South-East Asia, World Health House, New Delhi, India
| | - Manish Kakkar
- World Health Organization, Regional Office for South-East Asia, World Health House, New Delhi, India
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Influenza epidemiology and burden of disease in Mongolia, 2013-2014 to 2017-2018. Western Pac Surveill Response J 2021; 12:28-37. [PMID: 34540309 PMCID: PMC8421741 DOI: 10.5365/wpsar.2020.11.4.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Mongolia is a vast, sparsely populated country in central Asia. Its harsh climate and nomadic lifestyle make the population vulnerable to acute respiratory infections, particularly influenza. Evidence on the morbidity, mortality and socioeconomic impact of influenza in Mongolia is scarce; however, routine surveillance for influenza-like illness (ILI), severe acute respiratory infection (SARI) and laboratory-detected influenza is conducted. This paper describes the epidemiology of influenza and the estimated burden of influenza-associated illness in Mongolia in the five influenza seasons between 2013–2014 and 2017–2018. Methods Demographic and laboratory data from 152 sentinel surveillance sites on all patients who met the case definitions of ILI and SARI between October 2013 and May 2018 were extracted and analysed as described in A Manual for Estimating Disease Burden Associated with Seasonal Influenza. Results The estimated annual influenza-associated ILI and SARI rates, presented as ranges, were 1279–2798 and 81–666 cases per 100 000 population, respectively. Children aged < 5 years accounted for 67% of all ILI cases and 79% of all SARI cases. The annual specimen positivity for influenza was highest (11–30% for ILI and 8–31% for SARI) for children aged 5– < 15 years and children < 2 years old, respectively. The annual mortality rate due to pneumonia and SARI was highest among children aged < 2 years (15.8–54.0 per 100 000 population). Although the incidence of influenza-associated ILI and SARI was lowest for people aged 365 years, the mortality rate due to pneumonia and SARI (1.2–5.1 per 100 000) was higher than that for those aged 15–64 years. Conclusion The estimated influenza-associated ILI and SARI incidence rates are high in Mongolia, and children, especially those aged < 5 years, have the highest influenza-associated burden in Mongolia. These findings provide evidence for decision-makers in Mongolia to consider targeted influenza vaccination, particularly for children.
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Pang YK, Ismail AI, Chan YF, Cheong A, Chong YM, Doshi P, Lau JZH, Khor J, Wang LPL, Leong CL, Musa AN, Ng KS, Poh ME, Sam IC, Tan JL, Zim MAM, Taurel AF. Influenza in Malaysian adult patients hospitalized with community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease or asthma: a multicenter, active surveillance study. BMC Infect Dis 2021; 21:644. [PMID: 34225647 PMCID: PMC8256617 DOI: 10.1186/s12879-021-06360-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/18/2021] [Indexed: 01/07/2023] Open
Abstract
Background Available data on influenza burden across Southeast Asia are largely limited to pediatric populations, with inconsistent findings. Methods We conducted a multicenter, hospital-based active surveillance study of adults in Malaysia with community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute exacerbation of asthma (AEBA), who had influenza-like illness ≤10 days before hospitalization. We estimated the rate of laboratory-confirmed influenza and associated complications over 13 months (July 2018–August 2019) and described the distribution of causative influenza strains. We evaluated predictors of laboratory-confirmed influenza and severe clinical outcomes using multivariate analysis. Results Of 1106 included patients, 114 (10.3%) were influenza-positive; most were influenza A (85.1%), with A/H1N1pdm09 being the predominant circulating strain during the study following a shift from A/H3N2 from January–February 2019 onwards. In multivariate analyses, an absence of comorbidities (none versus any comorbidity [OR (95%CI), 0.565 (0.329–0.970)], p = 0.038) and of dyspnea (0.544 (0.341–0.868)], p = 0.011) were associated with increased risk of influenza positivity. Overall, 184/1106 (16.6%) patients were admitted to intensive care or high-dependency units (ICU/HDU) (13.2% were influenza positive) and 26/1106 (2.4%) died (2.6% were influenza positive). Males were more likely to have a severe outcome (ICU/HDU admission or death). Conclusions Influenza was a significant contributor to hospitalizations associated with CAP, AECOPD and AEBA. However, it was not associated with ICU/HDU admission in this population. Study registration, NMRR ID: NMRR-17-889-35,174. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06360-9.
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Affiliation(s)
- Yong Kek Pang
- Department of Medicine, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - Ahmad Izuanuddin Ismail
- Department of Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selayang Campus, Jalan Prima Selayang, Batu Caves, Selangor, Malaysia.
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Adelina Cheong
- Medical Department, Sanofi Pasteur, Plaza 33, 46200, Petaling Jaya, Selangor, Malaysia
| | - Yoong Min Chong
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Paras Doshi
- Department of Medicine, Kuala Lumpur General Hospital, Jalan Pahang, 50586, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Joanne Zhi Han Lau
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jean Khor
- Medical Department, Sanofi Pasteur, Plaza 33, 46200, Petaling Jaya, Selangor, Malaysia
| | - Lilian Phei Lian Wang
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Loon Leong
- Department of Medicine, Kuala Lumpur General Hospital, Jalan Pahang, 50586, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Aisya Natasya Musa
- Department of Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selayang Campus, Jalan Prima Selayang, Batu Caves, Selangor, Malaysia
| | - Kee Sing Ng
- Department of Medicine, Kuala Lumpur General Hospital, Jalan Pahang, 50586, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Mau Ern Poh
- Department of Medicine, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Jiunn Liang Tan
- Department of Medicine, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
| | - Mohd Arif Mohd Zim
- Department of Medicine, Faculty of Medicine, Universiti Teknologi Mara, Selayang Campus, Jalan Prima Selayang, Batu Caves, Selangor, Malaysia
| | - Anne-Frieda Taurel
- Vaccine Epidemiology and Modeling Department, Sanofi Pasteur, Singapore, Singapore
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Wong PL, Sii HL, P'ng CK, Ee SS, Yong Oong X, Ng KT, Hanafi NS, Tee KK, Tan MP. The effects of age on clinical characteristics, hospitalization and mortality of patients with influenza-related illness at a tertiary care centre in Malaysia. Influenza Other Respir Viruses 2020; 14:286-293. [PMID: 32022411 PMCID: PMC7182601 DOI: 10.1111/irv.12691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background Age is an established risk factor for poor outcomes in individuals with influenza‐related illness, and data on its influence on clinical presentations and outcomes in the South‐East Asian settings are scarce. The aim of this study was to determine the above among adults with influenza‐related upper respiratory tract infection at a teaching hospital in Malaysia. Methods A retrospective case‐note analysis was conducted on a cohort of 3935 patients attending primary care at the University Malaya Medical Centre, Malaysia from February 2012 till May 2014 with URTI symptoms. Demographics, clinical characteristics, medical and vaccination history were obtained from electronic medical records, and mortality data from the National Registration Department. Comparisons were made between those aged <25, ≥25 to <65 and ≥65 years. Results 470 (11.9%) had PCR‐confirmed influenza virus infection. Six (1.3%) received prior influenza vaccination. Those aged ≥65 years were more likely to have ≥2 comorbidities (P < .001) and were less likely to present with fever (P = .004). One‐third of those aged ≥65 years experienced hospitalization, intensive care admission or death within a year compared to 10% in the ≥25 to <65 years. Age ≥65 years was an independent predictor of hospitalization and death (OR = 9.97; 95% CI = 3.11‐31.93) compared to those aged <25 years. Conclusion Older patients in our cohort were more likely to have comorbidities and present with atypical features, with older age being an independent predictor of poor health outcomes. Our findings will now inform future health policies on older persons and economic modelling of adult vaccination programmes.
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Affiliation(s)
- Pui Li Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hoe Leong Sii
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chun Keat P'ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soon Sean Ee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Xiang Yong Oong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kim Tien Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nik Sherina Hanafi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Keng Tee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia
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Abstract
Influenza is a very important respiratory infectious disease that causes seasonal epidemics and pandemics. A well-organized surveillance system is necessary to monitor and respond effectively to the epidemiologic features of influenza. Korea currently operates a national influenza surveillance system based on the clinical sentinel surveillance system, laboratory sentinel surveillance system, and hospitalization and mortality surveillance system. However, there is a need for a better national surveillance system due to a demand for various pieces of information related to influenza. This article discusses the general aspects of influenza surveillance systems and the future direction of the national influenza surveillance system of Korea.
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Affiliation(s)
- Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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9
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Rudge JW, Inthalaphone N, Pavlicek R, Paboriboune P, Flaissier B, Monidarin C, Steenkeste N, Davong V, Vongsouvath M, Bonath KA, Messaoudi M, Saadatian-Elahi M, Newton P, Endtz H, Dance D, Paranhos Baccala G, Sanchez Picot V. "Epidemiology and aetiology of influenza-like illness among households in metropolitan Vientiane, Lao PDR": A prospective, community-based cohort study. PLoS One 2019; 14:e0214207. [PMID: 30951544 PMCID: PMC6450629 DOI: 10.1371/journal.pone.0214207] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/08/2019] [Indexed: 11/18/2022] Open
Abstract
Respiratory diseases are a major contributor to morbidity and mortality in many tropical countries, including Lao PDR. However, little has been published regarding viral or bacterial pathogens that can contribute to influenza-like illness (ILI) in a community setting. We report on the results of a community-based surveillance that prospectively monitored the incidence of ILI and its causative pathogens in Vientiane capital in Lao PDR. A cohort of 995 households, including 4885 study participants, were followed-up between May 2015 and May 2016. Nasopharyngeal swabs, throat swabs, and sputum specimens were collected from ILI cases identified through active case-finding. Real-Time PCR was used to test nasopharyngeal swabs for 21 respiratory pathogens, while throat and sputum samples were subjected to bacterial culture. Generalized linear mixed models were used to assess potential risk factors for associations with ILI. In total, 548 episodes of ILI were reported among 476 (9.7%) of the study participants and 330 (33.2%) of the study households. The adjusted estimated incidence of ILI within the study area was 10.7 (95%CI: 9.4-11.9) episodes per 100 person-years. ILI was significantly associated with age group (p<0.001), sex (p<0.001), and number of bedrooms (p = 0.04) in multivariate analysis. In 548 nasopharyngeal swabs, the most commonly detected potential pathogens were Streptococcus pneumoniae (17.0%), Staphylococcus aureus (11.3%), influenza A (11.1%; mostly subtype H3N2), rhinovirus (7.5%), and influenza B (8.0%). Streptococci were isolated from 42 (8.6%) of 536 throat swabs, most (27) of which were Lancefield Group G. Co-infections were observed in 132 (24.1%) of the 548 ILI episodes. Our study generated valuable data on respiratory disease burden and patterns of etiologies associated with community-acquired acute respiratory illness Laos. Establishment of a surveillance strategy in Laos to monitor trends in the epidemiology and burden of acute respiratory infections is required to minimize their impact on human health.
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Affiliation(s)
- James W. Rudge
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Nui Inthalaphone
- Center of Infectiology Christophe Mérieux of Laos, Vientiane, Laos
| | | | | | | | | | | | - Viengmon Davong
- Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | | | - K. A. Bonath
- University of Health Sciences, Phnom Penh, Cambodia
| | | | | | - Paul Newton
- Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
| | | | - David Dance
- Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos
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Harun A, Beyza E. Viral and Atypical Bacterial Respiratory Infections in a University Teaching Hospital. Jpn J Infect Dis 2019; 72:318-322. [DOI: 10.7883/yoken.jjid.2018.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Agca Harun
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University
| | - Ener Beyza
- Department of Medical Microbiology, Faculty of Medicine, Bursa Uludag University
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11
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Niang MN, Barry MA, Talla C, Mbengue A, Sarr FD, Ba IO, Hedible BG, Ndoye B, Vray M, Dia N. Estimation of the burden of flu-association influenza-like illness visits on total clinic visits through the sentinel influenza monitoring system in Senegal during the 2013-2015 influenza seasons. Epidemiol Infect 2018; 146:2049-2055. [PMID: 30196797 PMCID: PMC6453003 DOI: 10.1017/s0950268818002418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/28/2018] [Accepted: 07/30/2018] [Indexed: 11/06/2022] Open
Abstract
Knowing the burden of influenza is helpful for policy decisions. Here we estimated the contribution of influenza-like illness (ILI) visits associated with laboratory-confirmed influenza among all clinic visits in a Senegal sentinel network. ILI data from ten sentinel sites were collected from January 2013 to December 2015. ILI was defined as an axillary measured fever of more than 37.5 °C with a cough or a sore throat. Collected nasopharyngeal swabs were tested for influenza viruses by rRT-PCR. Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza. For the influenza disease burden estimation, we used all-case outpatient visits during the study period who sought care at selected sites. Of 4030 ILI outpatients tested, 1022 were influenza positive. The estimated proportional contribution of influenza-associated ILI was, per 100 outpatients, 1.2 (95% CI 1.1-1.3), 0.32 (95% CI 0.28-0.35), 1.11 (95% CI 1.05-1.16) during 2013, 2014, 2015, respectively. The age-specific outpatient visits proportions of influenza-associated ILI were higher among children under 5 years (0.68%, 95% CI: 0.62-0.70). The predominant virus during years 2013 and 2015 was influenza B while A/H3N2 subtype was predominant during 2014. Influenza viruses cause a substantial burden of outpatient visits particularly among children under 5 of age in Senegal and highlight the need of vaccination in risk groups.
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Affiliation(s)
- M. N. Niang
- Virology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - M. A. Barry
- Epidemiology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - C. Talla
- Epidemiology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - A. Mbengue
- Virology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - F. D. Sarr
- Epidemiology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - I. O. Ba
- World Health Organization local office, Dakar, Senegal
| | - B. G. Hedible
- Epidemiology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - B. Ndoye
- Ministry of Health, Dakar, Senegal
| | - M. Vray
- Epidemiology Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - N. Dia
- Virology Unit, Institut Pasteur de Dakar, Dakar, Senegal
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12
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Ram Purakayastha D, Vishnubhatla S, Rai SK, Broor S, Krishnan A. Estimation of Burden of Influenza among under-Five Children in India: A Meta-Analysis. J Trop Pediatr 2018; 64:441-453. [PMID: 29112737 DOI: 10.1093/tropej/fmx087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We estimated the burden of influenza-related acute respiratory tract infection (ARI) among under-fives in India through meta-analysis. METHODOLOGY We estimated pooled incidence and proportional positivity of laboratory-diagnosed influenza among under-fives using data from observational studies published from 1 January 1961 to 31 December 2016. Death due to influenza was estimated using a multiplier model. RESULTS Influenza-associated ARI incidence was estimated as 132 per 1000 child-years (115-149). The patients positive for influenza among ARI in outpatients and inpatients were estimated to be 11.2% (8.8-13.6) and 7.1% (5.5-8.8), respectively. We estimated total influenza cases during 2016 as 16 009 207 (13 942 916-18 082 769) in India. Influenza accounted for 10 913 476 (9 504 666-12 362 310) outpatient visits and 109 431 (83 882-134 980) hospitalizations. A total of 27 825 (21 382-34 408) influenza-associated under-five deaths were estimated in India in 2016. CONCLUSION Influenza imposes a substantial burden among under-fives in India. Public health approach for its prevention and control needs to be explored.
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Affiliation(s)
- Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sreenivas Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sanjay Kumar Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sobha Broor
- Department of Microbiology, Faculty of Medicine and health Sciences, SGT University, Chandu-Budhera, Gurugram-Badli Road, Gurgaon, Haryana, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
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Sruamsiri R, Ferchichi S, Jamotte A, Toumi M, Kubo H, Mahlich J. Impact of patient characteristics and treatment procedures on hospitalization cost and length of stay in Japanese patients with influenza: A structural equation modelling approach. Influenza Other Respir Viruses 2017; 11:543-555. [PMID: 28987034 PMCID: PMC5705683 DOI: 10.1111/irv.12505] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Little is known about the economic burden of influenza-related hospitalizations in Japan. This study sought to identify the factors that contribute to the total healthcare costs (THCs) associated with hospitalizations due to influenza in the Japanese population. STUDY DESIGN A retrospective cross-sectional database analysis study. METHODS A structural equation modelling approach was used to analyse a nationwide Japanese hospital claims data. This study included inpatients with at least 1 confirmed diagnosis of influenza and with a hospital stay of at least 2 days, who were admitted between April 2014 and March 2015. RESULTS A total of 5261 Japanese inpatients with a diagnosis of influenza were included in the final analysis. The elderly (≥65 years) and the young (≤15 years) comprised more than 85% of patients. The average length of stay (LOS) was 12.5 days, and the mean THC was 5402 US dollars (US$) per hospitalization. One additional hospital day increased the THC by 314 US$. Intensive care unit hospitalizations were linked to higher costs (+4957 US$) compared to regular hospitalizations. The biggest procedure-related cost drivers, which were also impacted by LOS, were blood transfusions (+6477 US$), tube feedings (+3501 US$) and dialysis (+2992 US$). CONCLUSIONS In Japan, the economic burden due to influenza-related hospitalizations for both children and the elderly is considerable and is further impacted by associated comorbidities, diagnostic tests and procedures that prolong the LOS.
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Affiliation(s)
- Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan.,Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
| | | | | | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Hiroshi Kubo
- Research & Development Department, Janssen Pharmaceutical KK, Tokyo, Japan
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan.,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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14
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Ly S, Arashiro T, Ieng V, Tsuyuoka R, Parry A, Horwood P, Heng S, Hamid S, Vandemaele K, Chin S, Sar B, Arima Y. Establishing seasonal and alert influenza thresholds in Cambodia using the WHO method: implications for effective utilization of influenza surveillance in the tropics and subtropics. Western Pac Surveill Response J 2017; 8:22-32. [PMID: 28409056 PMCID: PMC5375096 DOI: 10.5365/wpsar.2017.8.1.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To establish seasonal and alert thresholds and transmission intensity categories for influenza to provide timely triggers for preventive measures or upscaling control measures in Cambodia. METHODS Using Cambodia's influenza-like illness (ILI) and laboratory-confirmed influenza surveillance data from 2009 to 2015, three parameters were assessed to monitor influenza activity: the proportion of ILI patients among all outpatients, proportion of ILI samples positive for influenza and the product of the two. With these parameters, four threshold levels (seasonal, moderate, high and alert) were established and transmission intensity was categorized based on a World Health Organization alignment method. Parameters were compared against their respective thresholds. RESULTS Distinct seasonality was observed using the two parameters that incorporated laboratory data. Thresholds established using the composite parameter, combining syndromic and laboratory data, had the least number of false alarms in declaring season onset and were most useful in monitoring intensity. Unlike in temperate regions, the syndromic parameter was less useful in monitoring influenza activity or for setting thresholds. CONCLUSION Influenza thresholds based on appropriate parameters have the potential to provide timely triggers for public health measures in a tropical country where monitoring and assessing influenza activity has been challenging. Based on these findings, the Ministry of Health plans to raise general awareness regarding influenza among the medical community and the general public. Our findings have important implications for countries in the tropics/subtropics and in resource-limited settings, and categorized transmission intensity can be used to assess severity of potential pandemic influenza as well as seasonal influenza.
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Affiliation(s)
- Sovann Ly
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Takeshi Arashiro
- WHO Representative Office in Cambodia, Phnom Penh, Cambodia
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
- School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Vanra Ieng
- WHO Representative Office in Cambodia, Phnom Penh, Cambodia
| | - Reiko Tsuyuoka
- WHO Representative Office in Cambodia, Phnom Penh, Cambodia
| | - Amy Parry
- WHO Representative Office in Cambodia, Phnom Penh, Cambodia
| | - Paul Horwood
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Seng Heng
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Sarah Hamid
- Emerging Disease Surveillance and Response, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | - Savuth Chin
- National Public Health Laboratory, National Institution of Public Health, Phnom Penh, Cambodia
| | - Borann Sar
- Influenza Program, United States Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
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Singhi S, Rungta N, Nallasamy K, Bhalla A, Peter JV, Chaudhary D, Mishra R, Shastri P, Bhagchandani R, Chugh TD. Tropical Fevers in Indian Intensive Care Units: A Prospective Multicenter Study. Indian J Crit Care Med 2017; 21:811-818. [PMID: 29307960 PMCID: PMC5752788 DOI: 10.4103/ijccm.ijccm_324_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Infections in tropics often present as undifferentiated fevers with organ failures. We conducted this nationwide study to identify the prevalence, profile, resource utilization, and outcome of tropical fevers in Indian Intensive Care Units (ICUs). Materials and Methods This was a multicenter prospective observational study done in 34 ICUs across India (July 2013-September 2014). Critically ill adults and children with nonlocalizing fever >48 h and onset < 14 days with any of the following: thrombocytopenia/rash, respiratory distress, renal failure, encephalopathy, jaundice, or multiorgan failure were enrolled consecutively. Results Of 456 cases enrolled, 173 were children <12 years. More than half of the participants (58.7%) presented in postmonsoon months (August-October). Thrombocytopenia/rash was the most common presentation (60%) followed by respiratory distress (46%), encephalopathy (28.5%), renal failure (23.5%), jaundice (20%), and multiorgan failure (19%). An etiology could be established in 365 (80.5%) cases. Dengue (n = 105.23%) was the most common followed by scrub typhus (n = 83.18%), encephalitis/meningitis (n = 44.9.6%), malaria (n = 37.8%), and bacterial sepsis (n = 32.7%). Nearly, half (35% invasive; 12% noninvasive) received mechanical ventilation, a quarter (23.4%) required vasoactive therapy in first 24 h and 9% received renal replacement therapy. Median (interquartile range) ICU and hospital length of stay were 4 (3-7) and 7 (5-11.3) days. At 28 days, 76.2% survived without disability, 4.4% had some disability, and 18.4% died. Mortality was higher (27% vs. 15%) in patients with undiagnosed etiology (P < 0.01). On multivariate analysis, multiorgan dysfunction syndrome at admission (odds ratio [95% confidence interval]-2.8 [1.8-6.6]), day 1 Sequential Organ Failure Assessment score (1.2 [1.0-1.3]), and the need for invasive ventilation (8.3 [3.4-20]) were the only independent predictors of unfavorable outcome. Conclusions Dengue, scrub typhus, encephalitis, and malaria are the major tropical fevers in Indian ICUs. The data support a syndromic approach, point of care tests, and empiric antimicrobial therapy recommended by Indian Society of Critical Care Medicine in 2014.
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Affiliation(s)
- Sunit Singhi
- Professor Emeritus Pediatrics, PGIMER, Chandigarh, Haryana, India
| | - Narendra Rungta
- Critical Care Medicine, Jeevanrekha Critical Care and Trauma Hospital, Jaipur, Rajasthan, India
| | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, Haryana, India
| | - J V Peter
- Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhruva Chaudhary
- Department of Pulmonology and Critical Care, PGIMS, Haryana, India
| | - Rajesh Mishra
- Critical Care Medicine, Sanjivani Super Speciality Hospital, Ahmedabad, Gujarat, India
| | - Prakash Shastri
- Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | | | - T D Chugh
- Professor Emeritus Pathology, PGIMS, Rohtak, Haryana, India
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Zhang T, Zhang J, Hua J, Wang D, Chen L, Ding Y, Zeng S, Wu J, Jiang Y, Geng Q, Zhou S, Song Y, Iuliano AD, Greene CM, McFarland J, Zhao G. Influenza-associated outpatient visits among children less than 5 years of age in eastern China, 2011-2014. BMC Infect Dis 2016; 16:267. [PMID: 27287453 PMCID: PMC4901396 DOI: 10.1186/s12879-016-1614-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 06/03/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The disease burden of influenza in China has not been well described, especially among young children. The aim of this study was to estimate the incidence of outpatient visits associated with influenza in young children in Suzhou, a city of more than 11 million residents in Jiangsu Province in eastern China. METHODS Influenza-like illness (ILI) was defined as the presence of fever (axillary temperature ≥38 °C) and cough or sore throat. We collected throat swabs for children less than 5 years of age with ILI who visited Suzhou University Affiliated Children's Hospital (SCH) outpatient clinic or emergency room between April 2011 and March 2014. Suzhou CDC, a national influenza surveillance network laboratory, tested for influenza viruses by real-time reverse transcription-polymerase chain reaction assay (rRT-PCR). Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza by rRT-PCR. To calculate the incidence of influenza-associated outpatient visits, we conducted community-based healthcare utilization surveys to determine the proportion of hospital catchment area residents who sought care at SCH. RESULTS The estimated incidence of influenza-associated ILI outpatient visits among children aged <5 years in the catchment area of Suzhou was, per 100 population, 17.4 (95 % CI 11.0-25.3) during April 2011-March 2012, 14.6 (95 % CI 5.2-26.2) during April 2012-March 2013 and 21.4 (95 % CI: 10.9-33.5) during April 2013-March 2014. The age-specific outpatient visit rates of influenza-associated ILI were 4.9, 21.1 and 21.2 per 100 children aged 0- <6 months, 6- <24 months and 24- <60 months, respectively. CONCLUSION Influenza virus infection causes a substantial burden of outpatient visits among young children in Suzhou, China. Targeted influenza prevention and control strategies for young children in Suzhou are needed to reduce influenza-associated outpatient visits in this age group.
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Affiliation(s)
- Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Jun Hua
- Suzhou University Affiliated Children's Hospital, Suzhou, China
| | - Dan Wang
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Liling Chen
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Yunfang Ding
- Suzhou University Affiliated Children's Hospital, Suzhou, China
| | - Shanshan Zeng
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Jing Wu
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Yanwei Jiang
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Qian Geng
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Suizan Zhou
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ying Song
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
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Kittikraisak W, Chittaganpitch M, Gregory CJ, Laosiritaworn Y, Thantithaveewat T, Dawood FS, Lindblade KA. Assessment of potential public health impact of a quadrivalent inactivated influenza vaccine in Thailand. Influenza Other Respir Viruses 2016; 10:211-9. [PMID: 26588892 PMCID: PMC4814859 DOI: 10.1111/irv.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Each year, an influenza B strain representing only one influenza B lineage is included in the trivalent inactivated influenza vaccine (IIV3); a mismatch between the selected lineage and circulating viruses can result in suboptimal vaccine effectiveness. We modeled the added potential public health impact of a quadrivalent inactivated influenza vaccine (IIV4) that includes strains from both influenza B lineages compared to IIV3 on influenza-associated morbidity and mortality in Thailand. METHODS Using data on the incidence of influenza-associated hospitalizations and deaths, vaccine effectiveness, and vaccine coverage from the 2007-2012 influenza seasons in Thailand, we estimated rates of influenza-associated outcomes that might be averted using IIV4 instead of IIV3. We then applied these rates to national population estimates to calculate averted illnesses, hospitalizations, and deaths for each season. We assumed that the influenza B lineage included in IIV3 would provide a relative vaccine effectiveness of 75% against the other B lineage. RESULTS Compared to use of IIV3, use of IIV4 might have led to an additional reduction ranging from 0·4 to 14·3 influenza-associated illnesses per 100 000 population/year, <0·1 to 0·5 hospitalizations per 100 000/year, and <0·1 to 0·4 deaths per 1000/year. Based on extrapolation to national population estimates, replacement of IIV3 with IIV4 might have averted an additional 267-9784 influenza-associated illnesses, 9-320 hospitalizations, and 0-3 deaths. CONCLUSION Compared to use of IIV3, IIV4 has the potential to further reduce the burden of influenza-associated morbidity and mortality in Thailand.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
| | | | - Christopher J. Gregory
- International Emerging Infections ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Division of Global Health ProtectionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | | | | | - Fatimah S. Dawood
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kim A. Lindblade
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
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Chavan RD, Kothari ST, Zunjarrao K, Chowdhary AS. Surveillance of acute respiratory infections in Mumbai during 2011-12. Indian J Med Microbiol 2016; 33:43-50. [PMID: 25560001 DOI: 10.4103/0255-0857.148376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in individuals aged less than 5 years. ARI often leads to hospitalisation, and it has been indicated that causative viral and bacterial infections go undetermined and results in the occurrence of resistant strains. The objective of the study was to assess the prevalence of various viral and bacterial infections in patients with ARIs. MATERIALS AND METHODS Two hundred samples were collected from July 2011 to July 2012 with patients suffering from ARI. Viral and bacterial infections were determined by real time reverse transcriptase polymerase chain reaction. RESULTS Influenza-like illness (ILI) consisted of 109 patients and ARI consisted of 91 patients. Pandemic influenza A H1N1 was the major viral infection with 21 (19.2%) patients in ILI as compared with 16 (17.4%) patients in ARI. Respiratory syncytial virus (RSV) was found to be 1 (0.9%) in ILI and ARI. Viral co-infections were 16 (14.4%) in ILI and 4 (4.37%) in ARI where pandemic influenza A H1N1 and influenza type B were major contributors. In bacterial infections, Streptococcus pneumoniae with 11 (10.9%) cases were predominant in both the groups. Bacterial co-infection accounted for only 1 (1.09%) case in both the groups but the most significant finding was the viral-bacterial co-infection in which Haemophilus influenzae was the major co-infecting bacteria with the influenza viruses with 4 (4.36%) cases as compared with Streptotoccus pneumoniae. CONCLUSION This data indicate the need to undertake continued surveillance that will help to better define the circulation of respiratory viruses along with the bacterial infections.
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Affiliation(s)
- R D Chavan
- Departments of Virology and Immunology , Haffkine Institute for Training, Research and Testing, Parel, Mumbai, India
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Lafond KE, Nair H, Rasooly MH, Valente F, Booy R, Rahman M, Kitsutani P, Yu H, Guzman G, Coulibaly D, Armero J, Jima D, Howie SRC, Ampofo W, Mena R, Chadha M, Sampurno OD, Emukule GO, Nurmatov Z, Corwin A, Heraud JM, Noyola DE, Cojocaru R, Nymadawa P, Barakat A, Adedeji A, von Horoch M, Olveda R, Nyatanyi T, Venter M, Mmbaga V, Chittaganpitch M, Nguyen TH, Theo A, Whaley M, Azziz-Baumgartner E, Bresee J, Campbell H, Widdowson MA. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982-2012: A Systematic Analysis. PLoS Med 2016; 13:e1001977. [PMID: 27011229 PMCID: PMC4807087 DOI: 10.1371/journal.pmed.1001977] [Citation(s) in RCA: 253] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 02/05/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide. METHODS AND FINDINGS We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group (<6 mo, <1 y, <2 y, <5 y, 5-17 y, and <18 y). We applied this proportion to global estimates of acute lower respiratory infection hospitalizations among children aged <1 y and <5 y, to obtain the number and per capita rate of influenza-associated hospitalizations by geographic region and socio-economic status. Influenza was associated with 10% (95% CI 8%-11%) of respiratory hospitalizations in children <18 y worldwide, ranging from 5% (95% CI 3%-7%) among children <6 mo to 16% (95% CI 14%-20%) among children 5-17 y. On average, we estimated that influenza results in approximately 374,000 (95% CI 264,000 to 539,000) hospitalizations in children <1 y-of which 228,000 (95% CI 150,000 to 344,000) occur in children <6 mo-and 870,000 (95% CI 610,000 to 1,237,000) hospitalizations in children <5 y annually. Influenza-associated hospitalization rates were more than three times higher in developing countries than in industrialized countries (150/100,000 children/year versus 48/100,000). However, differences in hospitalization practices between settings are an important limitation in interpreting these findings. CONCLUSIONS Influenza is an important contributor to respiratory hospitalizations among young children worldwide. Increasing influenza vaccination coverage among young children and pregnant women could reduce this burden and protect infants <6 mo.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- School of Health Sciences, University of Tampere, Tampere, Finland
- * E-mail: (KEL); (MAW)
| | - Harish Nair
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
- Public Health Foundation of India, New Delhi, India
| | - Mohammad Hafiz Rasooly
- Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - Fátima Valente
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Paul Kitsutani
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | | | | | - Julio Armero
- Ministerio de Salud de El Salvador, San Salvador, El Salvador
| | - Daddi Jima
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Stephen R. C. Howie
- Medical Research Council Unit, Fajara, The Gambia
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ricardo Mena
- Ministerio de Salud Publica y Asistencia Social, Guatemala City, Guatemala
| | | | - Ondri Dwi Sampurno
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | | | - Andrew Corwin
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jean Michel Heraud
- National Influenza Centre, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Daniel E. Noyola
- Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Radu Cojocaru
- National Centre for Public Health, Chisinau, Republic of Moldova
| | | | - Amal Barakat
- Institut National d’Hygiène, Ministère de la Santé, Rabat, Morocco
| | | | - Marta von Horoch
- Ministerio de Salud Publica y Bienestar Social, Asunción, Paraguay
| | - Remigio Olveda
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Marietjie Venter
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Zoonoses Research Unit, Department Medical Virology, University of Pretoria, Pretoria, South Africa
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | - Andros Theo
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Melissa Whaley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Harry Campbell
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail: (KEL); (MAW)
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Lafond KE, Tam JS, Bresee JS, Widdowson MA. International meeting on influenza vaccine effectiveness, 3-4 December 2012, Geneva, Switzerland. Vaccine 2014; 32:6591-5. [PMID: 25446822 PMCID: PMC5733129 DOI: 10.1016/j.vaccine.2014.09.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
On December 3–4 2012, the World Health Organization convened a meeting of influenza vaccine effectiveness (VE) experts from over 25 countries in Geneva, Switzerland, to review recent developments in the global influenza vaccine landscape and evaluate approaches to determining the effectiveness of influenza vaccine products among target populations. Vaccine manufacturers from Thailand, Vietnam, India, and Brazil shared recent advances illustrating the expansion of influenza vaccine production worldwide. Randomized controlled trials are underway in several low and middle-income countries including India, Thailand, Bangladesh, and South Africa, to fill knowledge gaps in target populations such as children and pregnant women. National and international networks in the United States, Canada, Europe, Latin America and Australia are conducting multi-site observational studies with shared methodologies to generate national influenza VE estimates and pool data for regional estimates. Standardized VE estimation methods are key to generating point estimates that are comparable internationally and across different settings.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - John S. Tam
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Joseph S. Bresee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Owusu JT, Prapasiri P, Ditsungnoen D, Leetongin G, Yoocharoen P, Rattanayot J, Olsen SJ, Muangchana C. Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010-2012. Vaccine 2014; 33:742-7. [PMID: 25454853 PMCID: PMC4610807 DOI: 10.1016/j.vaccine.2014.10.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/29/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
Background The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months–2 years, persons ≥65 years, persons with chronic diseases, obese persons), and health-care personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. Methods National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. Results From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37–3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months–2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p < 0.01) and persons ≥65 years (12%, versus 20%; p < 0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p < 0.01), children 6 months–2 years (2.3% versus 0.9%; p < 0.01), pregnant women (1.1% versus 0.9%; p < 0.01), and obese persons (0.2% versus 0.1%; p < 0.01). Conclusions From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand.
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Affiliation(s)
- Jocelynn T Owusu
- 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 Prapasiri
- 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
| | | | - Pornsak Yoocharoen
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Sonja J Olsen
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Vashishtha VM, Kalra A, Choudhury P. Influenza vaccination in India: position paper of Indian Academy of Pediatrics, 2013. Indian Pediatr 2014; 50:867-74. [PMID: 24096845 DOI: 10.1007/s13312-013-0230-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Burden of Influenza is significantly higher in developing countries as compared to developed countries, but the data on the disease burden is less well defined in most of the developing countries including India, and consequently, constraints evolving strategies for prioritization of measures to prevent and control it. The swine flu or A(H1N1) pandemic is on the wane but the virus continues to circulate causing sporadic outbreaks even in 2013. The A(H1N1)pdm09 has replaced the previous circulating seasonal A (H1N1) virus and acquired the status of a seasonal virus. Limited influenza activity is usually seen throughout the year in India with a clear peaking during the rainy season. The rainy season in the country lasts from June to August in all the regions except Tamil Nadu where it occurs from October to December. IAP recommends the ideal time for offering influenza vaccines is just before the onset of rainy season. The efficacy/effectiveness data of trivalent inactivated influenza vaccines are also presented in different age groups and different categories of individuals. The IAP maintains its earlier recommendations of using the current trivalent inactivated influenza vaccine in all children with risk factors but not as a universal measure. IAP has now prioritized different target groups for influenza vaccination based on contribution of the group to the overall influenza burden, disease severity, and vaccine effectiveness in different age groups and categories. The current trivalent inactivated influenza vaccines incorporate the 2009 pandemic strain also, hence avert the need of a separate A (H1N1) vaccine. IAP stresses the need of more refined surveillance; large scale studies on effectiveness of seasonal influenza vaccines in Indian children, and more effective, properly matched, higher-valent influenza vaccines.
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Affiliation(s)
- V M Vashishtha
- Advisory Committee on Vaccines and Immunization Practices, Indian Academy of Pediatrics. Correspondence to: Dr Vipin M Vashishtha, Convener, IAP Advisory Committee on Vaccines and Immunization Practices (ACVIP), Mangla Hospital and Research Center, Shakti Chowk, Bijnor, Uttar Pradesh, 246701, India.
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Le MQ, Lam HM, Cuong VD, Lam TTY, Halpin RA, Wentworth DE, Hien NT, Thanh LT, Phuong HVM, Horby P, Boni MF. Migration and persistence of human influenza A viruses, Vietnam, 2001-2008. Emerg Infect Dis 2014; 19:1756-65. [PMID: 24188643 PMCID: PMC3837676 DOI: 10.3201/eid1911.130349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Understanding global influenza migration and persistence is crucial for vaccine strain selection. Using 240 new human influenza A virus whole genomes collected in Vietnam during 2001-2008, we looked for persistence patterns and migratory connections between Vietnam and other countries. We found that viruses in Vietnam migrate to and from China, Hong Kong, Taiwan, Cambodia, Japan, South Korea, and the United States. We attempted to reduce geographic bias by generating phylogenies subsampled at the year and country levels. However, migration events in these phylogenies were still driven by the presence or absence of sequence data, indicating that an epidemiologic study design that controls for prevalence is required for robust migration analysis. With whole-genome data, most migration events are not detectable from the phylogeny of the hemagglutinin segment alone, although general migratory relationships between Vietnam and other countries are visible in the hemagglutinin phylogeny. It is possible that virus lineages in Vietnam persisted for >1 year.
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Le MN, Yoshida LM, Suzuki M, Nguyen HA, Le HT, Moriuchi H, Dang DA, Ariyoshi K. Impact of 2009 pandemic influenza among Vietnamese children based on a population-based prospective surveillance from 2007 to 2011. Influenza Other Respir Viruses 2014; 8:389-96. [PMID: 24602158 PMCID: PMC4181797 DOI: 10.1111/irv.12244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2014] [Indexed: 11/29/2022] Open
Abstract
Background Influenza virus is one of the major viral pathogens causing pediatric acute respiratory infection (ARI). The spread of pandemic influenza A (A(H1N1)pdm09) in 2009 around the globe had a huge impact on global health. Objective To investigate the impact of A(H1N1)pdm09 on pediatric ARI in Vietnam. Study design An ongoing population-based prospective surveillance in central Vietnam was used. All children aged <15 years residing in Nha Trang city, enrolled to the ARI surveillance in Khanh Hoa General Hospital, from February 2007 through March 2011 were studied. Clinical data and nasopharyngeal swab samples were collected. Influenza A was detected and genotyped by multiplex polymerase chain reaction assays and sequencing. Results Among enrolled 2736 hospitalized ARI cases, 354 (13%) were positive for influenza A. Genotyping results revealed that seasonal H3N2 and H1N1 (sea-H1N1) viruses were cocirculating before A(H1N1)pdm09 appeared in July 2009. The A(H1N1)pdm09 replaced the sea-H1N1 after the pandemic. The majority of influenza A cases (90%) were aged <5 years with incidence rate of 537 (387–775) per 100 000 population. Annual incidence rates of hospitalized influenza cases for pre-, initial and post-pandemic periods among children aged <5 year were 474, 452, and 387 per 100 000, respectively. Children with A(H1N1)pdm09 were elder, visited the hospital earlier, less frequently had severe signs, and were less frequently associated with viral coinfection compared with seasonal influenza cases. Conclusions The A(H1N1)pdm09 did not increase the influenza annual hospitalization incidence or disease severity compared with seasonal influenza among pediatric ARI cases in central Vietnam.
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Affiliation(s)
- Minh Nhat Le
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; National Institutes of Hygiene and Epidemiology, Hanoi, Vietnam; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Single, dual and multiple respiratory virus infections and risk of hospitalization and mortality. Epidemiol Infect 2014; 143:37-47. [PMID: 24568719 DOI: 10.1017/s0950268814000302] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Respiratory virus infections cause a significant number of hospitalization and deaths globally. This study investigated the association between single and multiple respiratory virus infections and risk of admission to a general ward, intensive care unit or death in patients aged 0-105 years (mean ± s.d. = 24·4 ± 24·1 years), from North West England, that were tested for respiratory virus infections between January 2007 and June 2012. The majority of infections were in children aged ⩽5 years. Dual or multiple infections occurred in 10·4% (1214/11 715) of patients, whereas single infection occurred in 89·6% (10 501/11 715). Rhinovirus was the most common co-infecting virus (occurring in 69·5%; 844/1214 of co-infections). In a multivariate logistic regression model, multiple infections were associated with an increased risk of admission to a general ward [odds ratio (OR) 1·43, 95% confidence interval (CI) 1·2-1·7, P < 0·0001]. On the other hand, patients with respiratory syncytial virus (RSV) and human parainfluenza virus types 1-3 (hPIV1-3), as a single infection, had a higher risk of being admitted to a general ward (OR 1·49, 95% CI 1·28-1·73, P < 0·0001 and OR 1·34, 95% CI 1·003-1·8, P = 0·05, respectively); admitted to an intensive-care unit or dying (OR 1·5, 95% CI 1·20-2·0, P = 0·001 and OR 1·60, 95% CI 1·02-2·40, P = 0·04, respectively). This result emphasizes the importance of RSV, hPIV and mixed infections and calls for research on vaccines, drugs and diagnostic tests targeting these respiratory viruses.
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Tallo VL, Kamigaki T, Tan AG, Pamaran RR, Alday PP, Mercado ES, Javier JB, Oshitani H, Olveda RM. Estimating influenza outpatients' and inpatients' incidences from 2009 to 2011 in a tropical urban setting in the Philippines. Influenza Other Respir Viruses 2014; 8:159-68. [PMID: 24393336 PMCID: PMC4186463 DOI: 10.1111/irv.12223] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 12/03/2022] Open
Abstract
Objectives Although the public health significance of influenza in regions with a temperate climate has been widely recognized, information on influenza burden in tropical countries, including the Philippines, remains limited. We aimed to estimate influenza incidence rates for both outpatients and inpatients then characterized their demographic features. Design An enhanced surveillance was performed from January 2009 to December 2011 in an urbanized highland city. The influenza-like illness (ILI) surveillance involved all city health centers and an outpatient department of a tertiary government hospital. The severe acute respiratory infection (sARI) surveillance was also conducted with one government and four private hospitals since April 2009. Nasal and/or oropharyngeal swabs were collected and tested for influenza A, influenza B, and respiratory syncytial virus. Results and Conclusions We obtained 5915 specimens from 13 002 ILI cases and 2656 specimens from 10 726 sARI cases throughout the study period. We observed year-round influenza activity with two possible peaks each year. The overall influenza detection rate was 23% in the ILI surveillance and 9% in the sARI surveillance. The mean annual outpatient incidence rate of influenza was 5·4 per 1000 individuals [95% confidence interval (CI), 1·83–12·7], and the mean annual incidence of influenza-associated sARI was 1·0 per 1000 individuals (95% CI, 0·03–5·57). The highest incidence rates were observed among children aged <5 years, particularly those aged 6–23 months. Influenza posed a certain disease burden among inpatients and outpatients, particularly children aged <5 years, in an urbanized tropical city of the Philippines.
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Affiliation(s)
- Veronica L Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Manila, Philippines
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Suh M, Kang DR, Lee DH, Choi YJ, Tchoe B, Nam CM, Kim HJ, Lee JK, Jun BY, Youm Y, Bae GN, Lee TY, Kim MS, Shin DC, Kim C. Socioeconomic burden of influenza in the Republic of Korea, 2007-2010. PLoS One 2013; 8:e84121. [PMID: 24386339 PMCID: PMC3873972 DOI: 10.1371/journal.pone.0084121] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background Although the socioeconomic burden of 2009 pandemic influenza A (H1N1) was considerable, no reliable estimates have been reported. Our aim was to compared medical costs and socioeconomic burden resulting from pandemic influenza A (H1N1) 2009 with that of previous seasonal influenza. Methods We estimated the medical costs and socioeconomic burden of influenza from May 2007 to April 2010. We used representative national data sources(data from the Health Insurance Review Agency, the National Health Insurance Corporation, the Korea Centers for Disease Control and Prevention, and the Korean National Statistics Office) including medical utilization, prescription of antivirals, and vaccination. Uncertainty of data was explored through sensitivity analysis using Monte Carlo simulation. Results Compared with the seasonal influenza, total medical costs (US$291.7 million) associated with pandemic (H1N1) 2009 increased more than 37-fold. Compared with the 2007–2008 season, outpatient diagnostic costs (US$135.3 million) were 773 times higher in the 2009–2010 season, and the mean diagnostic cost per outpatient visit was 58.8 times higher. Total socioeconomic burden of pandemic (H1N1) 2009 was estimated at US$1581.3 million (10%–90%: US$1436.0–1808.3 million) and those of seasonal influenza was estimated at US$44.7 million (10%–90%: US$32.4–57.9 million) in 2007–2008 season and US$42.3 million (10%–90%: US$31.5–53.8 million) in 2008–2009 season. Indirect costs accounted for 56.0% of total costs in pandemic (H1N1) 2009, and 66.48–68.09% in seasonal influenza. The largest contributors to total burden were productivity losses of caregiver in pandemic (H1N1) 2009, and productivity losses due to morbidity of outpatient in seasonal influenza. Conclusions In the Republic of Korea, socioeconomic burden of pandemic (H1N1) 2009 were considerably higher than burden of the previous two influenza seasons, primarily because of high diagnostic costs and longer sick leave.
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Affiliation(s)
- Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | | | - Dong Han Lee
- Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Yoon Jung Choi
- Helath Insurance Review & Assessment Service, Seoul, Korea
| | - Byongho Tchoe
- Helath Insurance Review & Assessment Service, Seoul, Korea
| | - Chung Mo Nam
- Yonsei University College of Medicine, Seoul, Korea
| | | | - Jong Koo Lee
- Seoul National University Hospital, Seoul, Korea
| | - Byung Yool Jun
- Korea Centers for Disease Control and Prevention, Osong, Korea
| | - Yoosik Youm
- Department of Sociology, Yonsei University, Seoul, Korea
| | - Gwi-Nam Bae
- Environmental Sensor System Research Center, Korea Institute of Science and Technology, Seoul, Korea
| | - Tae Yong Lee
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Korea
| | - Moon Shik Kim
- School of Public Health, Ajou University, Suwon, Korea
| | | | - Changsoo Kim
- Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Turner P, Turner C, Watthanaworawit W, Carrara V, Cicelia N, Deglise C, Phares C, Ortega L, Nosten F. Respiratory virus surveillance in hospitalised pneumonia patients on the Thailand-Myanmar border. BMC Infect Dis 2013; 13:434. [PMID: 24498873 PMCID: PMC3847692 DOI: 10.1186/1471-2334-13-434] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/30/2013] [Indexed: 11/24/2022] Open
Abstract
Background Pneumonia is a significant cause of morbidity and mortality in the developing world. Viruses contribute significantly to pneumonia burden, although data for low-income and tropical countries are scarce. The aim of this laboratory-enhanced, hospital-based surveillance was to characterise the epidemiology of respiratory virus infections among refugees living on the Thailand-Myanmar border. Methods Maela camp provides shelter for ~45,000 refugees. Inside the camp, a humanitarian organisation provides free hospital care in a 158-bed inpatient department (IPD). Between 1st April 2009 and 30th September 2011, all patients admitted to the IPD with a clinical diagnosis of pneumonia were invited to participate. Clinical symptoms and signs were recorded and a nasopharyngeal aspirate (NPA) collected. NPAs were tested for adenoviruses, human metapneumovirus (hMPV), influenza A & B, and RSV by PCR. Results Seven hundred eight patient episodes (698 patients) diagnosed as pneumonia during the enhanced surveillance period were included in this analysis. The median patient age was 1 year (range: < 1-70), and 90.4% were aged < 5 years. At least one virus was detected in 53.7% (380/708) of episodes. Virus detection was more common in children aged < 5 years old (<1 year: OR 2.0, 95% CI 1.2-3.4, p = 0.01; 1-4 years: OR 1.4, 95% CI 0.8-2.3, p = 0.2). RSV was detected in 176/708 (24.9%); an adenovirus in 133/708 (18.8%); an influenza virus in 68/708 (9.6%); and hMPV in 33/708 (4.7%). Twenty-eight episodes of multiple viral infections were identified, most commonly adenovirus plus another virus. RSV was more likely to be detected in children <5 years (OR 12.3, 95% CI 3.0-50.8, p = 0.001) and influenza viruses in patients ≥5 years (OR 2.8, 95% CI 1.5-5.4, p = 0.002). IPD treatment was documented in 702/708 cases; all but one patient received antimicrobials, most commonly a beta-lactam (amoxicillin/ampicillin +/−gentamicin in 664/701, 94.7%). Conclusions Viral nucleic acid was identified in the nasopharynx in half the patients admitted with clinically diagnosed pneumonia. Development of immunisations targeting common respiratory viruses is likely to reduce the incidence of pneumonia in children living refugee camps and similar settings.
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Affiliation(s)
- Paul Turner
- Shoklo Malaria Research Unit, Mae Sot, Thailand.
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Nguyen YT, Graitcer SB, Nguyen TH, Tran DN, Pham TD, Le MT, Tran HN, Bui CT, Dang DT, Nguyen LT, Uyeki TM, Dennis D, Kile JC, Kapella BK, Iuliano A, Widdowson MA, Nguyen HT. National surveillance for influenza and influenza-like illness in Vietnam, 2006-2010. Vaccine 2013; 31:4368-74. [PMID: 23911781 PMCID: PMC5820022 DOI: 10.1016/j.vaccine.2013.07.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 11/20/2022]
Abstract
Influenza virus infections result in considerable morbidity and mortality both in the temperate and tropical world. Influenza surveillance over multiple years is important to determine the impact and epidemiology of influenza and to develop a national vaccine policy, especially in countries developing influenza vaccine manufacturing capacity, such as Vietnam. We conducted surveillance of influenza and influenza-like illness in Vietnam through the National Influenza Surveillance System during 2006-2010. At 15 sentinel sites, the first two patients presenting each weekday with influenza-like illness (ILI), defined as fever and cough and/or sore throat with illness onset within 3 days, were enrolled and throat specimens were collected and tested for influenza virus type and influenza A subtype by RT-PCR. De-identified demographic and provider reported subsequent hospitalization information was collected on each patient. Each site also collected information on the total number of patients with influenza-like illness evaluated per week. Of 29,804 enrolled patients presenting with influenza-like illness, 6516 (22%) were influenza positive. Of enrolled patients, 2737 (9.3%) were reported as subsequently hospitalized; of the 2737, 527 (19%) were influenza positive. Across all age groups with ILI, school-aged children had the highest percent of influenza infection (29%) and the highest percent of subsequent hospitalizations associated with influenza infection (28%). Influenza viruses co-circulated throughout most years in Vietnam during 2006-2010 and often reached peak levels multiple times during a year, when >20% of tests were influenza positive. Influenza is an important cause of all influenza-like illness and provider reported subsequent hospitalization among outpatients in Vietnam, especially among school-aged children. These findings may have important implications for influenza vaccine policy in Vietnam.
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Affiliation(s)
- Yen T. Nguyen
- National Institute of Hygiene and Epidemiology, Viet Nam
| | - Samuel B. Graitcer
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, USA
- Influenza Division, Centers for Disease Control and Prevention, USA
| | - Tuan H. Nguyen
- National Institute of Hygiene and Epidemiology, Viet Nam
| | - Duong N. Tran
- National Institute of Hygiene and Epidemiology, Viet Nam
| | - Tho D. Pham
- National Institute of Hygiene and Epidemiology, Viet Nam
| | - Mai T.Q. Le
- National Institute of Hygiene and Epidemiology, Viet Nam
| | - Huu N. Tran
- Pasteur Institute, Ho Chi Minh City, Viet Nam
| | | | | | | | - Timothy M. Uyeki
- Influenza Division, Centers for Disease Control and Prevention, USA
| | - David Dennis
- Influenza Division, Centers for Disease Control and Prevention, USA
| | - James C. Kile
- Influenza Division, Centers for Disease Control and Prevention, USA
| | - Bryan K. Kapella
- Influenza Division, Centers for Disease Control and Prevention, USA
| | - A.D. Iuliano
- Influenza Division, Centers for Disease Control and Prevention, USA
| | | | - Hien T. Nguyen
- National Institute of Hygiene and Epidemiology, Viet Nam
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Azziz-Baumgartner E, Cabrera AM, Cheng PY, Garcia E, Kusznierz G, Calli R, Baez C, Buyayisqui MP, Poyard E, Pérez E, Basurto-Davila R, Palekar R, Oliva O, Alencar AP, de Souza R, dos Santos T, Shay DK, Widdowson MA, Breese J, Echenique H. Incidence of influenza-associated mortality and hospitalizations in Argentina during 2002-2009. Influenza Other Respir Viruses 2013; 7:710-7. [PMID: 23210456 PMCID: PMC5855154 DOI: 10.1111/irv.12022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We estimated rates of influenza-associated deaths and hospitalizations in Argentina, a country that recommends annual influenza vaccination for persons at high risk of complications from influenza illness. METHODS We identified hospitalized persons and deaths in persons diagnosed with pneumonia and influenza (P&I, ICD-10 codes J10-J18) and respiratory and circulatory illness (R&C, codes I00-I99 and J00-J99). We defined the influenza season as the months when the proportion of samples that tested positive for influenza exceeded the annual median. We used hospitalizations and deaths during the influenza off-season to estimate, using linear regression, the number of excess deaths that occurred during the influenza season. To explore whether excess mortality varied by sex and whether people were age <65 or ≥ 65 years, we used Poisson regression of the influenza-associated rates. RESULTS During 2002-2009, 2411 P&I and 8527 R&C mean excess deaths occurred annually from May to October. If all of these excess deaths were associated with influenza, the influenza-associated mortality rate was 6/100,000 person-years (95% CI 4-8/100,000 person-years for P&I and 21/100,000 person-years (95% CI 12-31/100,000 person-years) for R&C. During 2005-2008, we identified an average of 7868 P&I excess hospitalizations and 22,994 R&C hospitalizations per year, resulting in an influenza-associated hospitalization rate of 2/10,000 person-years (95% CI 1-3/10,000 person-years) for P&I and 6/10,000 person-years (95% CI 3-8/10,000 person-years) for R&C. CONCLUSION Our findings suggest that annual rates of influenza-associated hospitalizations and death in Argentina were substantial and similar to neighboring Brazil.
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Nzussouo NT, Kadjo HA, Coulibaly D, Ekaza E, Kouakou B, N'Golo DC, Tempia S, Davis R, Dosso M, Thompson M. Comparing Influenza Positivity Rates by Real-Time RT-PCR, Elisa and Viral Culture Methods in Côte D'Ivoire, West Africa, in 2009. Afr J Infect Dis 2013; 7:31-35. [PMID: 28451079 DOI: 10.4314/ajid.v7i2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Detection of circulating influenza strains is a key public health concern especially in limited-resource settings where diagnosis capabilities remain a challenge. As part of multi-site surveillance in Côte d'Ivoire during the 2009 influenza A(H1N1) pandemic, we had the opportunity to test respiratory specimens collected from patients with acute respiratory illness (ARI). We analyzed and compared the percentage of specimens testing positive using three laboratory methods (rtRT-PCR, ELISA, viral culture). From January to October 2009, 1,356 respiratory specimens were collected from patients with acute respiratory illness and shipped at the WHO NIC (Institut Pasteur) Cote d'Ivoire, and 453 (33%) tested positive for influenza by one or more laboratory methods. The proportion of positive influenza tests did not differ by the sex or age of the patient or presenting symptoms, but did differ depending on the timing and site of specimen collection. Of the 453 positive specimens, 424 (93.6%) were detected by PCR, 199 (43.9%) by ELISA and 40 (8.8%) by viral culture. While seasonal influenza A(H1N1) virus strains were prominent, only four 2009 pandemic influenza A(H1N1) cases were detected. Use of molecular biology method (rtRT-PCR) increased sensitivity and diagnosis capabilities. Among all three methods used, rRT-PCR was the most sensitive and rapid method. More capacity building is still required for viral culture. Need to collect denominator data in order to have an accurate estimate of the burden of influenza. There was delayed introduction of pandemic influenza A(H1N1)2009 in Cote d'Ivoire.
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Affiliation(s)
- Ndahwouh Talla Nzussouo
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), South Africa.,Global Disease Detection and Response Program/U.S.-Naval Medical Research Unit-3 (NAMRU-3), South Africa.,Noguchi Memorial Institute for Medical Research (NMIMR), Room 230 P.O Box LG 581, University of Ghana, Legon, Accra
| | | | - Daouda Coulibaly
- Institut National d'Hygiene Publique, Côte d'Ivoire (INHP); National Institute for Communicable Diseases, South Africa
| | - Euloge Ekaza
- Institut Pasteur Côte d'Ivoire (IPCI), South Africa
| | | | | | - Stefano Tempia
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), South Africa.,Institut National d'Hygiene Publique, Côte d'Ivoire (INHP); National Institute for Communicable Diseases, South Africa
| | - Richard Davis
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), South Africa
| | | | - Mark Thompson
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), South Africa
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Dengue and other common causes of acute febrile illness in Asia: an active surveillance study in children. PLoS Negl Trop Dis 2013; 7:e2331. [PMID: 23936565 PMCID: PMC3723539 DOI: 10.1371/journal.pntd.0002331] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 06/14/2013] [Indexed: 11/25/2022] Open
Abstract
Background Common causes of acute febrile illness in tropical countries have similar symptoms, which often mimic those of dengue. Accurate clinical diagnosis can be difficult without laboratory confirmation and disease burden is generally under-reported. Accurate, population-based, laboratory-confirmed incidence data on dengue and other causes of acute fever in dengue-endemic Asian countries are needed. Methods and principal findings This prospective, multicenter, active fever surveillance, cohort study was conducted in selected centers in Indonesia, Malaysia, Philippines, Thailand and Vietnam to determine the incidence density of acute febrile episodes (≥38°C for ≥2 days) in 1,500 healthy children aged 2–14 years, followed for a mean 237 days. Causes of fever were assessed by testing acute and convalescent sera from febrile participants for dengue, chikungunya, hepatitis A, influenza A, leptospirosis, rickettsia, and Salmonella Typhi. Overall, 289 participants had acute fever, an incidence density of 33.6 per 100 person-years (95% CI: 30.0; 37.8); 57% were IgM-positive for at least one of these diseases. The most common causes of fever by IgM ELISA were chikungunya (in 35.0% of in febrile participants) and S. Typhi (in 29.4%). The overall incidence density of dengue per 100 person-years was 3.4 by nonstructural protein 1 (NS1) antigen positivity (95% CI: 2.4; 4.8) and 7.3 (95% CI: 5.7; 9.2) by serology. Dengue was diagnosed in 11.4% (95% CI: 8.0; 15.7) and 23.9% (95% CI: 19.1; 29.2) of febrile participants by NS1 positivity and serology, respectively. Of the febrile episodes not clinically diagnosed as dengue, 5.3% were dengue-positive by NS1 antigen testing and 16.0% were dengue-positive by serology. Conclusions During the study period, the most common identified causes of pediatric acute febrile illness among the seven tested for were chikungunya, S. Typhi and dengue. Not all dengue cases were clinically diagnosed; laboratory confirmation is essential to refine disease burden estimates. Acute febrile episodes are common in children living in tropical countries. Diagnosis can be challenging because symptoms of the more common infectious causes are similar and often mimic those of dengue. Asia Pacific has over 70% of the worldwide dengue disease burden, although dengue incidence is generally underestimated because most surveillance systems are passive or based on clinical diagnosis without laboratory confirmation. Understanding the local etiology of febrile illness and the incidence of dengue is important when planning large-scale vaccine trials. This prospective, active fever surveillance, cohort study was carried out in children in five dengue-endemic Asian countries – Indonesia, Malaysia, Philippines, Thailand and Vietnam – during 2010–2011. Acute febrile episodes occurred in 289 (19.3%) of the cohort of 1,500 children. Among the diseases for which antibodies were tested using commercial kits, the top three causes of acute fever were chikungunya, Salmonella Typhi and dengue, followed by influenza A, rickettsia and hepatitis A. Dengue was confirmed in 11.4% of the febrile children by viral protein detection and in 23.9% by serology. Clinical diagnosis was not sufficient to detect all dengue cases. These findings are of relevance to those planning clinical studies of vaccines against these infectious agents in Southeast Asia.
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Rhodes J, Dejsirilert S, Maloney SA, Jorakate P, Kaewpan A, Salika P, Akarachotpong T, Prapasiri P, Naorat S, Areerat P, Ruayajin A, Sawanpanyalert P, Akarasewi P, Peruski LF, Baggett HC. Pneumococcal Bacteremia Requiring Hospitalization in Rural Thailand: An Update on Incidence, Clinical Characteristics, Serotype Distribution, and Antimicrobial Susceptibility, 2005-2010. PLoS One 2013; 8:e66038. [PMID: 23840395 PMCID: PMC3694083 DOI: 10.1371/journal.pone.0066038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/30/2013] [Indexed: 11/21/2022] Open
Abstract
Background Streptococcus pneumoniae is an important cause of morbidity and mortality in Southeast Asia, but regional data is limited. Updated burden estimates are critical as pneumococcal conjugate vaccine (PCV) is highly effective, but not yet included in the Expanded Program on Immunization of Thailand or neighboring countries. Methods We implemented automated blood culture systems in two rural Thailand provinces as part of population-based surveillance for bacteremia. Blood cultures were collected from hospitalized patients as clinically indicated. Results From May 2005– March 2010, 196 cases of pneumococcal bacteremia were confirmed in hospitalized patients. Of these, 57% had clinical pneumonia, 20% required mechanical ventilation, and 23% (n = 46) died. Antibiotic use before blood culture was confirmed in 25% of those with blood culture. Annual incidence of hospitalized pneumococcal bacteremia was 3.6 per 100,000 person-years; rates were higher among children aged <5 years at 11.7 and adults ≥65 years at 14.2, and highest among infants <1 year at 33.8. The median monthly case count was higher during December–March compared to the rest of the year 6.0 vs. 1.0 (p<0.001). The most common serotypes were 23F (16%) and 14 (14%); 61% (74% in patients <5 years) were serotypes in the 10-valent PCV (PCV 10) and 82% (92% in <5 years) in PCV 13. All isolates were sensitive to penicillin, but non-susceptibility was high for co-trimoxazole (57%), erythromycin (30%), and clindamycin (20%). Conclusions We demonstrated a high pneumococcal bacteremia burden, yet underestimated incidence because we captured only hospitalized cases, and because pre-culture antibiotics were frequently used. Our findings together with prior research indicate that PCV would likely have high serotype coverage in Thailand. These findings will complement ongoing cost effectiveness analyses and support vaccine policy evaluation in Thailand and the region.
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Affiliation(s)
- Julia Rhodes
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- * E-mail:
| | - Surang Dejsirilert
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Susan A. Maloney
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Possawat Jorakate
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Anek Kaewpan
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Prasert Salika
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Thantapat Akarachotpong
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Prabda Prapasiri
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Sathapana Naorat
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Peera Areerat
- Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | | | | | | | - Leonard F. Peruski
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Henry C. Baggett
- International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
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Sam IC, Shaw R, Chan YF, Hooi PS, Hurt AC, Barr IG. Seroprevalence of Seasonal and Pandemic Influenza A in Kuala Lumpur, Malaysia in 2008-2010. J Med Virol 2013; 85:1420-5. [DOI: 10.1002/jmv.23622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/07/2022]
Affiliation(s)
- I-Ching Sam
- Department of Medical Microbiology; Tropical Infectious Diseases Research and Education Centre, University Malaya; Kuala Lumpur Malaysia
| | - Robert Shaw
- WHO Collaborating Centre for Reference and Research on Influenza; Melbourne Australia
| | - Yoke-Fun Chan
- Department of Medical Microbiology; Tropical Infectious Diseases Research and Education Centre, University Malaya; Kuala Lumpur Malaysia
| | - Poh-Sim Hooi
- Diagnostic Virology Laboratory; University Malaya Medical Centre; Kuala Lumpur Malaysia
| | - Aeron C. Hurt
- WHO Collaborating Centre for Reference and Research on Influenza; Melbourne Australia
| | - Ian G. Barr
- WHO Collaborating Centre for Reference and Research on Influenza; Melbourne Australia
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Kosasih H, R, N, Klimov A, Xiyan X, Lindstrom S, Mahoney F, Beckett C, Burgess TH, Blair PJ, Uyeki TM, Sedyaningsih ER. Surveillance of influenza in Indonesia, 2003–2007. Influenza Other Respir Viruses 2013; 7:312-20. [PMID: 22804910 PMCID: PMC5779827 DOI: 10.1111/j.1750-2659.2012.00403.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Longitudinal data are limited about the circulating strains of influenza viruses and their public health impact in Indonesia. We conducted influenza surveillance among outpatients and hospitalized patients with influenza-like illness (ILI) across the Indonesian archipelago from 2003 through 2007. METHODOLOGY Demographic, clinical data, and respiratory specimens were collected for 4236 ILI patients tested for influenza virus infection by RT-PCR and viral culture. PRINCIPAL FINDINGS Influenza A and B viruses co-circulated year-round with seasonal peaks in influenza A virus activity during the rainy season (December–January). During 2003–2007, influenza viruses were identified in 20·1% (4236 ⁄ 21 030) of ILI patients, including 20·1% (4015 ⁄ 20 012) of outpatients, and 21·7% (221 ⁄ 1018) of inpatients. One H5N1 case was identified retrospectively in an outpatient with ILI. Antigenic drift in circulating influenza A and B virus strains was detected during the surveillance period in Indonesia. In a few instances, antigenically drifted viruses similar to the World Health Organization (WHO) vaccine strains were detected earlier than the date of their designation by WHO. CONCLUSIONS Influenza A and B virus infections are an important cause of influenza-like illness among outpatients and hospitalized patients in Indonesia. While year-round circulation of influenza viruses occurs, prevention and control strategies should be focused upon the seasonal peak during rainy season months. Ongoing virologic surveillance and influenza disease burden studies in Indonesia are important priorities to better understand the public health impact of influenza in South-East Asia and the implications of influenza viral evolution and global spread.
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Affiliation(s)
- Herman Kosasih
- Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
- U.S. Naval Medical Research Unit (NAMRU), Jakarta, Indonesia
| | - Roselinda
- Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Nurhayati
- U.S. Naval Medical Research Unit (NAMRU), Jakarta, Indonesia
| | - Alexander Klimov
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Xu Xiyan
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Stephen Lindstrom
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
| | - Frank Mahoney
- U.S. Centers for Disease Control and Prevention, Jakarta, Indonesia
| | | | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Timothy M. Uyeki
- U.S. Centers for Disease Control and Prevention, Influenza Division, Atlanta, GA, USA
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Kieffer A, Paboriboune P, Crépey P, Flaissier B, Souvong V, Steenkeste N, Salez N, Babin FX, Longuet C, Carrat F, Flahault A, de Lamballerie X. 2009 A(H1N1) seroconversion rates and risk factors among the general population in Vientiane Capital, Laos. PLoS One 2013; 8:e61909. [PMID: 23637928 PMCID: PMC3630132 DOI: 10.1371/journal.pone.0061909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 03/14/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess 2009 A(H1N1) seroconversion rates and their determinants within an unvaccinated population in Vientiane Capital, Laos. METHODS CoPanFlu Laos, a general population cohort of 807 households and 4,072 participants was established in March 2010. Sociodemographic data, epidemiological data, and capillary blood samples were collected from all the household members in March, and again in October 2010, in order to assess the level of antibodies to 2009 A(H1N1) with the haemagglutination inhibition assay. 2009 A(H1N1) seroconversion was defined as a fourfold or greater increase in titre between inclusion and follow-up. Determinants for pandemic influenza infection were studied using the generalized estimating equations model, taking household clustering into account. RESULTS Between March and November 2010, 3,524 paired sera were tested. Prior to the pandemic, our cohort was almost completely vaccine-naive for seasonal influenza. The overall seroconversion rate among nonvaccinated individuals (n = 2,810) was 14.3% (95%CI [13.0, 15.6]), with the highest rate for participants under 20 yo (19.8%, 95%CI [17.4, 22.4]) and the lowest rate for participants over 60 yo (6.5%, 95%CI [3.7, 10.4]). Participants with lower baseline titres had significantly higher infection rates, with a dose-effect relationship. Odds ratios (ORs) ranged from 76.5 (95%CI [27.1, 215.8]), for those with a titre at inclusion of 1∶10, to 8.1 (95%CI [3.3, 20.4]), for those with a titre of 1∶40. Having another household member with a titre ≥1∶80 was associated with a higher likelihood of immunity (OR = 3.3, 95%CI [2.8, 3.9]). CONCLUSION The determinants and age distribution for seroconversion within a vaccine-naive population were similar to those found in developed countries. This pandemic was characterized by strong epidemiological determinants, regardless of geographical zone and level of development. Moreover, we detected pre-existing cross-reacting antibodies in participants over 60 yo, which could not have originated from former multiple vaccination as has been suggested elsewhere.
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Affiliation(s)
- Alexia Kieffer
- UMR 190, Aix-Marseille Université - IRD - EHESP, Marseille, France.
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Niang MN, Dosseh A, Ndiaye K, Sagna M, Gregory V, Goudiaby D, Hay A, Diop OM. Sentinel surveillance for influenza in Senegal, 1996-2009. J Infect Dis 2013; 206 Suppl 1:S129-35. [PMID: 23169958 DOI: 10.1093/infdis/jis576] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on influenza in tropical and resource-limited countries are scarce. In this study we present results from 14 years of influenza surveillance in Senegal, one of the few tropical countries in Africa from which longitudinal data are available. METHODS From 1996 to 2009, we collected respiratory specimens from outpatients presenting with influenza-like illness at 13 facilities in order to investigate the epidemiology of seasonal influenza and the characteristics of the circulating influenza viruses. Specimens were tested for influenza using viral isolation and/or reverse-transcription polymerase chain reaction (RT-PCR). RESULTS From 1996 to 2009, specimens were obtained from 9176 patients; 1233 (13%) were influenza-positive by virus isolation and/or RT-PCR. Among positive samples, 958 (77%) were influenza A, 268 (22%) influenza B, and 7 (1%) influenza type C; of influenza A viruses, 619 (65%) were A(H3) and 339 (35%) A(H1), of which 13 (1%) were identified as H1N2. The proportion positive was similar for children <15 years, young adults 16-35 years, and adults 36-55 years (15%), but lower for persons >55 years (9%). Although influenza A(H1), A(H3), and B all circulated during most years, influenza A(H3N2) predominated during 9 of the 14 years. Influenza activity consistently peaked during the rainy season (July-September). Phylogenetic analysis showed that viruses circulating in Senegal were similar to contemporary viruses circulating elsewhere in the world. CONCLUSIONS Our data confirm that influenza is prevalent in Senegal, occurs in seasonal epidemics, and contributes to the burden of respiratory diseases in all age groups.
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Sentinel surveillance of influenza and other respiratory viruses, Brazil, 2000-2010. Braz J Infect Dis 2013; 17:62-8. [PMID: 23287541 PMCID: PMC9427376 DOI: 10.1016/j.bjid.2012.09.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/19/2012] [Accepted: 09/03/2012] [Indexed: 11/23/2022] Open
Abstract
There are scanty data on the epidemiology of influenza and other respiratory viruses in South America and Brazil. The aim of this study was to summarize the data from the Brazilian surveillance system of influenza and other respiratory viruses and discuss the patterns of viral circulation. The system is based on detecting cases of influenza-like illness in sentinel sites and weekly collection of five nasopharyngeal secretions samples, which are processed in state public health laboratories for respiratory viruses by indirect immunofluorescence assay. Data from 2000 to 2010 were described over time, by region, gender, and age group, and an analysis of Spearman correlation was performed between monthly influenza detection and rainfall and temperature data in two state capitals with the highest number of positive samples, one from the northeast region (Maceió) and other from the southern region (Curitiba). There were 3,291,946 visits for influenza-like illness; of these, 37,120 had samples collected and 6421 tested positive: 1690 (26%) influenza A, 567 (9%) influenza B, 277 (4%) parainfluenza 1, 571 (9%) parainfluenza 2, 589 (9%) parainfluenza 3, 742 (12%) adenovirus, and 1985 (31%) respiratory syncytial virus. Overall, increased activity of respiratory syncytial virus was observed from March to June, preceding the peak of influenza activity, from May to August, but with regional differences. In Maceió, there was a weak correlation between temperature and influenza detection (ρ=0.05), but a moderate positive correlation between rainfall and influenza detection (ρ=0.36). In Curitiba, a high correlation was observed between the decrease in temperature and rainfall and the increase in influenza detection (ρ=-0.83 and -0.78 respectively). These data are important to guide public health control measures as the best time for influenza vaccination and use of antivirals.
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Incidence and epidemiology of hospitalized influenza cases in rural Thailand during the influenza A (H1N1)pdm09 pandemic, 2009-2010. PLoS One 2012; 7:e48609. [PMID: 23139802 PMCID: PMC3490866 DOI: 10.1371/journal.pone.0048609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 09/27/2012] [Indexed: 11/25/2022] Open
Abstract
Background Data on the burden of the 2009 influenza pandemic in Asia are limited. Influenza A(H1N1)pdm09 was first reported in Thailand in May 2009. We assessed incidence and epidemiology of influenza-associated hospitalizations during 2009–2010. Methods We conducted active, population-based surveillance for hospitalized cases of acute lower respiratory infection (ALRI) in all 20 hospitals in two rural provinces. ALRI patients were sampled 1∶2 for participation in an etiology study in which nasopharyngeal swabs were collected for influenza virus testing by PCR. Results Of 7,207 patients tested, 902 (12.5%) were influenza-positive, including 190 (7.8%) of 2,436 children aged <5 years; 86% were influenza A virus (46% A(H1N1)pdm09, 30% H3N2, 6.5% H1N1, 3.5% not subtyped) and 13% were influenza B virus. Cases of influenza A(H1N1)pdm09 first peaked in August 2009 when 17% of tested patients were positive. Subsequent peaks during 2009 and 2010 represented a mix of influenza A(H1N1)pdm09, H3N2, and influenza B viruses. The estimated annual incidence of hospitalized influenza cases was 136 per 100,000, highest in ages <5 years (477 per 100,000) and >75 years (407 per 100,000). The incidence of influenza A(H1N1)pdm09 was 62 per 100,000 (214 per 100,000 in children <5 years). Eleven influenza-infected patients required mechanical ventilation, and four patients died, all adults with influenza A(H1N1)pdm09 (1) or H3N2 (3). Conclusions Influenza-associated hospitalization rates in Thailand during 2009–10 were substantial and exceeded rates described in western countries. Influenza A(H1N1)pdm09 predominated, but H3N2 also caused notable morbidity. Expanded influenza vaccination coverage could have considerable public health impact, especially in young children.
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Clara W, Armero J, Rodriguez D, de Lozano C, Bonilla L, Minaya P, Chacón R, Jara J, Blanco N, Widdowson MA, Bresee J, Xu X, Klimov A, Azziz-Baumgartner E, Linares-Perez N. Estimated incidence of influenza-virus-associated severe pneumonia in children in El Salvador, 2008-2010. Bull World Health Organ 2012; 90:756-63. [PMID: 23109743 DOI: 10.2471/blt.11.098202] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 07/05/2012] [Accepted: 07/10/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the incidence of influenza-virus-associated severe pneumonia among Salvadorian children aged < 5 years. METHODS Data on children aged < 5 years admitted with severe pneumonia to a sentinel hospital in the western region were collected weekly. Nasal and oropharyngeal swab specimens were collected from a convenience sample of case patients for respiratory virus testing. A health-care utilization survey was conducted in the hospital catchment area to determine the proportion of residents who sought care at the hospital. The incidence of influenza-virus-associated severe pneumonia among all Salvadorian children aged < 5 years was estimated from surveillance and census data, with adjustment for health-care utilization. Influenza virus strains were characterized by the United States Centers for Disease Control and Prevention to determine their correspondence with northern and southern hemisphere influenza vaccine formulations. FINDINGS Physicians identified 2554 cases of severe pneumonia. Samples from 608 cases were tested for respiratory viruses and 37 (6%) were positive for influenza virus. The estimated incidence of influenza-virus-associated severe pneumonia was 3.2 cases per 1000 person-years (95% confidence interval, CI: 2.8-3.7) overall, 1.5 cases per 1000 person-years (95% CI: 1.0-2.0) during 2008, 7.6 cases per 1000 person-years (95% CI: 6.5-8.9) during 2009 and 0.6 cases per 1000 person-years (95% CI: 0.3-1.0) during 2010. Northern and southern hemisphere vaccine formulations matched influenza virus strains isolated during 2008 and 2010. CONCLUSION Influenza-virus-associated severe pneumonia occurred frequently among young Salvadorian children during 2008-2010. Antigens in northern and southern hemisphere influenza vaccine formulations corresponded to circulating strains.
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Affiliation(s)
- Wilfrido Clara
- Centers for Disease Control and Prevention, Central American Region (CDC-CAR), Embassy of the United States in San Salvador El Salvador, Final Blvd Santa Elena, Antiguo Cuscatlan, La Libertad, El Salvador.
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Khamphaphongphane B, Ketmayoon P, Lewis HC, Phonekeo D, Sisouk T, Xayadeth S, Ongkhammy S, Vongphrachanh P, Tsuyuoka R, Moen A, Corwin A. Epidemiological and virological characteristics of seasonal and pandemic influenza in Lao PDR, 2008-2010. Influenza Other Respir Viruses 2012; 7:304-11. [PMID: 22716289 PMCID: PMC5779841 DOI: 10.1111/j.1750-2659.2012.00394.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Information on influenza virology and epidemiology from Lao PDR is limited and the seasonal patterns of influenza have not been previously described. Objectives To describe epidemiological and virologic characteristics of influenza in Lao PDR to recommend public health interventions, including improvements in surveillance and response. Patients/Methods We performed a descriptive analysis of samples taken from patients with influenza‐like‐illness (ILI) (fever >38°C with cough and/or sore throat) presenting at seven sentinel hospitals in three regions of Lao PDR, January 2008–December 2010. A nasopharyngeal (NP) swab or combined nasal with oropharyngeal swab was collected from patients with ILI. Samples were tested for influenza by either Luminex RVP, conventional reverse transcriptase PCR (RT‐PCR) (January 2008–2009), or by real‐time PCR (rRT‐PCR) using US CDC reagents (February 2009 onward). Results Of 2346 samples tested from patients with ILI, 523 (22%) were positive for influenza. The median age of those positive was 12 years (range, <1–60 year). The percentage of samples that were influenza positive was similar over the 3 years (20–23%). Each year 3–4 types/subtypes cocirculated with differing predominant type/subtype. Influenza was detected year‐round with the highest proportion of positive specimens in the 3rd and 4th quarter. Conclusions Similar to other countries in the region, we found that influenza is present year‐round and has a peak activity from July to December. Dominant types or subtypes vary by year. A large proportion of patients with ILI are not influenza positive. ILI surveillance is critical for weighing disease burden, both morbidity and mortality, against the costs of advancing influenza vaccine delivery strategy.
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Affiliation(s)
- Bouaphanh Khamphaphongphane
- National Center for Laboratory and Epidemiology, Ministry of Health, Vientiane, Lao People's Democratic Republic
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Wang XL, Yang L, Chan KP, Chiu SS, Chan KH, Peiris JSM, Wong CM. Model selection in time series studies of influenza-associated mortality. PLoS One 2012; 7:e39423. [PMID: 22745751 PMCID: PMC3380027 DOI: 10.1371/journal.pone.0039423] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 05/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poisson regression modeling has been widely used to estimate influenza-associated disease burden, as it has the advantage of adjusting for multiple seasonal confounders. However, few studies have discussed how to judge the adequacy of confounding adjustment. This study aims to compare the performance of commonly adopted model selection criteria in terms of providing a reliable and valid estimate for the health impact of influenza. METHODS We assessed four model selection criteria: quasi Akaike information criterion (QAIC), quasi bayesian information criterion (QBIC), partial autocorrelation functions of residuals (PACF), and generalized cross-validation (GCV), by separately applying them to select the Poisson model best fitted to the mortality datasets that were simulated under the different assumptions of seasonal confounding. The performance of these criteria was evaluated by the bias and root-mean-square error (RMSE) of estimates from the pre-determined coefficients of influenza proxy variable. These four criteria were subsequently applied to an empirical hospitalization dataset to confirm the findings of simulation study. RESULTS GCV consistently provided smaller biases and RMSEs for the influenza coefficient estimates than QAIC, QBIC and PACF, under the different simulation scenarios. Sensitivity analysis of different pre-determined influenza coefficients, study periods and lag weeks showed that GCV consistently outperformed the other criteria. Similar results were found in applying these selection criteria to estimate influenza-associated hospitalization. CONCLUSIONS GCV criterion is recommended for selection of Poisson models to estimate influenza-associated mortality and morbidity burden with proper adjustment for confounding. These findings shall help standardize the Poisson modeling approach for influenza disease burden studies.
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Affiliation(s)
- Xi-Ling Wang
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lin Yang
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- * E-mail:
| | - King-Pan Chan
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Susan S. Chiu
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Hung Chan
- Department of microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - J. S. Malik Peiris
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
- The University of Hong Kong Pasteur Research Center, Hong Kong Special Administrative Region, China
| | - Chit-Ming Wong
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Horby P, Mai LQ, Fox A, Thai PQ, Thi Thu Yen N, Thanh LT, Le Khanh Hang N, Duong TN, Thoang DD, Farrar J, Wolbers M, Hien NT. The epidemiology of interpandemic and pandemic influenza in Vietnam, 2007-2010: the Ha Nam household cohort study I. Am J Epidemiol 2012; 175:1062-74. [PMID: 22411862 PMCID: PMC3353138 DOI: 10.1093/aje/kws121] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective community-based studies have provided fundamental insights into the epidemiology of influenza in temperate regions, but few comparable studies have been undertaken in the tropics. The authors conducted prospective influenza surveillance and intermittent seroprevalence surveys in a household-based cohort in Vietnam between December 2007 and April 2010, resulting in 1,793 person-seasons of influenza surveillance. Age- and sex-standardized estimates of the risk of acquiring any influenza infection per season in persons 5 years of age or older were 21.1% (95% confidence interval: 17.4, 24.7) in season 1, 26.4% (95% confidence interval: 22.6, 30.2) in season 2, and 17.0% (95% confidence interval: 13.6, 20.4) in season 3. Some individuals experienced multiple episodes of infection with different influenza types/subtypes in the same season (n = 27) or reinfection with the same subtype in different seasons (n = 22). The highest risk of influenza infection was in persons 5-9 years old, in whom the risk of influenza infection per season was 41.8%. Although the highest infection risk was in school-aged children, there were important heterogeneities in the age of infection by subtype and season. These heterogeneities could influence the impact of school closure and childhood vaccination on influenza transmission in tropical areas, such as Vietnam.
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Affiliation(s)
- Peter Horby
- Oxford University Clinical Research Unit, National Hospital of Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam.
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Abstract
Collaborative capacity serves for organizations as the capacity to collaborate with other network players. Organizational capacity matters as collaboration outcomes usually go beyond single-shot implementation efforts or a single-minded focus on either the vertical dimension of program or the horizontal component. This review article explores organizational collaborative capacities from the perspective of public management, in particular, network theory. By applying the 5 attributes of network theory—interdependence, membership, resources, information, and learning—to the explanation of collaborative capacity in fighting pandemic crises, I argue in some ways organizational collaborative capacity is very much like an organization in its own right. Studying collaborative capacity in the battle against pandemics facilitate our understanding of multisectoral collaboration in technical, political, and institutional dimensions, and greatly advances the richness of capacity vocabulary in pandemic response and preparedness.
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Broor S, Krishnan A, Roy DS, Dhakad S, Kaushik S, Mir MA, Singh Y, Moen A, Chadha M, Mishra AC, Lal RB. Dynamic patterns of circulating seasonal and pandemic A(H1N1)pdm09 influenza viruses from 2007-2010 in and around Delhi, India. PLoS One 2012; 7:e29129. [PMID: 22235265 PMCID: PMC3250412 DOI: 10.1371/journal.pone.0029129] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 11/21/2011] [Indexed: 01/03/2023] Open
Abstract
Influenza surveillance was carried out in a subset of patients with influenza-like illness (ILI) presenting at an Employee Health Clinic (EHS) at All India Institute of Medical Sciences (AIIMS), New Delhi (urban) and pediatric out patients department of civil hospital at Ballabhgarh (peri-urban), under the Comprehensive Rural Health Services Project (CRHSP) of AIIMS, in Delhi region from January 2007 to December 2010. Of the 3264 samples tested, 541 (17%) were positive for influenza viruses, of which 221 (41%) were pandemic Influenza A(H1N1)pdm09, 168 (31%) were seasonal influenza A, and 152 (28%) were influenza B. While the Influenza viruses were detected year-round, their types/subtypes varied remarkably. While there was an equal distribution of seasonal A(H1N1) and influenza B in 2007, predominance of influenza B was observed in 2008. At the beginning of 2009, circulation of influenza A(H3N2) viruses was observed, followed later by emergence of Influenza A(H1N1)pdm09 with co-circulation of influenza B viruses. Influenza B was dominant subtype in early 2010, with second wave of Influenza A(H1N1)pdm09 in August-September, 2010. With the exception of pandemic H1N1 emergence in 2009, the peaks of influenza activity coincided primarily with monsoon season, followed by minor peak in winter at both urban and rural sites. Age group analysis of influenza positivity revealed that the percent positivity of Influenza A(H1N1)pdm09 influenza virus was highest in >5-18 years age groups (OR 2.5; CI = 1.2-5.0; p = 0.009) when compared to seasonal influenza. Phylogenetic analysis of Influenza A(H1N1)pdm09 from urban and rural sites did not reveal any major divergence from other Indian strains or viruses circulating worldwide. Continued surveillance globally will help define regional differences in influenza seasonality, as well as, to determine optimal periods to implement influenza vaccination programs among priority populations.
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Affiliation(s)
- Shobha Broor
- All India Institute of Medical Sciences, Delhi, India.
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Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, Simmerman JM, Gordon A, Sato M, Howie S, Krishnan A, Ope M, Lindblade KA, Carosone-Link P, Lucero M, Ochieng W, Kamimoto L, Dueger E, Bhat N, Vong S, Theodoratou E, Chittaganpitch M, Chimah O, Balmaseda A, Buchy P, Harris E, Evans V, Katayose M, Gaur B, O'Callaghan-Gordo C, Goswami D, Arvelo W, Venter M, Briese T, Tokarz R, Widdowson MA, Mounts AW, Breiman RF, Feikin DR, Klugman KP, Olsen SJ, Gessner BD, Wright PF, Rudan I, Broor S, Simões EAF, Campbell H. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet 2011; 378:1917-30. [PMID: 22078723 DOI: 10.1016/s0140-6736(11)61051-9] [Citation(s) in RCA: 662] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years. METHODS We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality. FINDINGS We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49-162 million) new cases of influenza (data from nine studies), 20 million (13-32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1-2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28,000-111,500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting. INTERPRETATION Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available. FUNDING WHO; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK.
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Azziz-Baumgartner E, Alamgir ASM, Rahman M, Homaira N, Sohel BM, Sharker MAY, Zaman RU, Dee J, Gurley ES, Al Mamun A, Mah-E-Muneer S, Fry AM, Widdowson MA, Bresee J, Lindstrom S, Azim T, Brooks A, Podder G, Hossain MJ, Rahman M, Luby SP. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008-2010. Bull World Health Organ 2011; 90:12-9. [PMID: 22271960 DOI: 10.2471/blt.11.090209] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/12/2011] [Accepted: 08/22/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine how much influenza contributes to severe acute respiratory illness (SARI), a leading cause of death in children, among people of all ages in Bangladesh. METHODS Physicians obtained nasal and throat swabs to test for influenza virus from patients who were hospitalized within 7 days of the onset of severe acute respiratory infection (SARI) or who consulted as outpatients for influenza-like illness (ILI). A community health care utilization survey was conducted to determine the proportion of hospital catchment area residents who sought care at study hospitals and calculate the incidence of influenza using this denominator. FINDINGS The estimated incidence of SARI associated with influenza in children < 5 years old was 6.7 (95% confidence interval, CI: 0-18.3); 4.4 (95% CI: 0-13.4) and 6.5 per 1000 person-years (95% CI: 0-8.3/1000) during the 2008, 2009 and 2010 influenza seasons, respectively. The incidence of SARI in people aged ≥ 5 years was 1.1 (95% CI: 0.4-2.0) and 1.3 (95% CI: 0.5-2.2) per 10,000 person-years during 2009 and 2010, respectively. The incidence of medically attended, laboratory-confirmed seasonal influenza in outpatients with ILI was 10 (95% CI: 8-14), 6.6 (95% CI: 5-9) and 17 per 100 person-years (95% CI: 13-22) during the 2008, 2009 and 2010 influenza seasons, respectively. CONCLUSION Influenza-like illness is a frequent cause of consultation in the outpatient setting in Bangladesh. Children aged less than 5 years are hospitalized for influenza in greater proportions than children in other age groups.
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Affiliation(s)
- Eduardo Azziz-Baumgartner
- International Centre for Diarrhoeal Disease Research, 68, Shaheed Tajuddin Ahmed, Sarani, Mohakhali, Dhaka 1212, Bangladesh.
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Gessner BD, Shindo N, Briand S. Seasonal influenza epidemiology in sub-Saharan Africa: a systematic review. THE LANCET. INFECTIOUS DISEASES 2011; 11:223-35. [PMID: 21371656 DOI: 10.1016/s1473-3099(11)70008-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Acute respiratory infection (ARI) is a leading cause of mortality worldwide, of which influenza is an important cause that can be prevented with vaccination. We did a systematic review of research published from 1980 to 2009 on seasonal influenza epidemiology in sub-Saharan Africa to identify data strengths and weaknesses that might affect policy decisions, to assess the state of knowledge on influenza disease burden, and to ascertain unique features of influenza epidemiology in the region. We assessed 1203 papers, reviewed 104, and included 49 articles. 1-25% of outpatient ARI visits were caused by influenza (11 studies; mean 9·5%; median 10%), whereas 0·6-15·6% of children admitted to hospital for ARI had influenza identified (15 studies; mean 6·6%; median 6·3%). Influenza was highly seasonal in southern Africa. Other data were often absent, particularly direct measurement of influenza incidence rates for all ages, within different patient settings (outpatient, inpatient, community), and for all countries. Data from sub-Saharan Africa are insufficient to allow most countries to prioritise strategies for influenza prevention and control. Key data gaps include incidence and case-fatality ratios for all ages, the contribution of influenza towards admission of adults to hospital for ARI, representative seasonality data, economic burden, and the interaction of influenza with prevalent disorders in Africa, such as malaria, HIV, and malnutrition.
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Koul PA, Mir MA, Bali NK, Chawla-Sarkar M, Sarkar M, Kaushik S, Khan UH, Ahmad F, Garten R, Lal RB, Broor S. Pandemic and seasonal influenza viruses among patients with acute respiratory illness in Kashmir (India). Influenza Other Respir Viruses 2011; 5:e521-7. [PMID: 21668665 PMCID: PMC5780669 DOI: 10.1111/j.1750-2659.2011.00261.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Please cite this paper as: Koul PA., et al. (2011) Pandemic and seasonal influenza viruses among patients with acute respiratory illness in Kashmir (India). Influenza and Other Respiratory Viruses 5(6), e521–e527. Background With the emergence of pandemic influenza A (2009A/H1N1) virus in India, we sought to determine the prevalence and clinical presentations of seasonal and pandemic influenza viruses among acute respiratory illness (ARI) patients from Srinagar, a temperate climate area in northern India, during the peak winter season. Methods Combined throat and nasal swabs, obtained from 194 (108 male) presenting with ARI from January to March 2010 (Week 53‐week 10), were tested by RT‐PCR for influenza A and B, including 2009A/H1N1 viruses. HA1 gene of selected 2009A/H1N1‐positive samples was sequenced, and phylogenetic analysis was carried out. Results Twenty‐one (10·8%, age 15–80 years, median age 40 years) patients tested positive for influenza viruses: 13 (62%) for 2009A/H1N1 virus, 6 (28·5%) for seasonal influenza A (H3N2), and 2 (9·5%) for influenza B. Twelve of the 13 patients with 2009A/H1N1 presented with febrile ARI, and eight had associated comorbidities. All of the patients recovered. Phylogenetic analysis of HA gene (n = 8) revealed that all strains from Srinagar clustered in 2009A/H1N1 clade seven along with the other 2009A/H1N1 strains from India. Amino acid substitutions in the HA protein defining clade seven (P83S, S203T, and I321V) were found in almost all isolates from Srinagar. Conclusions Both seasonal and 2009A/H1N1 viruses appear to be associated with ARI in Srinagar. The 2009A/H1N1 in Srinagar is genetically similar to globally circulating clade 7 strains, with unique signature sequences in the HA gene. Further investigations into ascertain the role of these mutations in possible alteration of the virulence and transmissibility of the virus are needed.
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Affiliation(s)
- Parvaiz A Koul
- Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
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Bennett B, Carney T. Pandemic preparedness in Asia: a role for law and ethics? Asia Pac J Public Health 2011; 23:419-30. [PMID: 21551132 DOI: 10.1177/1010539511408411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of pandemic influenza relies on complex coordination of many different dimensions of the health and social care systems, emergency services, levels of national and local government, civil society, communications and media, and cultural expectations. Law is one small but important component of those arrangements, which touch on fundamental ethical debates. This review demonstrates that the Asian region is actively engaging those issues in diverse ways in light of their varied socioeconomic and cultural backgrounds, but scope remains for prioritising further research into these relationships.
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Affiliation(s)
- Belinda Bennett
- Faculty of Law, University of Sydney, Sydney, New South Wales, Australia.
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