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Bishop K, Meiring S, Tempia S, von Gottberg A, Wolter N, Kleynhans J, Moosa F, du Plessis M, Moyes J, Makhasi M, Chuene B, Samuels A, Dawood H, Reubenson G, Zar H, Quan V, Cohen C, Walaza S. Risk Factors for Severe COVID-19 Among Children and Adolescents Enrolled in Acute Respiratory Infection Sentinel Surveillance in South Africa, 2020-2022. Influenza Other Respir Viruses 2024; 18:e13300. [PMID: 38666359 PMCID: PMC11046310 DOI: 10.1111/irv.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Identifying children at risk for severe COVID-19 disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may guide future mitigation interventions. Using sentinel surveillance data, we aimed to identify risk factors for SARS-CoV-2-associated hospitalisation among patients aged ≤ 18 years with respiratory illness. METHODS From April 2020 to March 2022, patients meeting study case definitions were enrolled at four outpatient influenza-like illness (ILI) and five inpatient severe respiratory infection (SRI) surveillance sites and tested for SARS-CoV-2 infection using polymerase chain reaction (PCR). Each ILI clinic shared a catchment area with its corresponding SRI hospital. Potential risk factors for SARS-CoV-2-associated hospitalisation were analysed using multivariable logistic regression by comparing inpatient versus outpatient SARS-CoV-2 cases. RESULTS Of 4688 participants aged ≤ 18 years, 4556 (97%) with complete PCR and HIV data were included in the analysis. Among patients with ILI and SRI, 92/1145 (8%) and 154/3411 (5%) tested SARS-CoV-2 positive, respectively. Compared to outpatients, hospitalised SARS-CoV-2 cases were associated with age < 6 months ([adjusted odds ratio (aOR) 8.0, 95% confidence interval (CI) 2.7-24.0] versus 1-4 years); underlying medical condition other than HIV [aOR 5.8, 95% CI 2.3-14.6]; laboratory-confirmed Omicron BA.1/BA.2 or Delta variant ([aOR 4.9, 95% CI 1.7-14.2] or [aOR 2.8, 95% CI 1.1-7.3] compared to ancestral SARS-CoV-2); and respiratory syncytial virus coinfection [aOR 6.2, 95% CI 1.0-38.5]. CONCLUSION Aligning with previous research, we identified age < 6 months or having an underlying condition as risk factors for SARS-CoV-2-associated SRI hospitalisation and demonstrated the potential of sentinel surveillance to monitor COVID-19 in children.
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Affiliation(s)
- Kate Bishop
- Division of Public Health Surveillance and ResponseNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Susan Meiring
- Division of Public Health Surveillance and ResponseNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- MassGenicsDuluthGeorgiaUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Pathology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Fahima Moosa
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Mvuyo Makhasi
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Boitumelo Chuene
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Aaron M. Samuels
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
- Influenza DivisionNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Halima Dawood
- Infectious Diseases Unit, Department of MedicineGreys HospitalPietermaritzburgKwaZulu‐NatalSouth Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and SA‐MRC Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Vanessa Quan
- Division of Public Health Surveillance and ResponseNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS)JohannesburgSouth Africa
- DST/NRF Vaccine Preventable DiseasesRespiratory and Meningeal Pathogens Research Unit (RMPRU)JohannesburgSouth Africa
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Davids M, Johnstone S, Mendes A, Brecht G, Avenant T, du Plessis N, de Villiers M, Page N, Venter M. Changes in Prevalence and Seasonality of Pathogens Identified in Acute Respiratory Tract Infections in Hospitalised Individuals in Rural and Urban Settings in South Africa; 2018-2022. Viruses 2024; 16:404. [PMID: 38543769 PMCID: PMC10974059 DOI: 10.3390/v16030404] [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: 12/07/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
Severe acute respiratory tract infections (SARIs) has been well described in South Africa with seasonal patterns described for influenza and respiratory syncytial virus (RSV), while others occur year-round (rhinovirus and adenovirus). This prospective syndromic hospital-based surveillance study describes the prevalence and impact of public interventions on the seasonality of other respiratory pathogens during the coronavirus disease-19 (COVID-19) pandemic. This occurred from August 2018 to April 2022, with 2595 patients who met the SARS case definition and 442 controls, from three sentinel urban and rural hospital sites in South Africa. Naso/oro-pharyngeal (NP/OP) swabs were tested using the FastTrack Diagnostics® Respiratory pathogens 33 (RUO) kit. Descriptive statistics, odds ratios, and univariate/multivariate analyses were used. Rhinovirus (14.80%, 228/1540) and Streptococcus pneumoniae (28.50%, 439/1540) were most frequently detected in NP/OP swabs and in children <1 years old (35%, 648/1876). Among others, pathogens associated with SARI cases causing disease were influenza A&B, HRV, RSV, hCoV 229e, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae. Pre-COVID-19, seasonal trends of these pathogens correlated with previous years, with RSV and influenza A seasons only resuming after the national lockdown (2021). It is evident that stringent lockdown conditions have severe impacts on the prevalence of respiratory tract infections.
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Affiliation(s)
- Michaela Davids
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Siobhan Johnstone
- Centre for Enteric Diseases, Virology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (S.J.); (N.P.)
| | - Adriano Mendes
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Gadean Brecht
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Theunis Avenant
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria 0084, South Africa
| | - Nicolette du Plessis
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria 0084, South Africa
| | - Maryke de Villiers
- Department of Internal Medicine, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria 0084, South Africa
| | - Nicola Page
- Centre for Enteric Diseases, Virology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (S.J.); (N.P.)
- Centre of Enteric Diseases, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Marietjie Venter
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
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3
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Wolter N, Tempia S, von Gottberg A, Bhiman JN, Walaza S, Kleynhans J, Moyes J, Aitken S, Magni S, Yun J, Fellows T, Makamadi T, Weiner R, Cawood C, Martinson N, Lebina L, Cohen C. Healthcare utilization during the first two waves of the COVID-19 epidemic in South Africa: A cross-sectional household survey. PLoS One 2023; 18:e0290787. [PMID: 37624826 PMCID: PMC10456221 DOI: 10.1371/journal.pone.0290787] [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: 02/03/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Healthcare utilization surveys contextualize facility-based surveillance data for burden estimates. We describe healthcare utilization in the catchment areas for sentinel site healthcare facilities during the first year of the COVID-19 pandemic. We conducted a cross-sectional healthcare utilization survey in households in three communities from three provinces (KwaZulu-Natal, Western Cape and North West). Field workers administered structured questionnaires electronically with the household members reporting influenza-like illness (ILI) in the past 30 days or severe respiratory illness (SRI) since March 2020. Multivariable logistic regression was used to identify factors associated with healthcare utilization among individuals that reported illness. From November 2020 through April 2021, we enrolled 5804 households and 23,003 individuals. Any respiratory illness was reported by 1.6% of individuals; 0.7% reported ILI only, 0.8% reported SRI only, and 0.1% reported both ILI and SRI. Any form of medical care was sought by 40.8% (95% CI 32.9% - 49.6%) and 71.3% (95% CI 63.2% - 78.6%) of individuals with ILI and SRI, respectively. On multivariable analysis, respiratory illness was more likely to be medically attended for individuals at the Pietermaritzburg site (aOR 3.2, 95% CI 1.1-9.5, compared to Klerksdorp), that were underweight (aOR 11.5, 95% CI 1.5-90.2, compared to normal weight), with underlying illness (aOR 3.2, 95%CI 1.2-8.5), that experienced severe illness (aOR 4.8, 95% CI 1.6-14.3) and those with symptom duration of ≥10 days (aOR 7.9, 95% CI 2.1-30.2, compared to <5 days). Less than half of ILI episodes and only 71% of SRI episodes were medically attended during the first two COVID-19 waves in South Africa. Facility-based data may underestimate disease burden during the COVID-19 pandemic.
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Affiliation(s)
- Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N. Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sue Aitken
- Genesis Analytics, Johannesburg, South Africa
| | - Sarah Magni
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Genesis Analytics, Johannesburg, South Africa
| | - Jessica Yun
- Genesis Analytics, Johannesburg, South Africa
| | | | | | - Renay Weiner
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - Limakatso Lebina
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nyawanda BO, Murunga N, Otieno NA, Bigogo G, Nyiro JU, Vodicka E, Bulterys M, Nokes DJ, Munywoki PK, Emukule GO. Estimates of the national burden of respiratory syncytial virus in Kenyan children aged under 5 years, 2010-2018. BMC Med 2023; 21:122. [PMID: 37004034 PMCID: PMC10067313 DOI: 10.1186/s12916-023-02787-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is among the leading childhood causes of viral pneumonia worldwide. Establishing RSV-associated morbidity and mortality is important in informing the development, delivery strategies, and evaluation of interventions. METHODS Using data collected during 2010-2018 from base regions (population-based surveillance studies in western Kenya and the Kilifi Health and Demographic Surveillance Study), we estimated age-specific rates of acute respiratory illness (ARI), severe acute respiratory illness (SARI-defined as hospitalization with cough or difficulty breathing with onset within the past 10 days), and SARI-associated deaths. We extrapolated the rates from the base regions to other regions of Kenya, while adjusting for risk factors of ARI and healthcare seeking behavior, and finally applied the proportions of RSV-positive cases identified from various sentinel and study facilities to the rates to obtain regional age-specific rates of RSV-associated outpatient and non-medically attended ARI and hospitalized SARI and severe ARI that was not hospitalized (non-hospitalized SARI). We applied age-specific RSV case fatality ratios to SARI to obtain estimates of RSV-associated in- and out-of-hospital deaths. RESULTS Among Kenyan children aged < 5 years, the estimated annual incidence of outpatient and non-medically attended RSV-associated ARI was 206 (95% credible interval, CI; 186-229) and 226 (95% CI; 204-252) per 1000 children, respectively. The estimated annual rates of hospitalized and non-hospitalized RSV-associated SARI were 349 (95% CI; 303-404) and 1077 (95% CI; 934-1247) per 100,000 children respectively. The estimated annual number of in- and out-of-hospital deaths associated with RSV infection in Kenya were 539 (95% CI; 420-779) and 1921 (95% CI; 1495-2774), respectively. Children aged < 6 months had the highest burden of RSV-associated severe disease: 2075 (95% CI; 1818-2394) and 44 (95% CI 25-71) cases per 100,000 children for hospitalized SARI and in-hospital deaths, respectively. CONCLUSIONS Our findings suggest a substantial disease burden due to RSV infection, particularly among younger children. Prioritizing development and use of maternal vaccines and affordable long-lasting monoclonal antibodies could help reduce this burden.
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Affiliation(s)
- Bryan O Nyawanda
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | - Nickson Murunga
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Nancy A Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Joyce U Nyiro
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Marc Bulterys
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - D James Nokes
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
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Guerra-de-Blas PDC, Ortega-Villa AM, Ortiz-Hernández AA, Ramírez-Venegas A, Moreno-Espinosa S, Llamosas-Gallardo B, Pérez-Patrigeon S, Hunsberger S, Magaña M, Valdez-Vázquez R, Freimanis L, Galán-Herrera JF, Guerrero-Almeida ML, Powers JH, Ruiz-Palacios GM, Beigel J, Galindo-Fraga A. Etiology, clinical characteristics, and risk factors associated with severe influenza-like illnesses in Mexican adults. IJID REGIONS 2023; 6:152-158. [PMID: 36865993 PMCID: PMC9972394 DOI: 10.1016/j.ijregi.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
Objective The aim of this study was to determine the risk factors associated with severe influenza-like illness (ILI) in Mexican adults that could be useful to clinicians when assessing patients with ILI. Methods Data from adult patients enrolled from 2010 through 2014 in ILI002 - a prospective hospital-based observational cohort study - were analyzed. Etiology and clinical characteristics were compared between cases of severe ILI (defined as hospitalization and/or death) and cases of non-severe ILI. Results Overall, 1428 (39.0%) out of a total 3664 cases of ILI were classified as severe. Adjusted analyses showed a higher risk of severe ILI associated with signs and symptoms related to lower tract infection, i.e. cough with sputum (odds ratio (OR) 2.037, 95% confidence interval (CI) 1.206-3.477; P = 0.008), dyspnea (OR 5.044, 95% CI 2.99-8.631; and shortness of breath (OR 5.24, 95% CI 3.0839.124; P < 0.001), and with increases in lactate dehydrogenase (OR 4.426, 95% CI 2.321-8.881; P < 0.001) and C-reactive protein (OR 3.618, 95% CI 2.5955.196; P < 0.001). Further, there was an increased risk of severe ILI with a longer time between symptom onset and inclusion (OR 1.108, 95% CI 1.049-1.172; P < 0.001) and with chronic steroid use (OR 14.324, 95% CI 8.059-26.216; P < 0.001). Conclusions Respiratory viruses can cause severe ILI. The results of this study highlight the importance of evaluating data compatible with lower tract involvement and previous use of immunosuppressants at baseline, because patients meeting these conditions may develop severe illness.
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Affiliation(s)
| | - Ana M. Ortega-Villa
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | | | | | | | | | - Sally Hunsberger
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Martín Magaña
- Hospital Regional Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | | | - Juan Francisco Galán-Herrera
- The Mexican Emerging Infectious Diseases Clinical Research Network (LaRed), Mexico City, Mexico,Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - John H. Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | | | - John Beigel
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico,Corresponding author: Arturo Galindo-Fraga, Hospital Epidemiology and Medical Attention Quality Control, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico 14080.
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Obesity as a risk factor for severe influenza infection in children and adolescents: a systematic review and meta-analysis. Eur J Pediatr 2023; 182:363-374. [PMID: 36369400 PMCID: PMC9652042 DOI: 10.1007/s00431-022-04689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED Obesity has been recently identified as a predisposing factor for a worse prognosis in viral illnesses such as SARS-CoV-2; however, its role in children with influenza is not yet clarified. The current systematic review and meta-analysis aims to assess whether obesity is a risk factor for either hospitalization or a worse prognosis when hospitalized among children infected by influenza. We systematically searched the following databases using a structured algorithm: MEDLINE, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Statistical meta-analysis was performed using the "meta" package in R software, and included studies were evaluated using the Newcastle-Ottawa scale. Among children with influenza, obesity increased the odds of hospitalization with a pooled OR of 1.89 (95% CI [1.23, 2.9], I2 = 0, p = 0.003). When hospitalized, children with obesity were also more likely to have a worse outcome than their healthy-weight counterparts, with a pooled OR of 1.24 (95% Cl [1.02; 1.51], I2 = 11, p = 0.03). In an effort to lower heterogeneity, a leave-one-out meta-analysis was conducted. Publication bias was assessed with the visual inspection of funnel plots and the trim-and-fill method. Certainty assessment was evaluated using the GRADE score. CONCLUSIONS The findings of our meta-analysis suggest that obesity in children with influenza is associated with a worse prognosis, both hospitalization and ICU admission/death. WHAT IS KNOWN • Obesity has been identified as a risk factor for non-communicable as well as communicable diseases. • A previous meta-analysis failed to demonstrate a statistically significant association between obesity and influenza infection severity. WHAT IS NEW • Children with high BMI and influenza infection are more likely to get hospitalized. • Pediatric inpatients with increased BMI and influenza infection may have a worse prognosis.
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7
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Walaza S, Tempia S, von Gottberg A, Wolter N, Bhiman JN, Buys A, Amoako D, Moosa F, du Plessis M, Moyes J, McMorrow ML, Dawood H, Variava E, Reubenson G, Nel J, Zar HJ, Makhasi M, Meiring S, Quan V, Cohen C. Risk Factors for Severe Coronavirus Disease 2019 Among Human Immunodeficiency Virus-Infected and -Uninfected Individuals in South Africa, April 2020-March 2022: Data From Sentinel Surveillance. Open Forum Infect Dis 2022; 9:ofac578. [PMID: 36570970 PMCID: PMC9772867 DOI: 10.1093/ofid/ofac578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Data on risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization and mortality in high human immunodeficiency virus (HIV) prevalence settings are limited. Methods Using existing syndromic surveillance programs for influenza-like-illness and severe respiratory illness at sentinel sites in South Africa, we identified factors associated with COVID-19 hospitalization and mortality. Results From April 2020 through March 2022, severe acute respiratory syndrome coronavirus 2 was detected in 24.0% (660 of 2746) of outpatient and 32.5% (2282 of 7025) of inpatient cases. Factors associated with COVID-19-associated hospitalization included the following: older age (25-44 [adjusted odds ratio {aOR}= 1.8, 95% confidence interval (CI) = 1.1-2.9], 45-64 [aOR = 6.8, 95% CI = 4.2-11.0] and ≥65 years [aOR = 26.6, 95% CI = 14.4-49.1] vs 15-24 years); black race (aOR, 3.3; 95% CI, 2.2-5.0); obesity (aOR, 2.3; 95% CI, 1.4-3.9); asthma (aOR, 3.5; 95% CI, 1.4-8.9); diabetes mellitus (aOR, 5.3; 95% CI, 3.1-9.3); HIV with CD4 ≥200/mm3 (aOR, 1.5; 95% CI, 1.1-2.2) and CD4 <200/mm3 (aOR, 10.5; 95% CI, 5.1-21.6) or tuberculosis (aOR, 12.8; 95% CI, 2.8-58.5). Infection with Beta (aOR, 0.5; 95% CI, .3-.7) vs Delta variant and being fully vaccinated (aOR, 0.1; 95% CI, .1-.3) were less associated with COVID-19 hospitalization. In-hospital mortality was increased in older age (45-64 years [aOR, 2.2; 95% CI, 1.6-3.2] and ≥65 years [aOR, 4.0; 95% CI, 2.8-5.8] vs 25-44 years) and male sex (aOR, 1.3; 95% CI, 1.0-1.6) and was lower in Omicron-infected (aOR, 0.3; 95% CI, .2-.6) vs Delta-infected individuals. Conclusions Active syndromic surveillance encompassing clinical, laboratory, and genomic data identified setting-specific risk factors associated with COVID-19 severity that will inform prioritization of COVID-19 vaccine distribution. Elderly people with tuberculosis or people with HIV, especially severely immunosuppressed, should be prioritized for vaccination.
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Affiliation(s)
- Sibongile Walaza
- Correspondence: Sibongile Walaza, MBBCh, PhD, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, Gauteng, South Africa ()
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,MassGenics, Atlanta, Georgia, USA,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Daniel Amoako
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Fahima Moosa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Program, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Halima Dawood
- Department of Medicine, Greys Hospital, Pietermaritzburg, South Africa,Caprisa, University of KwaZulu - Natal, Pietermaritzburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa,Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | - Jeremy Nel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather J Zar
- Department of Paediatrics, Red Cross War Memorial Hospital, andSouth African-Medical Research Council on Child and Adolescent Health, University of Cape Town, South Africa
| | - Mvuyo Makhasi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Susan Meiring
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Divison of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Vanessa Quan
- Divison of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
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8
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Wolter N, Tempia S, von Gottberg A, Bhiman JN, Walaza S, Kleynhans J, Moyes J, Buys A, McMorrow ML, Aitken S, Magni S, Yun J, Fellows T, Maakamedi T, Weiner R, Cawood C, Martinson N, Lebina L, Jassat W, Brauer M, Cohen C. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 After the Second Wave in South Africa in Human Immunodeficiency Virus-Infected and Uninfected Persons: A Cross-Sectional Household Survey. Clin Infect Dis 2022; 75:e57-e68. [PMID: 35271693 PMCID: PMC9047164 DOI: 10.1093/cid/ciac198] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Seroprevalence studies are important for quantifying the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in resource-constrained countries. METHODS We conducted a cross-sectional household survey spanning the second pandemic wave (November 2020 to April 2021) in 3 communities. Blood was collected for SARS-CoV-2 antibody (2 enzyme-linked immunosorbent assays targeting spike and nucleocapsid) and human immunodeficiency virus (HIV) testing. An individual was considered seropositive if testing positive on ≥1 assay. Factors associated with infection, and the age-standardized infection case detection rate, infection hospitalization rate, and infection fatality rate were calculated. RESULTS Overall, 7959 participants were enrolled, with a median age of 34 years and an HIV prevalence of 22.7%. SARS-CoV-2 seroprevalence was 45.2% (95% confidence interval 43.7%-46.7%) and increased from 26.9% among individuals enrolled in December 2020 to 47.1% among those enrolled in April 2021. On multivariable analysis, seropositivity was associated with age, sex, race, being overweight/obese, having respiratory symptoms, and low socioeconomic status. Persons living with HIV with high viral load were less likely to be seropositive than HIV-uninfected individuals. The site-specific infection case detection rate, infection hospitalization rate, and infection fatality rate ranged across sites from 4.4% to 8.2%, 1.2% to 2.5%, and 0.3% to 0.6%, respectively. CONCLUSIONS South Africa has experienced a large burden of SARS-CoV-2 infections, with <10% of infections diagnosed. Lower seroprevalence among persons living with HIV who are not virally suppressed, likely as a result of inadequate antibody production, highlights the need to prioritize this group for intervention.
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Affiliation(s)
- Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
| | - Sue Aitken
- Genesis Analytics, Johannesburg, South Africa
| | - Sarah Magni
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Genesis Analytics, Johannesburg, South Africa
| | - Jessica Yun
- Genesis Analytics, Johannesburg, South Africa
| | | | | | - Renay Weiner
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Neil Martinson
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, USA
| | - Limakatso Lebina
- Perinatal HIV Research Unit, MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, South Africa
| | - Waasila Jassat
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africaand
| | - Marieke Brauer
- Immunology Department, National Reference Laboratory, Ampath Pathology, Pretoria, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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9
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Derqui N, Nealon J, Mira-Iglesias A, Díez-Domingo J, Mahé C, Chaves SS. Predictors of influenza severity among hospitalized adults with laboratory confirmed influenza: Analysis of nine influenza seasons from the Valencia region, Spain. Influenza Other Respir Viruses 2022; 16:862-872. [PMID: 35411561 PMCID: PMC9343335 DOI: 10.1111/irv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose Influenza hospitalizations contribute substantially to healthcare disruption. We explored the impact of ageing, comorbidities and other risk factors to better understand associations with severe clinical outcomes in adults hospitalized with influenza. Methods We analysed multi‐season data from adults ≥18 years, hospitalized with laboratory‐confirmed influenza in Valencia, Spain. Severity was defined as intensive care unit (ICU) admission, assisted ventilation and/or death. Generalized estimating equations were used to estimate associations between risk factors and severity. Rate of hospital discharge was analysed with a cumulative incidence function. Results Only 26% of influenza patients had their primary discharge diagnosis coded as influenza. Comorbidities were associated with severity among adults aged 50–79 years, with the highest odds ratio (OR) in patients with ≥3 comorbidities aged 50–64 years (OR = 6.7; 95% CI: 1.0–44.6). Morbid obesity and functional dependencies were also identified risk factors (ORs varying from 3 to 5 depending on age). The presence of increasing numbers of comorbidities was associated with prolonged hospital stay. Conclusions Influenza clinical outcomes are aggravated by the presence of comorbidities and ageing. Increased awareness of influenza among hospitalized patients could prompt clinical and public health interventions to reduce associated burden.
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Affiliation(s)
- Nieves Derqui
- Sanofi Pasteur, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Joshua Nealon
- Sanofi Pasteur, Lyon, France.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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10
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Fraser H, Tombe-Mdewa W, Kohli-Lynch C, Hofman K, Tempia S, McMorrow M, Lambach P, Ramkrishna W, Cohen C, Hutubessy R, Edoka I. Costs of seasonal influenza vaccination in South Africa. Influenza Other Respir Viruses 2022; 16:873-880. [PMID: 35355414 PMCID: PMC9343325 DOI: 10.1111/irv.12987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Influenza accounts for a substantial number of deaths and hospitalisations annually in South Africa. To address this disease burden, the South African National Department of Health introduced a trivalent inactivated influenza vaccination programme in 2010. Methods We adapted and populated the WHO Seasonal Influenza Immunization Costing Tool (WHO SIICT) with country‐specific data to estimate the cost of the influenza vaccination programme in South Africa. Data were obtained through key‐informant interviews at different levels of the health system and through a review of existing secondary data sources. Costs were estimated from a public provider perspective and expressed in 2018 prices. We conducted scenario analyses to assess the impact of different levels of programme expansion and the use of quadrivalent vaccines on total programme costs. Results Total financial and economic costs were estimated at approximately USD 2.93 million and USD 7.91 million, respectively, while financial and economic cost per person immunised was estimated at USD 3.29 and USD 8.88, respectively. Expanding the programme by 5% and 10% increased economic cost per person immunised to USD 9.36 and USD 9.52 in the two scenarios, respectively. Finally, replacing trivalent inactivated influenza vaccine (TIV) with quadrivalent vaccine increased financial and economic costs to USD 4.89 and USD 10.48 per person immunised, respectively. Conclusion We adapted the WHO SIICT and provide estimates of the total costs of the seasonal influenza vaccination programme in South Africa. These estimates provide a basis for planning future programme expansion and may serve as inputs for cost‐effectiveness analyses of seasonal influenza vaccination programmes.
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Affiliation(s)
- Heather Fraser
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Winfrida Tombe-Mdewa
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ciaran Kohli-Lynch
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,MassGenics, Duluth, Georgia, USA.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,US Public Health Service, Rockville, Maryland, USA
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, Pretoria, South Africa
| | - Cheryl Cohen
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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11
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Gachari MN, Ndegwa L, Emukule GO, Kirui L, Kalani R, Juma B, Mayieka L, Kinuthia P, Widdowson MA, Chaves SS. Severe acute respiratory illness surveillance for influenza in Kenya: Patient characteristics and lessons learnt. Influenza Other Respir Viruses 2022; 16:740-748. [PMID: 35289078 PMCID: PMC9111565 DOI: 10.1111/irv.12979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background We describe the epidemiology and clinical features of Kenyan patients hospitalized with laboratory‐confirmed influenza compared with those testing negative and discuss the potential contribution of severe acute respiratory illness (SARI) surveillance in monitoring a broader range of respiratory pathogens. Methods We described demographic and clinical characteristics of SARI cases among children (<18 years) and adults, separately. We compared disease severity (clinical features and treatment) of hospitalized influenza positive versus negative cases and explored independent predictors of death among SARI cases using a multivariable logistic regression model. Results From January 2014 to December 2018, 11,166 persons were hospitalized with SARI and overall positivity for influenza was ~10%. There were 10,742 (96%) children (<18 years)—median age of 1 year, interquartile range (IQR = 6 months, 2 years). Only 424 (4%) of the SARI cases were adults (≥18 years), with median age of 38 years (IQR 28 years, 52 years). There was no difference in disease severity comparing influenza positive and negative cases among children. Children hospitalized with SARI who had an underlying illness had greater odds of in‐hospital death compared with those without (adjusted odds ratio 2.11 95% CI 1.09–4.07). No further analysis was done among adults due to the small sample size. Conclusion Kenya's sentinel surveillance for SARI mainly captures data on younger children. Hospital‐based platforms designed to monitor influenza viruses and associated disease burden may be adapted and expanded to other respiratory viruses to inform public health interventions. Efforts should be made to capture adults as part of routine respiratory surveillance.
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Affiliation(s)
- Maryanne N Gachari
- Kenya Field Epidemiology and Laboratory Training Program (K-FELTP), Nairobi, Kenya
| | - Linus Ndegwa
- Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Gideon O Emukule
- Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Lily Kirui
- Ministry of Health, National Influenza Centre (NIC), Nairobi, Kenya
| | - Rosalia Kalani
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi, Kenya
| | - Bonventure Juma
- Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Lilian Mayieka
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Peter Kinuthia
- Ministry of Health, National Influenza Centre (NIC), Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.,Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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12
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Al Amad M, Almoayed K. Influenza circulating viruses, positivity rate and risk factors for influenza associated severe acute respiratory infection during 2018/2019 winter season, Yemen. BMC Infect Dis 2022; 22:111. [PMID: 35105332 PMCID: PMC8804082 DOI: 10.1186/s12879-022-07090-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of seasonal influenza in conflict counties is exacerbated due to limited resource and collapse of health system. During 2018 /2019 season, two-fold increase in the incidence of influenza was reported in Yemen with 22% case fatality of severe acute respiratory infection (SARI). The aims are to analyze the influenza circulating viruses, positivity rate and risk factors for hospitalizing influenza associated-SARI. METHODOLOGY We used a retrospective analytical study based on surveillance data. All reported patients during 2018/2019 season, fulfilling the WHO cases definition for SARI or influenza like illness (ILI), and had laboratory result from the National Laboratory were included. Influenza positivity rate was calculated, all SARI and ILI patients with positive influenza were included for further analysis by univariate and multivariate binary logistic regression. Crude and adjusted Odds ratio (AOR), 95% confidence interval and P-value < 0.05 were used for statistically significant. RESULTS Out of 2186 patients enrolled, 768 patients were tested for influenza viruses,: 19% were children < 15 years, 15% were ≥ 65 years, 69% males and 18% had co-morbidity with chronic diseases. Patients with SARI were 37% and 63% were ILI patients. Influenza viruses were detected in 411 (53.5%), 68% were influenza A subtype (H1N1)pdm09, 27% influenza B and 5% was influenza A not subtyped. The influenza positivity was significantly higher in SARI compared to ILI for patients < 15 years (95% vs, 66%, p < 0.001), and patients ≥ 65 years (83% vs. 56%, p < 0.002), respectively. The highest positivity for influenza type A and B reached 44% and 33% for patients ≥ 65 years and < 15 years, respectively. The risk factors for influenza-associated SARI in multivariate analysis included age < 5 [AOR 2.8] and ≥ 65 years old [AOR 3.1] compared to age 5- < 25 years, diabetes [AOR 4.7], heart diseases [AOR 3.1] and chronic respiratory diseases [AOR 5.0]. CONCLUSION The influenza positivity during 2018/2019 winter season was high in Yemen and varied by age distribution. Influenza subtype A (H1N1) pdm09 was the predominant and co circulated with influenza B. An influenza vaccination program for the risk group is necessary. Strengthening lab capacity to detect respiratory pathogens and further prospective study for more comprehensive picture are recommended.
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Risk Factors of Influenza-Associated Respiratory Illnesses Reported to a Sentinel Hospital of Lahore, Pakistan: 2015-2016. ACTA ACUST UNITED AC 2021; 2021:2460553. [PMID: 34745395 PMCID: PMC8566087 DOI: 10.1155/2021/2460553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
Epidemiological data about determinants of influenza A virus (IAV) in the Pakistani population is scarce. We aimed to conduct a prospective hospital-based active surveillance study from October 2015 to May 2016 to identify potential risk factors associated with IAV infection among patients with influenza-like illness (ILI) and severe acute respiratory illness (SARI). Surveillance was conducted in Lahore General Hospital, selected as a sentinel site in Lahore District, Pakistan. Nasal/throat samples were collected along with epidemiological and clinical data from enrolled patients. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) was performed to identify IAV and its subtypes (H1N1pdm09, H3N2). Data were analyzed to determine risk factors and risk markers associated with IAV infections. A total of 311 suspected ILI and SARI cases were enrolled in the study, and among these 50 were IAV-positive. Of these 50 confirmed cases of IAV, 14 were subtyped as H1N1pdm09 and 15 were H3N2; the remaining 21 were untyped. A final multivariable model identified four independent risk factors/markers for IAV infection: exposure history to ILI patients within last 7 days and gender being male were identified as risk factors of IAV infection, while use of antibiotics prior to hospital consultation and presence of fever were identified as risk markers. We concluded that adopting nonpharmaceutical interventions like hand hygiene, masks, social distancing, and where possible, avoiding identified risk factors could decrease the risk of IAV infection and may prevent imminent outbreaks of IAV in the community.
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14
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Capacity and use of diagnostics and treatment for patients with severe acute respiratory infections in the pre-COVID-19 era in district and provincial hospitals in Viet Nam. Western Pac Surveill Response J 2021; 12:1-9. [PMID: 35251746 PMCID: PMC8873919 DOI: 10.5365/wpsar.2021.12.4.835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To describe the burden of severe acute respiratory infection (SARI) and the infrastructure and current practices of SARI management in hospitals in Viet Nam. Methods We conducted a short observational study at critical care units (CCUs) in 32 district hospitals and 16 provincial hospitals in five provinces in Viet Nam from March to July 2019. We collected data on hospital equipment and medicines used in SARI management. At the patient level, data were collected for 14 consecutive days on all patients presenting to CCUs, including information on demographics, intervention and treatment within 24 hours of CCU admission and 7-day outcome. Results There were significant differences between district and provincial hospitals in the availability of microbial culture, rapid influenza diagnostic tests, inflammatory markers and mechanical ventilation. Among 1722 eligible patients admitted to CCUs, there were 395 (22.9%) patients with SARI. The median age of SARI patients was 74 (interquartile range: 58–84) years; 49.1% were male. Although systemic antibiotics were available in all hospitals and were empirically given to 93.4% of patients, oseltamivir was available in 25% of hospitals, and only 0.5% of patients received empiric oseltamivir within 24 hours of admission. The 7-day mortality was 6.6% (26/395). Independent factors associated with 7-day mortality were septic shock and requiring respiratory support within 24 hours of admission. Discussion SARI is a major burden on CCUs in Viet Nam. Barriers to delivering quality care include the limited availability of diagnostics and medication and non-protocolized management of SARI in CCUs.
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15
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Loevinsohn G, Hamahuwa M, Sinywimaanzi P, Fenstermacher KZJ, Shaw-Saliba K, Pekosz A, Monze M, Rothman RE, Simulundu E, Thuma PE, Sutcliffe CG. Facility-based surveillance for influenza and respiratory syncytial virus in rural Zambia. BMC Infect Dis 2021; 21:986. [PMID: 34548020 PMCID: PMC8453466 DOI: 10.1186/s12879-021-06677-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While southern Africa experiences among the highest mortality rates from respiratory infections, the burden of influenza and respiratory syncytial virus (RSV) in rural areas is poorly understood. METHODS We implemented facility-based surveillance in Macha, Zambia. Outpatients and inpatients presenting with influenza-like illness (ILI) underwent testing for influenza A, influenza B, and RSV and were prospectively followed for 3 to 5 weeks to assess clinical course. Log-binomial models assessed correlates of infection and clinical severity. RESULTS Between December 2018 and December 2019, 17% of all outpatients presented with ILI and 16% of inpatients were admitted with an acute respiratory complaint. Influenza viruses and RSV were detected in 17% and 11% of outpatient participants with ILI, and 23% and 16% of inpatient participants with ILI, respectively. Influenza (July-September) and RSV (January-April) prevalence peaks were temporally distinct. RSV (relative risk [RR]: 1.78; 95% confidence interval [CI] 1.51-2.11), but not influenza, infection was associated with severe disease among patients with ILI. Underweight patients with ILI were more likely to be infected with influenza A (prevalence ratio [PR]: 1.72; 95% CI 1.04-2.87) and to have severe influenza A infections (RR: 2.49; 95% CI 1.57-3.93). CONCLUSIONS Populations in rural Zambia bear a sizeable burden of viral respiratory infections and severe disease. The epidemiology of infections in this rural area differs from that reported from urban areas in Zambia.
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Affiliation(s)
- Gideon Loevinsohn
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Kathryn Shaw-Saliba
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mwaka Monze
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Philip E Thuma
- Macha Research Trust, Macha, Choma, Zambia
- Department of Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD, 21205, USA.
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16
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Van Goethem N, Robert A, Bossuyt N, Van Poelvoorde LAE, Quoilin S, De Keersmaecker SCJ, Devleesschauwer B, Thomas I, Vanneste K, Roosens NHC, Van Oyen H. Evaluation of the added value of viral genomic information for predicting severity of influenza infection. BMC Infect Dis 2021; 21:785. [PMID: 34376182 PMCID: PMC8353062 DOI: 10.1186/s12879-021-06510-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The severity of an influenza infection is influenced by both host and viral characteristics. This study aims to assess the relevance of viral genomic data for the prediction of severe influenza A(H3N2) infections among patients hospitalized for severe acute respiratory infection (SARI), in view of risk assessment and patient management. METHODS 160 A(H3N2) influenza positive samples from the 2016-2017 season originating from the Belgian SARI surveillance were selected for whole genome sequencing. Predictor variables for severity were selected using a penalized elastic net logistic regression model from a combined host and genomic dataset, including patient information and nucleotide mutations identified in the viral genome. The goodness-of-fit of the model combining host and genomic data was compared using a likelihood-ratio test with the model including host data only. Internal validation of model discrimination was conducted by calculating the optimism-adjusted area under the Receiver Operating Characteristic curve (AUC) for both models. RESULTS The model including viral mutations in addition to the host characteristics had an improved fit ([Formula: see text]=12.03, df = 3, p = 0.007). The optimism-adjusted AUC increased from 0.671 to 0.732. CONCLUSIONS Adding genomic data (selected season-specific mutations in the viral genome) to the model containing host characteristics improved the prediction of severe influenza infection among hospitalized SARI patients, thereby offering the potential for translation into a prospective strategy to perform early season risk assessment or to guide individual patient management.
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Affiliation(s)
- Nina Van Goethem
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Woluwe-Saint-Lambert, Belgium.
| | - Annie Robert
- Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, 1200, Woluwe-Saint-Lambert, Belgium
| | - Nathalie Bossuyt
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Laura A E Van Poelvoorde
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Sophie Quoilin
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Isabelle Thomas
- National Reference Center Influenza, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Kevin Vanneste
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Nancy H C Roosens
- Transversal Activities in Applied Genomics, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Herman Van Oyen
- Scientific Directorate of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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17
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James PT, Ali Z, Armitage AE, Bonell A, Cerami C, Drakesmith H, Jobe M, Jones KS, Liew Z, Moore SE, Morales-Berstein F, Nabwera HM, Nadjm B, Pasricha SR, Scheelbeek P, Silver MJ, Teh MR, Prentice AM. The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. J Nutr 2021; 151:1854-1878. [PMID: 33982105 PMCID: PMC8194602 DOI: 10.1093/jn/nxab059] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020. RESULTS Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.
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Affiliation(s)
- Philip T James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zakari Ali
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ana Bonell
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Carla Cerami
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Modou Jobe
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kerry S Jones
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Zara Liew
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sophie E Moore
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Fernanda Morales-Berstein
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen M Nabwera
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Behzad Nadjm
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
| | - Pauline Scheelbeek
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matt J Silver
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Megan R Teh
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew M Prentice
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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18
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Development and Characterization of a Highly Sensitive NanoLuciferase-Based Immunoprecipitation System for the Detection of Anti-Influenza Virus HA Antibodies. mSphere 2021; 6:6/3/e01342-20. [PMID: 33980684 PMCID: PMC8125058 DOI: 10.1128/msphere.01342-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Antibody detection is crucial for monitoring host immune responses to specific pathogen antigens (Ags) and evaluating vaccine efficacies. The luciferase immunoprecipitation system (LIPS) was developed for sensitive detection of Ag-specific antibodies in sera from various species. In this study, we describe NanoLIPS, an improved LIPS assay based on NanoLuciferase (NLuc), and employ the assay for monitoring antibody responses following influenza virus infection or vaccination. We generated recombinant influenza virus hemagglutinin (HA) proteins tagged with N-terminal (N-NLuc-HA) or C-terminal (C-NLuc-HA) NLuc reporters. NLuc-HA yielded an at least 20-fold higher signal-to-noise ratio than did a LIPS assay employing a recombinant HA-Gaussia princeps luciferase (GLuc) fusion protein. NanoLIPS-based detection of anti-HA antibodies yielded highly reproducible results with a broad dynamic range. The levels of antibodies against C-NLuc-HA generated by mice vaccinated with recombinant vaccinia virus DIs strain expressing an influenza virus HA protein (rDIs-HA) was significantly correlated with the protective effect elicited by the rDIs-HA vaccine. C-NLuc-HA underwent glycosylation with native conformations and assembly to form a trimeric structure and was detected by monoclonal antibodies that detect conformational epitopes present on the globular head or stalk domain of HA. Therefore, NanoLIPS is applicable for evaluating vaccine efficacy. We also showed that C-NLuc-HA is applicable for detection of HA-specific antibodies in sera from various experimental species, including mouse, cynomolgus macaque, and tree shrew. Thus, NanoLIPS-based detection of HA offers a simple and high-sensitivity method that detects native conformational epitopes and can be used in various experimental animal models.IMPORTANCE Influenza virus HA-specific antibodies can be detected via the hemagglutination inhibition (HI) assay, the neutralization (NT) assay, and the enzyme-linked immunosorbent assay (ELISA). However, these assays have some drawbacks, including narrow dynamic range and the requirement for large amounts of sera. As an alternative to an ELISA-based method, luciferase immunoprecipitation system (LIPS) was developed. We focused on NanoLuciferase (NLuc), which has a small size, higher intensity, and longer stability. In this study, we developed a technically feasible and highly sensitive method for detecting influenza virus-specific antibodies using a NLuc-tagged recombinant HA protein produced in mammalian cells. HA with a C-terminal NLuc extension (C-NLuc-HA) was glycosylated and formed trimeric complexes when expressed in mammalian cells. Furthermore, C-NLuc-HA was recognized not only by monoclonal antibodies that bind to the globular head domain but also by those that bind to the stalk domain. We also demonstrated that the data obtained by this assay correlate with the protection of an experimental vaccine in animal models.
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19
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Larsen L, Nguyen MTT, Johansen IS. The coverage of influenza and pneumococcal vaccinations among people living with HIV in Denmark: A single-center cross-sectional survey. Hum Vaccin Immunother 2021; 17:2700-2705. [PMID: 33760692 DOI: 10.1080/21645515.2021.1894895] [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: 10/21/2022] Open
Abstract
Annual influenza vaccination is recommended for all people living with HIV (PLWH), and so is pneumococcal vaccination at least once. This is due to higher incidence rates for both infections among PLWH, compared to HIV negative, even in the later highly active antiretroviral therapy era. To clarify the uptake of and attitude toward both vaccines among PLWH in Denmark, a survey on self-reported vaccine uptake was performed during 2017. Analyses identifying factors associated with vaccine uptake in the latest season for 203 participants were performed. Both influenza and pneumococcal vaccination uptake are low among PLWH in Denmark, 31.0% and 4.4%, respectively. Previous vaccination against influenza had the highest impact on influenza vaccine uptake, and lack of immunization guidance lowers the likelihood. Interventions to improve vaccination coverage are needed, such as increased awareness about guidelines and physician education.
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Affiliation(s)
- Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark
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20
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Zhao X, Gang X, He G, Li Z, Lv Y, Han Q, Wang G. Obesity Increases the Severity and Mortality of Influenza and COVID-19: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:595109. [PMID: 33408692 PMCID: PMC7779975 DOI: 10.3389/fendo.2020.595109] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
Since December 2019, COVID-19 has aroused global attention. Studies show the link between obesity and severe outcome of influenza and COVID-19. Thus, we aimed to compare the impacts of obesity on the severity and mortality of influenza and COVID-19 by performing a meta-analysis. A systematic search was performed in MEDLINE, EMASE, ClinicalTrials.gov, and Web of Science from January 2009 to July 2020. The protocol was registered onto PROSPERO (CRD42020201461). After selection, 46 studies were included in this meta-analysis. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were analyzed. We found obesity was a risk factor for the severity and mortality of influenza (ORsevere outcome = 1.56, CI: 1.28-1.90; ORmortality = 1.99, CI: 1.15-3.46). For COVID-19, obesity was a significant risk factor only for severe outcome (OR = 2.07, CI: 1.53-2.81) but not for mortality (OR = 1.57, CI: 0.85-2.90). Compared with obesity, morbid obesity was linked with a higher risk for the severity and mortality of both influenza (OR = 1.40, CI: 1.10-1.79) and COVID-19 (OR = 3.76, CI: 2.67-5.28). Thus, obesity should be recommended as a risk factor for the prognosis assessment of COVID-19. Special monitoring and earlier treatment should be implemented in patients with obesity and COVID-19.
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Affiliation(s)
- Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guangyu He
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Zhuo Li
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - You Lv
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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21
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Lagare A, Rajatonirina S, Testa J, Mamadou S. The epidemiology of seasonal influenza after the 2009 influenza pandemic in Africa: a systematic review. Afr Health Sci 2020; 20:1514-1536. [PMID: 34394213 PMCID: PMC8351825 DOI: 10.4314/ahs.v20i4.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Influenza infection is a serious public health problem that causes an estimated 3 to 5 million cases and 250,000 deaths worldwide every year. The epidemiology of influenza is well-documented in high- and middle-income countries, however minimal effort had been made to understand the epidemiology, burden and seasonality of influenza in Africa. This study aims to assess the state of knowledge of seasonal influenza epidemiology in Africa and identify potential data gaps for policy formulation following the 2009 pandemic. Method We reviewed articles from Africa published into four databases namely: MEDLINE (PubMed), Google Scholar, Cochrane Library and Scientific Research Publishing from 2010 to 2019. Results We screened titles and abstracts of 2070 studies of which 311 were selected for full content evaluation and 199 studies were considered. Selected articles varied substantially on the basis of the topics they addressed covering the field of influenza surveillance (n=80); influenza risk factors and co-morbidities (n=15); influenza burden (n=37); influenza vaccination (n=40); influenza and other respiratory pathogens (n=22) and influenza diagnosis (n=5). Conclusion Significant progress has been made since the last pandemic in understanding the influenza epidemiology in Africa. However, efforts still remain for most countries to have sufficient data to allow countries to prioritize strategies for influenza prevention and control.
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Affiliation(s)
- Adamou Lagare
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | | | - Jean Testa
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
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22
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Otieno NA, Nyawanda B, Otiato F, Adero M, Wairimu WN, Atito R, Wilson AD, Gonzalez-Casanova I, Malik FA, Verani JR, Widdowson MA, Omer SB, Chaves SS. Knowledge and attitudes towards influenza and influenza vaccination among pregnant women in Kenya. Vaccine 2020; 38:6832-6838. [PMID: 32893035 PMCID: PMC7526973 DOI: 10.1016/j.vaccine.2020.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza vaccination during pregnancy benefits mothers and children. Kenya and other low- and middle-income countries have no official influenza vaccination policies to date but are moving towards issuing such policies. Understanding determinants of influenza vaccine uptake during pregnancy in these settings is important to inform policy decisions and vaccination rollout. METHODS We interviewed a convenience sample of women at antenatal care facilities in four counties (Nairobi, Mombasa, Marsabit, Siaya) in Kenya. We described knowledge and attitudes regarding influenza vaccination and assessed factors associated with willingness to receive influenza vaccine. RESULTS We enrolled 507 pregnant women, median age was 26 years (range 15-43). Almost half (n = 240) had primary or no education. Overall, 369 (72.8%) women had heard of influenza. Among those, 288 (78.1%) believed that a pregnant woman would be protected if vaccinated, 252 (68.3%) thought it was safe to receive a vaccine while pregnant, and 223 (60.4%) believed a baby would be protected if mother was vaccinated. If given opportunity, 309 (83.7%) pregnant women were willing to receive the vaccine. Factors associated with willingness to receive influenza vaccine were mothers' belief in protective effect (OR 3.87; 95% CI 1.56, 9.59) and safety (OR 5.32; 95% CI 2.35, 12.01) of influenza vaccines during pregnancy. CONCLUSION Approximately one third of pregnant women interviewed had never heard of influenza. Willingness to receive influenza vaccine was high among women who had heard about influenza. If the Kenyan government recommends influenza vaccine for pregnant women, mitigation of safety concerns and education on the benefits of vaccination could be the most effective strategies to improve vaccine acceptance.
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Affiliation(s)
- Nancy A Otieno
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya.
| | - Bryan Nyawanda
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Fredrick Otiato
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Maxwel Adero
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Winnie N Wairimu
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Raphael Atito
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Andrew D Wilson
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Ines Gonzalez-Casanova
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Fauzia A Malik
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Jennifer R Verani
- Centers for Disease Control and Prevention, Division of Global Health Protection, Kenya
| | - Marc-Alain Widdowson
- Centers for Disease Control and Prevention, Division of Global Health Protection, Kenya
| | - Saad B Omer
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
| | - Sandra S Chaves
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Kenya
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23
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Ezzine H, Cherkaoui I, Rguig A, Oumzil H, Mrabet M, Bimouhen A, Falaki FE, Regragui Z, Tarhda Z, Youbi M, Naciri M. Influenza epidemiology and risk factors for severe acute respiratory infection in Morocco during the 2016/2017 and 2017/2018 seasons. Pan Afr Med J 2020; 36:159. [PMID: 32874423 PMCID: PMC7436631 DOI: 10.11604/pamj.2020.36.159.21239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/02/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction in order to implement an influenza vaccination program for high-risk-groups in Morocco, as recommended by the World Health Organization, an epidemiological study indicating the influenza virus effect in the development of complicated influenza for subjects with co-morbidity was required. The present study aims to evaluate the risk factors for severe acute respiratory infections caused by influenza in risk groups. Methods this research is based on the epidemiological and virological surveillance data of severe acute respiratory infections and influenza-like illness during the 2016/2017 and 2017/2018 seasons. It was realized using a retrospective series study with a descriptive and analytical purpose. Results the over-recruitment of pediatric cases with a severe acute respiratory infection has been significantly rectified because cases of severe acute respiratory infections under 15 years old in the 2017/2018 season represent only 57.9%, whereas they represented 75.9% of the total cases of severe acute respiratory infections during the 2016/2017 season. The influenza positivity rate has increased globally and specifically by age group, clinical service and co-morbidity. The risk factors considered were significantly associated with hospitalization for influenza-associated severe acute respiratory infections. The multivariate logistic regression analysis considers male sex (OR=2.1), age ≥65 years (OR=5.4), presence of influenza cases in the surroundings (OR=0.1), diabetes (OR=7.5) and chronic respiratory disease (OR=10.9) as risk factors influenza-associated severe acute respiratory infections. Conclusion the risk assessment of influenza-associated severe acute respiratory infections in high-risk groups revealed national epidemiological findings, particularly for diabetics and the elderly. An influenza vaccination program for these high-risk-groups becomes much recommended in Morocco.
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Affiliation(s)
- Hind Ezzine
- Directorate of Epidemiology and Disease Control, Ministry of Health, Morocco.,Research Center (BIOBIO), Laboratory of Biodiversity, Ecology and Genome, Faculty of Sciences, University Mohammed V of Rabat, Morocco
| | - Imad Cherkaoui
- Directorate of Epidemiology and Disease Control, Ministry of Health, Morocco
| | - Ahmed Rguig
- Directorate of Epidemiology and Disease Control, Ministry of Health, Morocco
| | - Hicham Oumzil
- National Influenza Center, National Institute of Hygiene, Ministry of Health, Morocco
| | - Mouad Mrabet
- Directorate of Epidemiology and Disease Control, Ministry of Health, Morocco
| | - Abderrahman Bimouhen
- National Influenza Center, National Institute of Hygiene, Ministry of Health, Morocco
| | - Fatima El Falaki
- National Influenza Center, National Institute of Hygiene, Ministry of Health, Morocco
| | - Zakia Regragui
- National Influenza Center, National Institute of Hygiene, Ministry of Health, Morocco
| | - Zineb Tarhda
- Directorate of Epidemiology and Disease Control, Ministry of Health, Morocco
| | - Mohammed Youbi
- Directorate of Epidemiology and Disease Control, Ministry of Health, Morocco
| | - Mariam Naciri
- Research Center (BIOBIO), Laboratory of Biodiversity, Ecology and Genome, Faculty of Sciences, University Mohammed V of Rabat, Morocco
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24
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Tempia S, Walaza S, Moyes J, McMorrow ML, Cohen AL, Edoka I, Fraser H, Treurnicht FK, Hellferscee O, Wolter N, von Gottberg A, McAnerney JM, Dawood H, Variava E, Cohen C. Influenza disease burden among potential target risk groups for immunization in South Africa, 2013-2015. Vaccine 2020; 38:4288-4297. [PMID: 32389494 DOI: 10.1016/j.vaccine.2020.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Data on influenza burden in risk groups for severe influenza are important to guide targeted influenza immunization, especially in resource limited settings. However, this information is limited overall and in particular in low- and middle-income countries. We sought to assess the mean annual national burden of medically and non-medically attended influenza-associated mild, severe-non-fatal and fatal illness among potential target groups for influenza immunization in South Africa during 2013-2015. METHODS We used published mean national annual estimates of mild, severe-non-fatal, and fatal influenza-associated illness in South Africa during 2013-2015 and estimated the number of such illnesses occurring among the following risk groups: (i) children aged 6-59 months; (ii) individuals aged 5-64 years with HIV, and/or pulmonary tuberculosis (PTB), and/or selected underlying medical conditions (UMC); (iii) pregnant women; and (iv) individuals aged ≥65 years. We also estimated the number of individuals among the same risk groups in the population. RESULTS During 2013-2015, individuals in the selected risk groups accounted for 45.3% (24,569,328/54,086,144) of the population and 43.5% (4,614,763/10,598,138), 86.8% (111,245/128,173) and 94.5% (10,903/11,536) of the mean annual estimated number of influenza-associated mild, severe-non-fatal and fatal illness episodes, respectively. The rates of influenza-associated illness were highest in children aged 6-59 months (23,983 per 100,000 population) for mild illness, in pregnant women (930 per 100,000 population) for severe-non-fatal illness and in individuals aged ≥65 years (138 per 100,000 population) for fatal illness. CONCLUSION Influenza immunization of the selected risk groups has the potential to prevent a substantial number of influenza-associated severe illness. Nonetheless, because of the high number of individuals at risk, South Africa, due to financial resources constrains, may need to further prioritize interventions among risk populations. Cost-burden and cost-effectiveness estimates may assist with further prioritization.
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Affiliation(s)
- Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; MassGenics, Duluth, GA, United States.
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; Department of Immunization, Vaccines and Biological, World Health Organization, Geneva, Switzerland
| | - Ijeoma Edoka
- South Africa Medical Research Council/Wits Centre for Health Economics and Decision Science, PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburga South Africa
| | - Heather Fraser
- South Africa Medical Research Council/Wits Centre for Health Economics and Decision Science, PRICELESS SA, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburga South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital, Pietermaritzburg, South Africa; Department of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa; Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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25
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Tam BT, Morais JA, Santosa S. Obesity and ageing: Two sides of the same coin. Obes Rev 2020; 21:e12991. [PMID: 32020741 DOI: 10.1111/obr.12991] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
Conditions and comorbidities of obesity mirror those of ageing and age-related diseases. Obesity and ageing share a similar spectrum of phenotypes such as compromised genomic integrity, impaired mitochondrial function, accumulation of intracellular macromolecules, weakened immunity, shifts in tissue and body composition, and enhanced systemic inflammation. Moreover, it has been shown that obesity reduces life expectancy by 5.8 years in men and 7.1 years in women after the age of 40. Shorter life expectancy could be because obesity holistically accelerates ageing at multiple levels. Besides jeopardizing nuclear DNA and mitochondrial DNA integrity, obesity modifies the DNA methylation pattern, which is associated with epigenetic ageing in different tissues. Additionally, other signs of ageing are seen in individuals with obesity including telomere shortening, systemic inflammation, and functional declines. This review aims to show how obesity and ageing are "two sides of the same coin" through discussing how obesity predisposes an individual to age-related conditions, illness, and disease. We will further demonstrate how the mechanisms that perpetuate the early-onset of chronic diseases in obesity parallel those of ageing.
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Affiliation(s)
- Bjorn T Tam
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Quebec, Montreal, Canada.,Metabolism, Obesity, and Nutrition Lab, PERFORM Centre, Concordia University, Quebec, Montreal, Canada
| | - Jose A Morais
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Quebec, Montreal, Canada.,Division of Geriatric Medicine and Research Institute, McGill University Health Centre, Quebec, Montreal, Canada
| | - Sylvia Santosa
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Quebec, Montreal, Canada.,Metabolism, Obesity, and Nutrition Lab, PERFORM Centre, Concordia University, Quebec, Montreal, Canada.,Research Centre, Centre intégré universitarie de santé et de services sociaux du Nord-de-I'Île-de-Montréal, Hôpital du Sacré-Cœur de Monréal (CIUSS-NIM, HSCM), Quebec, Montreal, Canada
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26
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Simusika P, Tempia S, Chentulo E, Polansky L, Mazaba ML, Ndumba I, Mbewe QK, Monze M. An evaluation of the Zambia influenza sentinel surveillance system, 2011-2017. BMC Health Serv Res 2020; 20:35. [PMID: 31931793 PMCID: PMC6958603 DOI: 10.1186/s12913-019-4884-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/30/2019] [Indexed: 08/21/2023] Open
Abstract
Background Over the past decade, influenza surveillance has been established in several African countries including Zambia. However, information on the on data quality and reliability of established influenza surveillance systems in Africa are limited. Such information would enable countries to assess the performance of their surveillance systems, identify shortfalls for improvement and provide evidence of data reliability for policy making and public health interventions. Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza surveillance system (ISS) in Zambia during 2011–2017 using 9 attributes: (i) data quality and completeness, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability, (viii) utility, and (ix) sustainability. Each attribute was evaluated using pre-defined indicators. For each indicator we obtained the proportion (expressed as percentage) of the outcome of interest over the total. A scale from 1 to 3 was used to provide a score for each attribute as follows: < 60% (as obtained in the calculation above) scored 1 (weak performance); 60–79% scored 2 (moderate performance); ≥80% scored 3 (good performance). An overall score for each attribute and the ISS was obtained by averaging the scores of all evaluated attributes. Results The overall mean score for the ISS in Zambia was 2.6. Key strengths of the system were the quality of data generated (score: 2.9), its flexibility (score: 3.0) especially to monitor viral pathogens other than influenza viruses, its simplicity (score: 2.8), acceptability (score: 3.0) and stability (score: 2.6) over the review period and its relatively low cost ($310,000 per annum). Identified weaknesses related mainly to geographic representativeness (score: 2.0), timeliness (score: 2.5), especially in shipment of samples from remote sites, and sustainability (score: 1.0) in the absence of external funds. Conclusions The system performed moderately well in our evaluation. Key improvements would include improvements in the timeliness of samples shipments and geographical coverage. However, these improvements would result in increased cost and logistical complexity. The ISSS in Zambia is largely reliant on external funds and the acceptability of maintaining the surveillance system through national funds would require evaluation.
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Affiliation(s)
- Paul Simusika
- National Influenza Center, Virology Laboratory, University Teaching Hospital, Lusaka, Zambia.
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,MassGenics, Duluth, GA, USA
| | - Edward Chentulo
- National Influenza Center, Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Lauren Polansky
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mazyanga Lucy Mazaba
- National Influenza Center, Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Idah Ndumba
- National Influenza Center, Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Quinn K Mbewe
- National Influenza Center, Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Mwaka Monze
- National Influenza Center, Virology Laboratory, University Teaching Hospital, Lusaka, Zambia.
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27
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Babakazo P, Kabamba-Tshilobo J, Wemakoy EO, Lubula L, Manya LK, Ilunga BK, Disasuani W, Nkwembe E, Kavunga-Membo H, Changachanga JC, Muhemedi S, Tamfum JJM, Tempia S. Evaluation of the influenza sentinel surveillance system in the Democratic Republic of Congo, 2012-2015. BMC Public Health 2019; 19:1652. [PMID: 31823763 PMCID: PMC6902419 DOI: 10.1186/s12889-019-8008-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). METHODS We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012-2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: < 60% weak performance; 60-79% moderate performance; ≥80% good performance. RESULTS During 2012-2015, we enrolled and tested 4339 patients with influenza-like illness (ILI) and 2869 patients with severe acute respiratory illness (SARI) from 11 sentinel sites situated in 5 of 11 provinces. Influenza viruses were detected in 446 (10.3%) samples from patients with ILI and in 151 (5.5%) samples from patients with SARI with higher detection during December-May. Data quality and completeness was > 90% for all evaluated indicators. Other strengths of the system were timeliness, simplicity, stability and utility that scored > 70% each. Representativeness, flexibility and acceptability had moderate performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. CONCLUSIONS The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.
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Affiliation(s)
- Pélagie Babakazo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Joelle Kabamba-Tshilobo
- Influenza and Monkeypox Program, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Léopold Lubula
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Léonie Kitoko Manya
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Benoit Kebela Ilunga
- Division de Lutte Contre la Maladie, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Wally Disasuani
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Edith Nkwembe
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Hugo Kavunga-Membo
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Jean-Claude Changachanga
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Saleh Muhemedi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
- MassGenics, Duluth, GA, USA.
- Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Private Bag X4, Sandringham, Gauteng, 2131, South Africa.
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Ho A, Aston SJ, Jary H, Mitchell T, Alaerts M, Menyere M, Mallewa J, Nyirenda M, Everett D, Heyderman RS, French N. Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study. Clin Infect Dis 2019; 66:865-876. [PMID: 29045699 PMCID: PMC5850564 DOI: 10.1093/cid/cix903] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background The impact of human immunodeficiency virus (HIV) infection on influenza incidence and severity in adults in sub-Saharan Africa is unclear. Seasonal influenza vaccination is recommended for HIV-infected persons in developed settings but is rarely implemented in Africa. Methods We conducted a prospective cohort study to compare the incidence of laboratory-confirmed influenza illness between HIV-infected and HIV-uninfected adults in Blantyre, Malawi. In a parallel case-control study, we explored risk factors for severe influenza presentation of severe (hospitalized) lower respiratory tract infection, and mild influenza (influenza-like illness [ILI]). Results The cohort study enrolled 608 adults, of whom 360 (59%) were HIV infected. Between April 2013 and March 2015, 24 of 229 ILI episodes (10.5%) in HIV-infected and 5 of 119 (4.2%) in HIV-uninfected adults were positive for influenza by means of polymerase chain reaction (incidence rate, 46.0 vs 14.5 per 1000 person-years; incidence rate ratio, 2.75; 95% confidence interval, 1.02-7.44; P = .03; adjusted for age, sex, household crowding, and food security). In the case-control study, influenza was identified in 56 of 518 patients (10.8%) with hospitalized lower respiratory tract infection, and 88 or 642 (13.7%) with ILI. The HIV prevalence was 69.6% and 29.6%, respectively, among influenza-positive case patients and controls. HIV was a significant risk factor for severe influenza (odds ratio, 4.98; 95% confidence interval, 2.09-11.88; P < .001; population-attributable fraction, 57%; adjusted for season, sanitation facility, and food security). Conclusions HIV is an important risk factor for influenza-associated ILI and severe presentation in this high-HIV prevalence African setting. Targeted influenza vaccination of HIV-infected African adults should be reevaluated, and the optimal mechanism for vaccine introduction in overstretched health systems needs to be determined.
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Affiliation(s)
- Antonia Ho
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Stephen J Aston
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Hannah Jary
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical of Medicine, United Kingdom
| | - Tamara Mitchell
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Maaike Alaerts
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Mavis Menyere
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jane Mallewa
- Queen Elizabeth Central Hospital, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dean Everett
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,University College London, United Kingdom
| | - Neil French
- Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Lafond KE, Praptiningsih CY, Mangiri A, Syarif M, Triada R, Mulyadi E, Septiawati C, Setiawaty V, Samaan G, Storms AD, Uyeki TM, Iuliano AD. Seasonal Influenza and Avian Influenza A(H5N1) Virus Surveillance among Inpatients and Outpatients, East Jakarta, Indonesia, 2011-2014. Emerg Infect Dis 2019; 25:2031-2039. [PMID: 31625837 PMCID: PMC6810195 DOI: 10.3201/eid2511.181844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
During October 2011-September 2014, we screened respiratory specimens for seasonal and avian influenza A(H5N1) virus infections among outpatients with influenza-like illness and inpatients with severe acute respiratory infection (SARI) in East Jakarta, an Indonesia district with high incidence of H5N1 virus infection among poultry. In total, 31% (1,875/6,008) of influenza-like illness case-patients and 15% (571/3,811) of SARI case-patients tested positive for influenza virus. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B virus infections were detected in all 3 years, and the epidemic season extended from November through May. Although 28% (2,810/10,135) of case-patients reported exposure to poultry, only 1 SARI case-patient with an H5N1 virus infection was detected. Therefore, targeted screening among case-patients with high-risk poultry exposures (e.g., a recent visit to a live bird market or close proximity to sick or dead poultry) may be a more efficient routine surveillance strategy for H5N1 virus in these types of settings.
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30
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Sitnikov IG, Fazylov VK, Silina EV. [Treatment of influenza and other acute respiratory viral infections in patients with diabetes mellitus]. TERAPEVT ARKH 2019; 91:39-47. [PMID: 32598630 DOI: 10.26442/00403660.2019.10.000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE OF THE STUDY The study of the influenza and ARVI clinical performance, the development of patients with diabetes mellitus, evaluation of the effectiveness and safety application of antiviral therapy, carried out in the framework of routine clinical practice. MATERIALS AND METHODS 126 patients aged from 22 to 83 years (27.8% of men) with ARVI or influenza that occurred with medical care during the first 5 days of the disease (60.3% in the first 48 hours) are included. All patients suffer from diabetes, for the treatment of which oral hypoglycemic agents or insulins were constantly taken. The patients were divided into two groups: the first group received standard symptomatic treatment of ARVI; antiviral drug Kagocel. RESULTS AND CONCLUSION Diabetes and other acute respiratory viral infections. There is an increase in the incidence of bacterial complications - 2.2 times, an increase in the frequency of systemic antibiotics - 2.3 times. The purpose of the drug prescription led to a more rapid regression of all the symptoms of influenza and ARVI, but the most striking positive dynamics was observed in the symptoms of general weakness and headache. The prescription of Kagocel was accompanied by a 58% reduction in the number of bacterial complications and a 53% reduction in the use of antibiotics, which led to a reduction in the number of cases of the disease and an improvement in initial diseases, with an frequency increase in 1.8 times. The most significant effect achieved with early treatment and early initiation of antiviral therapy (in the first 48 hours of the disease).
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Affiliation(s)
| | | | - E V Silina
- Sechenov First Moscow State Medical University (Sechenov University)
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31
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Tempia S, Walaza S, Moyes J, Cohen AL, McMorrow ML, Treurnicht FK, Hellferscee O, Wolter N, von Gottberg A, Nguweneza A, McAnerney JM, Dawood H, Variava E, Madhi SA, Cohen C. Quantifying How Different Clinical Presentations, Levels of Severity, and Healthcare Attendance Shape the Burden of Influenza-associated Illness: A Modeling Study From South Africa. Clin Infect Dis 2019; 69:1036-1048. [PMID: 30508065 PMCID: PMC7804385 DOI: 10.1093/cid/ciy1017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/29/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Burden estimates of medically and nonmedically attended influenza-associated illness across syndromes and levels of severity are lacking. METHODS We estimated the national burden of medically and nonmedically attended influenza-associated illness among individuals with different clinical presentations (all-respiratory, all-circulatory, and nonrespiratory/noncirculatory) and levels of severity (mild, fatal, and severe, nonfatal) using a combination of case-based (from laboratory-confirmed influenza surveillance) and ecological studies, as well as data from healthcare utilization surveys in South Africa during 2013-2015. In addition, we compared estimates of medically attended influenza-associated respiratory illness, obtained from case-based and ecological studies. Rates were reported per 100 000 individuals in the population. RESULTS The estimated mean annual number of influenza-associated illness episodes was 10 737 847 (19.8% of 54 096 705 inhabitants). Of these episodes, 10 598 138 (98.7%) were mild, 128 173 (1.2%) were severe, nonfatal, and 11 536 (0.1%) were fatal. There were 2 718 140 (25.6%) mild, 56 226 (43.9%) severe, nonfatal, and 4945 (42.8%) medically attended should be after fatal episodes. Influenza-associated respiratory illness accounted for 99.2% (10 576 146) of any mild, 65.5% (83 941) of any severe, nonfatal, and 33.7% (3893) of any fatal illnesses. Ecological and case-based estimates of medically attended, influenza-associated, respiratory mild (rates: ecological, 1778.8, vs case-based, 1703.3; difference, 4.4%), severe, nonfatal (rates: ecological, 88.6, vs case-based, 75.3; difference, 15.0%), and fatal (rates: ecological, 3.8, vs case-based, 3.5; difference, 8.4%) illnesses were similar. CONCLUSIONS There was a substantial burden of influenza-associated symptomatic illness, including severe, nonfatal and fatal illnesses, and a large proportion was nonmedically attended. Estimates, including only influenza-associated respiratory illness, substantially underestimated influenza-associated, severe, nonfatal and fatal illnesses. Ecological and case-based estimates were found to be similar for the compared categories.
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Affiliation(s)
- Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Global Immunization Monitoring and Surveillance Team, Expanded Programme on Immunization, Department of Immunization, Vaccines and Biological, World Health Organization, Geneva, Switzerland
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Arthemon Nguweneza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital, South Africa
- Caprisa, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, South Africa
- Department of Medicine, Faculty of Health Sciences, South Africa
- Perinatal Human Immunodeficiency Virus Research Unit, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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32
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Ho A, Mapurisa G, Madanitsa M, Kalilani-Phiri L, Kamiza S, Makanani B, Ter Kuile FO, Buys A, Treurnicht F, Everett D, Mwapasa V, Widdowson MA, Mcmorrow M, Heyderman RS. Impact of Maternal HIV Infection and Placental Malaria on the Transplacental Transfer of Influenza Antibodies in Mother-Infant Pairs in Malawi, 2013-2014. Open Forum Infect Dis 2019; 6:ofz383. [PMID: 31660347 PMCID: PMC6785697 DOI: 10.1093/ofid/ofz383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background Maternal influenza vaccination protects infants against influenza virus infection. Impaired transplacental transfer of influenza antibodies may reduce this protection. Methods We conducted a cross-sectional study of influenza vaccine–naïve pregnant women recruited at delivery from Blantyre (urban, low malaria transmission) and Chikwawa (rural, high malaria transmission) in Southern Malawi. HIV-infected mothers were excluded in Chikwawa. Maternal and cord blood antibodies against circulating influenza strains A/California/7/2009, A/Victoria/361/2011, B/Brisbane/60/2008, and B/Wisconsin/1/2010 were measured by hemagglutination inhibition (HAI). We studied the impact of maternal HIV infection and placental malaria on influenza antibody levels in mother–infant pairs in Blantyre and Chikwawa, respectively. Results We included 454 mother–infant pairs (Blantyre, n = 253; Chikwawa, n = 201). HIV-infected mothers and their infants had lower seropositivity (HAI titer ≥1:40) against influenza A(H1N1)pdm09 (mothers, 24.3 vs 45.4%; P = .02; infants, 24.3 vs 50.5%; P = .003) and A(H3N2) (mothers, 37.8% vs 63.9%; P = .003; infants, 43.2 vs 64.8%; P = .01), whereas placental malaria had an inconsistent effect on maternal and infant seropositivity. In multivariable analyses, maternal HIV infection was associated with reduced infant seropositivity (A(H1N1)pdm09: adjusted odds ratio [aOR], 0.34; 95% confidence interval [CI], 0.15–0.79; A(H3N2): aOR, 0.43; 95% CI, 0.21–0.89). Transplacental transfer was not impaired by maternal HIV or placental malaria. Conclusions Maternal HIV infection influenced maternal antibody response to influenza A virus infection, and thereby antibody levels in newborns, but did not affect transplacental antibody transfer.
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Affiliation(s)
- Antonia Ho
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Gugulethu Mapurisa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Mwayiwawo Madanitsa
- University of Malawi College of Medicine, Blantyre, Malawi.,MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - Steve Kamiza
- University of Malawi College of Medicine, Blantyre, Malawi
| | - B Makanani
- Department of Obstetrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Feiko O Ter Kuile
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Amelia Buys
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, South Africa
| | - Florette Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham, South Africa.,Department of Medical Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Victor Mwapasa
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Meredith Mcmorrow
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Division of Infection and Immunity, University College London, London, UK
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Emukule GO, Namagambo B, Owor N, Bakamutumaho B, Kayiwa JT, Namulondo J, Byaruhanga T, Tempia S, Chaves SS, Lutwama JJ. Influenza-associated pneumonia hospitalizations in Uganda, 2013-2016. PLoS One 2019; 14:e0219012. [PMID: 31306466 PMCID: PMC6629074 DOI: 10.1371/journal.pone.0219012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Influenza is an important contributor to acute respiratory illness, including pneumonia, and results in substantial morbidity and mortality globally. Understanding the local burden of influenza-associated severe disease can inform decisions on allocation of resources toward influenza control programs. Currently, there is no national influenza vaccination program in Uganda. METHODS In this study, we used data on pneumonia hospitalizations that were collected and reported through the Health Management Information System (HMIS) of the Ministry of Health, Uganda, and the laboratory-confirmed influenza positivity data from severe acute respiratory illness (SARI) surveillance in three districts (Wakiso, Mbarara, and Tororo) to estimate the age-specific incidence of influenza-associated pneumonia hospitalizations from January 2013 through December 2016. RESULTS The overall estimated mean annual rate of pneumonia hospitalizations in the three districts was 371 (95% confidence interval [CI] 323-434) per 100,000 persons, and was highest among children aged <5 years (1,524 [95% CI 1,286-1,849]) compared to persons aged ≥5 years (123 [95% CI 105-144]) per 100,000 persons. The estimated mean annual rate of influenza-associated pneumonia hospitalization was 34 (95% CI 23-48) per 100,000 persons (116 [95% CI 78-165] and 16 [95% CI 6-28] per 100,000 persons among children aged <5 years and those ≥5 years, respectively). Among children aged <5 years, the rate of hospitalized influenza-associated pneumonia was highest among those who were <2 years old (178 [95% CI 109-265] per 100,000 persons). Over the period of analysis, the estimated mean annual number of hospitalized influenza-associated pneumonia cases in the three districts ranged between 672 and 1,436, of which over 70% represent children aged <5 years. CONCLUSIONS The burden of influenza-associated pneumonia hospitalizations was substantial in Uganda, and was highest among young children aged <5 years. Influenza vaccination may be considered, especially for very young children.
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Affiliation(s)
- Gideon O. Emukule
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
| | - Barbara Namagambo
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Nicholas Owor
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - John T. Kayiwa
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Joyce Namulondo
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Timothy Byaruhanga
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Stefano Tempia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sandra S. Chaves
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julius J. Lutwama
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
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34
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Tempia S, Moyes J, Cohen AL, Walaza S, Edoka I, McMorrow ML, Treurnicht FK, Hellferscee O, Wolter N, von Gottberg A, Nguweneza A, McAnerney JM, Dawood H, Variava E, Cohen C. Health and economic burden of influenza-associated illness in South Africa, 2013-2015. Influenza Other Respir Viruses 2019; 13:484-495. [PMID: 31187609 PMCID: PMC6692552 DOI: 10.1111/irv.12650] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background Economic burden estimates are essential to guide policy‐making for influenza vaccination, especially in resource‐limited settings. Methods We estimated the cost, absenteeism, and years of life lost (YLL) of medically and non‐medically attended influenza‐associated mild and severe respiratory, circulatory and non‐respiratory/non‐circulatory illness in South Africa during 2013‐2015 using a modified version of the World Health Organization (WHO) worksheet based tool for estimating the economic burden of seasonal influenza. Additionally, we restricted the analysis to influenza‐associated severe acute respiratory illness (SARI) and influenza‐like illness (ILI; subsets of all‐respiratory illnesses) as suggested in the WHO manual. Results The estimated mean annual cost of influenza‐associated illness was $270.5 million, of which $111.3 million (41%) were government‐incurred costs, 40.7 million (15%) were out‐of‐pocket expenses, and $118.4 million (44%) were indirect costs. The cost of influenza‐associated medically attended mild illness ($107.9 million) was 2.3 times higher than that of severe illness ($47.1 million). Influenza‐associated respiratory illness costs ($251.4 million) accounted for 93% of the total cost. Estimated absenteeism and YLL were 13.2 million days and 304 867 years, respectively. Among patients with influenza‐associated WHO‐defined ILI or SARI, the costs ($95.3 million), absenteeism (4.5 million days), and YLL (65 697) were 35%, 34%, and 21% of the total economic and health burden of influenza. Conclusion The economic burden of influenza‐associated illness was substantial from both a government and a societal perspective. Models that limit estimates to those obtained from patients with WHO‐defined ILI or SARI substantially underestimated the total economic and health burden of influenza‐associated illness.
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Affiliation(s)
- Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,MassGenics, Duluth, Georgia
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Expanded Programme on Immunization, Department of Immunization, Vaccines and Biological, World Health Organization, Geneva, Switzerland
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Ijeoma Edoka
- Priority Cost Effectiveness Lessons for System Strengthening South Africa, South Africa Medical Research Council, Wits Center for Health Economic and Decision Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Athermon Nguweneza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Greys Hospital, Pietermaritzburg, South Africa.,Caprisa, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa.,Faculty of Health Sciences, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Nunes MC, Weinberg A, Cutland CL, Jones S, Wang D, Dighero-Kemp B, Levine MZ, Wairagkar N, Madhi SA. Neutralization and hemagglutination-inhibition antibodies following influenza vaccination of HIV-infected and HIV-uninfected pregnant women. PLoS One 2018; 13:e0210124. [PMID: 30596775 PMCID: PMC6312282 DOI: 10.1371/journal.pone.0210124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022] Open
Abstract
Background We previously reported that despite HIV-infected pregnant women had modest humoral immune responses to inactivated influenza vaccine (IIV) measured by hemagglutination-inhibition (HAI) assay, the observed vaccine efficacy against influenza disease was higher than predicted by HAI; suggesting that IIV may confer protection to HIV-infected individuals by additional mechanisms. We evaluated the response to IIV by microneutralization (MN) and HAI assays and correlated both methods in HIV-infected and HIV-uninfected pregnant women. Methods MN and HAI antibodies were measured pre-vaccination and approximately one-month post-vaccination in 80 HIV-infected and 75 HIV-uninfected women who received IIV. Geometric mean titers (GMTs), fold-change in titers and seroconversion rates were determined for the three influenza stains in the vaccine. Results After vaccination there were significant increases in MN and HAI GMTs for the three vaccine strains in both HIV-infected and HIV-uninfected women. HIV-infected women had, however, a lower immune response compared to HIV-uninfected. Fold-increases were 2 to 3-times higher for MN assay compared to HAI assay for the influenza-A strains. Also a higher percentage of women seroconverted by MN than by HAI assay for the influenza-A strains. There was high positive correlation between MN and HAI assays, except for the B/Victoria strain at pre-vaccination. Conclusions In general, the MN assay was more sensitive than the HAI assay. Microneutralization antibodies might correlate better with protection against influenza infection.
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Affiliation(s)
- Marta C. Nunes
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Adriana Weinberg
- Department of Pediatrics, Medicine and Pathology, University of Colorado, Aurora, Colorado, United States of America
| | - Clare L. Cutland
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Jones
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Wang
- Influenza division, centre for Diseases Control and Prevention, Atlanta, Georgia, United States of America
| | - Bonnie Dighero-Kemp
- Influenza division, centre for Diseases Control and Prevention, Atlanta, Georgia, United States of America
| | - Min Z. Levine
- Influenza division, centre for Diseases Control and Prevention, Atlanta, Georgia, United States of America
| | - Niteen Wairagkar
- The Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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36
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Rabarison JH, Tempia S, Harimanana A, Guillebaud J, Razanajatovo NH, Ratsitorahina M, Heraud JM. Burden and epidemiology of influenza- and respiratory syncytial virus-associated severe acute respiratory illness hospitalization in Madagascar, 2011-2016. Influenza Other Respir Viruses 2018; 13:138-147. [PMID: 30596225 PMCID: PMC6379640 DOI: 10.1111/irv.12557] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2018] [Indexed: 12/01/2022] Open
Abstract
Background Influenza and respiratory syncytial virus (RSV) infections are responsible for substantial global morbidity and mortality in young children and elderly individuals. Estimates of the burden of influenza‐ and RSV‐associated hospitalization are limited in Africa. Methods We conducted hospital‐based surveillance for laboratory‐confirmed influenza‐ and RSV‐associated severe acute respiratory illness (SARI) among patients of any age at one hospital and a retrospective review of SARI hospitalizations in five hospitals situated in Antananarivo during 2011‐2016. We estimated age‐specific rates (per 100 000 population) of influenza‐ and RSV‐associated SARI hospitalizations for the Antananarivo region and then extrapolated these rates to the national level. Results Overall, the mean annual national number of influenza‐associated SARI hospitalizations for all age groups was 6609 (95% CI: 5381‐7835‐rate: 30.0; 95% CI: 24.4‐35.6), 4468 (95% CI: 3796‐5102‐rate: 127.6; 95% CI: 108.4‐145.7), 2141 (95% CI: 1585‐2734‐rate: 11.6; 95% CI: 8.6‐14.8), and 339 (95% CI: 224‐459‐rate: 50.0; 95% CI: 36.3‐74.4) among individuals aged <5, ≥5, and ≥65 years, respectively. For these same age groups, the mean annual number of RSV‐associated SARI hospitalizations was 11 768 (95% CI: 10 553‐12 997‐rate: 53.4; 95% CI: 47.9‐59.0), 11 299 (95% CI: 10 350‐12 214‐rate: 322.7; 95% CI: 295.6‐348.8), 469 (95% CI: 203‐783‐rate: 2.5;95% CI: 1.1‐4.2), and 36 (95% CI: 0‐84‐rate: 5.8; 0.0‐13.5), respectively. Conclusion The burden of influenza‐ and RSV‐associated SARI hospitalization was high among children aged <5 years. These first estimates for Madagascar will enable government to make informed evidence‐based decisions when allocating scarce resources and planning intervention strategies to limit the impact and spread of these viruses.
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Affiliation(s)
| | - Stefano Tempia
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Aina Harimanana
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Julia Guillebaud
- National Influenza Centre, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Norosoa H Razanajatovo
- National Influenza Centre, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Maherisoa Ratsitorahina
- Direction de la Veille Sanitaire et de la Surveillance Epidemiologique, Ministry of Public Health, Antananarivo, Madagascar
| | - Jean-Michel Heraud
- National Influenza Centre, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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37
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McMorrow ML, Tempia S, Walaza S, Treurnicht FK, Ramkrishna W, Azziz-Baumgartner E, Madhi SA, Cohen C. Prioritization of risk groups for influenza vaccination in resource limited settings - A case study from South Africa. Vaccine 2018; 37:25-33. [PMID: 30471956 PMCID: PMC6470296 DOI: 10.1016/j.vaccine.2018.11.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Due to competing health priorities, low- and middle-income countries (LMIC) may need to prioritize between different influenza vaccine risk groups. Risk group prioritization may differ in LMIC based upon programmatic feasibility, country-specific prevalence of risk conditions and influenza-associated morbidity and mortality. METHODS In South Africa, we collected local disease burden data (both published and unpublished) and published vaccine efficacy data in risk groups and healthy adults. We used these data to aid policy makers with risk group prioritization for influenza vaccination. We used the following formula to assess potential vaccine averted disease in each risk group: rate of influenza-associated hospitalization (or death) per 100,000 population * influenza vaccine efficacy (VE). We further estimated the cost per hospital day averted and the cost per year of life saved by influenza vaccination. RESULTS Pregnant women, HIV-infected adults, and adults and children with tuberculosis disease had among the highest estimates of hospitalizations averted per 100,000 vaccinated and adults aged 65 years and older had the highest estimated deaths averted per 100,000 vaccinated. However, when assessing both the cost per hospital day averted (range: USD148-1,344) and the cost per year of life saved (range: USD112-1,230); adults and children with TB disease, HIV-infected adults and pregnant women had the lowest cost per outcome averted. DISCUSSION An assessment of the potential disease outcomes averted and associated costs may aid policymakers in risk group prioritization for influenza vaccination.
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Affiliation(s)
- Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; U.S. Public Health Service, Rockville, MD, United States.
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Wayne Ramkrishna
- Communicable Disease Cluster, National Department of Health, South Africa
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; U.S. Public Health Service, Rockville, MD, United States
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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38
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Solanki G, Cornell M, Lalloo R. Uptake and cost of influenza vaccines in a private health insured South African population. S Afr J Infect Dis 2018. [DOI: 10.1080/23120053.2018.1504532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Geetesh Solanki
- Health System Research Unit, Medical Research Council of South Africa, Cape Town, South Africa
- Health Economics Unit, Department of Public Health, University of Cape Town, South Africa
- Towers Watson, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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39
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Solanki G, Cornell M, Lalloo R. Uptake and cost of influenza vaccines in a private health insured South African population. S Afr J Infect Dis 2018; 33. [PMID: 32051821 PMCID: PMC7015168 DOI: 10.4102/sajid.v33i5.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Influenza vaccination is regarded as the most effective form of prevention and is particularly recommended for individuals at increased risk of developing severe influenza. Data on uptake (coverage) and costs in South Africa are limited. Methods This study examined influenza vaccination uptake amongst South African private health insurance scheme members. All claims received for services rendered in 2015 were collated at an individual level and the claims related to the provision of influenza vaccines were analysed. Results Of the almost 520 000 members, overall 5.0% (95% CI 4.9%; 5.1%) received the influenza vaccine in 2015. Priority risk groups such as pregnant women, older adults and those with a medical condition were significantly more likely to be vaccinated, as were members belonging to insurance schemes that offered a specific influenza vaccine benefit. The average cost of providing the vaccination was R350. Conclusions Influenza vaccination coverage was low in this privately insured population. There were more members vaccinated in the priority risk groups. There is an urgent need to implement strategies to increase this coverage in privately insured South Africans.
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Affiliation(s)
- Geetesh Solanki
- Health System Research Unit, Medical Research Council of South Africa, Cape Town, South Africa.,Health Economics Unit, Department of Public Health, University of Cape Town, South Africa.,Towers Watson, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ratilal Lalloo
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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40
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Tempia S, Walaza S, Moyes J, Cohen AL, von Mollendorf C, McMorrow ML, Mhlanga S, Treurnicht FK, Venter M, Pretorius M, Hellferscee O, Wolter N, von Gottberg A, Nguweneza A, McAnerney JM, Dawood H, Variava E, Madhi SA, Cohen C. The effects of the attributable fraction and the duration of symptoms on burden estimates of influenza-associated respiratory illnesses in a high HIV prevalence setting, South Africa, 2013-2015. Influenza Other Respir Viruses 2018; 12:360-373. [PMID: 29210203 PMCID: PMC5907815 DOI: 10.1111/irv.12529] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The attributable fraction of influenza virus detection to illness (INF-AF) and the duration of symptoms as a surveillance inclusion criterion could potentially have substantial effects on influenza disease burden estimates. METHODS We estimated rates of influenza-associated influenza-like illness (ILI) and severe acute (SARI-10) or chronic (SCRI-10) respiratory illness (using a symptom duration cutoff of ≤10 days) among HIV-infected and HIV-uninfected patients attending 3 hospitals and 2 affiliated clinics in South Africa during 2013-2015. We calculated the unadjusted and INF-AF-adjusted rates and relative risk (RR) due to HIV infection. Rates were expressed per 100 000 population. RESULTS The estimated mean annual unadjusted rates of influenza-associated illness were 1467.7, 50.3, and 27.4 among patients with ILI, SARI-10, and SCRI-10, respectively. After adjusting for the INF-AF, the percent reduction in the estimated rates was 8.9% (rate: 1336.9), 11.0% (rate: 44.8), and 16.3% (rate: 22.9) among patients with ILI, SARI-10, and SCRI-10, respectively. HIV-infected compared to HIV-uninfected individuals experienced a 2.3 (95% CI: 2.2-2.4)-, 9.7 (95% CI: 8.0-11.8)-, and 10.0 (95% CI: 7.9-12.7)-fold increased risk of influenza-associated illness among patients with ILI, SARI-10, and SCRI-10, respectively. Overall 34% of the estimated influenza-associated hospitalizations had symptom duration of >10 days; 8% and 44% among individuals aged <5 and ≥5 years, respectively. CONCLUSION The marginal differences between unadjusted and INF-AF-adjusted rates are unlikely to affect policies on prioritization of interventions. HIV-infected individuals experienced an increased risk of influenza-associated illness and may benefit more from annual influenza immunization. The use of a symptom duration cutoff of ≤10 days may underestimate influenza-associated disease burden, especially in older individuals.
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Affiliation(s)
- Stefano Tempia
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGAUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Adam L. Cohen
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGAUSA
- Global Immunization Monitoring and Surveillance Team, Expanded Programme on ImmunizationDepartment of Immunization, Vaccines and BiologicalWorld Health OrganizationGenevaSwitzerland
| | - Claire von Mollendorf
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Meredith L. McMorrow
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGAUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
| | - Sarona Mhlanga
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Florette K. Treurnicht
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Marietjie Venter
- Centre for Viral ZoonosesDepartment of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
| | - Marthi Pretorius
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- Centre for Viral ZoonosesDepartment of Medical VirologyUniversity of PretoriaPretoriaSouth Africa
- Tshwane Academic DivisionNational Health Laboratory ServicePretoriaSouth Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of PathologyFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of PathologyFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of PathologyFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Arthemon Nguweneza
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Johanna M. McAnerney
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Halima Dawood
- Department of MedicinePietermaritzburg Metropolitan HospitalPietermaritzburgSouth Africa
- Department of MedicineUniversity of KwaZulu‐NatalPietermaritzburgSouth Africa
| | - Ebrahim Variava
- Department of MedicineKlerksdorp‐Tshepong Hospital ComplexKlerksdorpSouth Africa
- Department of MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Perinatal HIV Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Shabir A. Madhi
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- Medical Research CouncilRespiratory and Meningeal Pathogens Research UnitUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable DiseasesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
- School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Nguenha N, Tivane A, Pale M, Machalele L, Nacoto A, Pires G, Mationane E, Salência J, Gundane F, Muteto D, Chilundo J, Mavale S, Adamo N, Semá-Baltazar C, Augusto O, Gudo E, Mussá T. Clinical and epidemiological characterization of influenza virus infections in children with severe acute respiratory infection in Maputo, Mozambique: Results from the implementation of sentinel surveillance, 2014 - 2016. PLoS One 2018; 13:e0194138. [PMID: 29590162 PMCID: PMC5874022 DOI: 10.1371/journal.pone.0194138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 02/11/2018] [Indexed: 11/16/2022] Open
Abstract
In Sub-Saharan Africa, where burden, impact, and incidence of acute respiratory infections (ARI) are the highest in the world, conversely, the epidemiology of influenza-associated severe acute respiratory infections (SARI) is incompletely known. The aim of this study was to describe the clinical and epidemiological features of influenza-associated SARI in hospitalized children in Maputo city, Mozambique. Nasopharyngeal and oropharyngeal swabs were collected from children aged 0-14 years old who met the case definition for SARI in two hospitals in Maputo city after their parents or legal representative consented to participate. A structured questionnaire was used to collect clinical and demographic data. Typing and subtyping of influenza were performed by real-time PCR. From January 2014 to December 2016, a total of 2,007 eligible children were recruited, of whom 1,997 (99.5%) were screened for influenza by real-time PCR. The median age of participants was 16.9 months (IQR: 7.0-38.9 months) and 53.9% (1076/1991) were male. A total of 77 were positive for influenza, yielding a frequency of 3.9% (77/1,991), with the highest frequency being reported in the age group 1-5 years old. Cases of influenza peaked twice each year, during which, its frequency reached up to 60%-80%. Among all influenza confirmed cases, 33.7% (26/77), 35.1% (27/77) and 28.6% (22/77) were typed as influenza A/H3N2, A/H1N1pdm09, and B, respectively. This represents the first report of influenza in urban/sub urban setting in Mozambique and the first evidence of distribution of strains of influenza in the country. Our data showed that frequency of influenza was lower than reported in a rural setting in Mozambique and the frequency of seasonal (A/H1N1pdm09) and (A/H3N2) subtypes were similar in children with SARI.
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Affiliation(s)
- Neuza Nguenha
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Almiro Tivane
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Mirela Pale
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Loira Machalele
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Afonso Nacoto
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Germano Pires
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Edirsse Mationane
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Judite Salência
- National Institute of Health, Ministry of Health, Maputo, Mozambique
- Pediatric Departament, Hospital Geral de Mavalane, Maputo, Mozambique
| | - Félix Gundane
- National Institute of Health, Ministry of Health, Maputo, Mozambique
- Pediatric Departament, Hospital Geral de Mavalane, Maputo, Mozambique
| | - Délcio Muteto
- Pediatric Departament, Hospital Central de Maputo, Maputo, Mozambique
| | - Josina Chilundo
- Pediatric Departament, Hospital Central de Maputo, Maputo, Mozambique
| | - Sandra Mavale
- Pediatric Departament, Hospital Central de Maputo, Maputo, Mozambique
| | - Noorbebi Adamo
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | - Orvalho Augusto
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Eduardo Gudo
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Tufária Mussá
- National Institute of Health, Ministry of Health, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Tempia S, Walaza S, Moyes J, Cohen AL, von Mollendorf C, McMorrow ML, Treurnicht FK, Venter M, Pretorius M, Hellferscee O, Wolter N, von Gottberg A, Nguweneza A, McAnerney JM, Dawood H, Variava E, Madhi SA, Cohen C. Attributable Fraction of Influenza Virus Detection to Mild and Severe Respiratory Illnesses in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012-2016. Emerg Infect Dis 2018. [PMID: 28628462 PMCID: PMC5512492 DOI: 10.3201/eid2307.161959] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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
The attributable fraction (AF) of influenza virus detection to illness has not been described for patients in different age groups or with different HIV infection statuses. We compared the age group–specific prevalence of influenza virus infection among patients with influenza-like illness (ILI) or severe acute or chronic respiratory illness (SARI and SCRI, respectively) with that among controls, stratified by HIV serostatus. The overall AF for influenza virus detection to illness was 92.6% for ILI, 87.4% for SARI, and 86.2% for SCRI. Among HIV-uninfected patients, the AF for all syndromes was highest among persons <1 and >65 years of age and lowest among persons 25–44 years of age; this trend was not observed among HIV-infected patients. Overall, influenza viruses when detected in patients with ILI, SARI, or SCRI are likely attributable to illness. This finding is particularly likely among children and the elderly irrespective of HIV serostatus and among HIV-infected persons irrespective of age.
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Cohen C, Walaza S, Treurnicht FK, McMorrow M, Madhi SA, McAnerney JM, Tempia S. In- and Out-of-hospital Mortality Associated with Seasonal and Pandemic Influenza and Respiratory Syncytial Virus in South Africa, 2009-2013. Clin Infect Dis 2018; 66:95-103. [PMID: 29040527 PMCID: PMC5813484 DOI: 10.1093/cid/cix740] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
Background Estimates of influenza- and respiratory syncytial virus (RSV)-associated mortality burden are important to guide policy for control. Data are limited on the contribution of out-of-hospital deaths to this mortality. Methods We modeled excess mortality attributable to influenza and RSV infection by applying regression models to weekly deaths from national vital statistics from 2009 through 2013, using influenza and RSV laboratory surveillance data as covariates. We fitted separate models for in- and out-of-hospital deaths. Results There were 509791 average annual deaths in South Africa, of which 44% (95% confidence interval [CI] 43%-45%) occurred out-of-hospital. Seasonal influenza and RSV all-cause mortality rates were 23.0 (95% CI 11.0-30.6) and 13.2 (95% CI 6.4-33.8) per 100000 population annually (2.3% [95%CI 2.3%-2.4%] and 1.3% [95% CI 1.2%-1.4%] of all deaths respectively). The peak mortality rate was in individuals aged ≥75 years (386.0; 95% CI 176.5-466.3) for influenza and in infants (143.4; 95% CI 0-194.8) for RSV. Overall, 63% (95% CI 62%--65%) of seasonal influenza and 48% (95% CI 47%-49%) of RSV-associated deaths occurred out-of-hospital. Among children aged <5 years, RSV-associated deaths were more likely to occur in-hospital, whereas influenza-associated deaths were more likely to occur out-of-hospital. The mortality rate was 6.7 (95% CI 6.4-33.8) in the first influenza A(H1N1)pdm09 wave in 2009 and 20.9 (95% CI 6.4-33.8) in the second wave in 2011, with 30% (95% CI 29%-32%) of A(H1N1)pdm09-associated deaths in 2009 occurring out-of-hospital. Discussion More than 45% of seasonal influenza- and RSV-associated deaths occur out-of-hospital in South Africa. These data suggest that hospital-based studies may substantially underestimate mortality burden.
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Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- US Public Health Service, Rockville, Maryland
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
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Theo A, Tempia S, Cohen AL, Simusika P, Chentulo E, Chikamukwa CM, Monze M. The national burden of influenza-associated severe acute respiratory illness hospitalization in Zambia, 2011-2014. Influenza Other Respir Viruses 2018; 12:46-53. [PMID: 29243406 PMCID: PMC5818337 DOI: 10.1111/irv.12492] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Estimates of influenza-associated hospitalization are limited in low- and middle-income countries, especially in Africa. OBJECTIVE To estimate the national number of influenza-associated severe acute respiratory illness (SARI) hospitalization in Zambia. METHODS We conducted active prospective hospital-based surveillance for SARI at the University Teaching Hospital (UTH) situated in Lusaka Province during 2011-2014. Upper respiratory tract samples were tested for influenza virus using a reverse transcriptase polymerase chain reaction assay. We estimated age-specific rates of influenza-associated SARI hospitalizations for the UTH using census and secondary data on respiratory hospitalizations following estimation approaches recommended by the World Health Organization. We used the UTH hospitalization rates as a proxy for Lusaka Province. These rates were adjusted for each of the remaining 9 provinces based on their prevalence of risk factors for pneumonia and healthcare-seeking behavior. Rates were expressed per 100,000 population. RESULTS SARI cases accounted for 77.1% (13 389/17 354) of respiratory admissions at the UTH; 82.7% (11 859/14 344) and 50.8% (1530/3010) among individuals aged <5 and ≥5 years, respectively. Among SARI cases tested, the influenza virus detection rate was 5.5% (152/2734), 4.8% (48/998), and 6.0% (104/1736) among individuals aged <5 and ≥5 years, respectively. The mean annual national number of influenza-associated SARI hospitalizations was 6181 (95% CI: 4321-8041-rate: 43.9; 95% CI: 30.7-57.1); 4669 (95% CI: 3287-6051-rate: 187.7; 95% CI: 132.1-243.3) among children aged <5 years; and 1512 (95% CI: 1037-1987-rate: 13.1; 95% CI: 9.0-17.2) among individuals aged ≥5 years. CONCLUSIONS The burden of influenza-associated SARI hospitalizations was substantial and was highest among children aged <5 years.
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Affiliation(s)
- Andros Theo
- Cavendish University School of MedicineLusakaZambia
| | - Stefano Tempia
- Influenza DivisionCenters for Disease Control and PreventionAtlantaUSA
- Influenza ProgramCenters for Disease Control and PreventionPretoriaSouth Africa
- Centre for Respiratory Diseases and MeningitisNational Institute for Communicable Diseases of the National Health Laboratory ServiceJohannesburgSouth Africa
| | - Adam L Cohen
- Cavendish University School of MedicineLusakaZambia
- Strategic Information GroupExpanded Programme on ImmunizationDepartment of Immunization, Vaccines and BiologicalWorld Health OrganizationGenevaSwitzerland
| | - Paul Simusika
- National Influenza CenterVirology LaboratoryUniversity Teaching HospitalLusakaZambia
| | - Edward Chentulo
- National Influenza CenterVirology LaboratoryUniversity Teaching HospitalLusakaZambia
| | | | - Mwaka Monze
- National Influenza CenterVirology LaboratoryUniversity Teaching HospitalLusakaZambia
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McMorrow ML, Emukule GO, Obor D, Nyawanda B, Otieno NA, Makokha C, Mott JA, Bresee JS, Reed C. Maternal influenza vaccine strategies in Kenya: Which approach would have the greatest impact on disease burden in pregnant women and young infants? PLoS One 2017; 12:e0189623. [PMID: 29283997 PMCID: PMC5746219 DOI: 10.1371/journal.pone.0189623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent influenza surveillance data from Africa suggest an important burden of influenza-associated morbidity and mortality. In tropical countries where influenza virus transmission may not be confined to a single season alternative strategies for vaccine distribution via antenatal care (ANC) or semiannual campaigns should be considered. Methods Using data on monthly influenza disease burden in women of child-bearing age and infants aged 0–5 months in Kenya from 2010–2014, we estimated the number of outcomes (illnesses, medical visits, hospitalizations, and deaths) that occurred and that may have been averted through influenza vaccination of pregnant women using: 1) a year-round immunization strategy through ANC, 2) annual vaccination campaigns, and 3) semiannual vaccination campaigns. Results During 2010–2014, influenza resulted in an estimated 279,047 illnesses, 36,276 medical visits, 1612 hospitalizations and 243 deaths in pregnant women and 157,053 illnesses, 65,177 medical visits, 4197 hospitalizations, and 755 deaths in infants aged 0–5 months in Kenya. Depending on the mode of distribution and the vaccine coverage achieved, 12.8–31.4% of influenza-associated disease in pregnant women and 11.6–22.1% in infants aged 0–5 months might have been prevented through maternal influenza immunization. In this model, point estimates for influenza-associated disease averted through maternal vaccination delivered year-round in ANC or semiannually in campaigns were higher than vaccination delivered in a single annual campaign, but confidence intervals overlapped. Conclusions Vaccinating pregnant women against influenza can reduce the burden of influenza-associated illness, hospitalization and death in both pregnant women and their young infants. Alternative immunization strategies may avert more influenza-associated disease in countries where influenza virus transmission occurs throughout the year.
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Affiliation(s)
- Meredith L. McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Gideon O. Emukule
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - David Obor
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | | | | | - Joshua A. Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
| | - Joseph S. Bresee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Nyamusore J, Rukelibuga J, Mutagoma M, Muhire A, Kabanda A, Williams T, Mutoni A, Kamwesiga J, Nyatanyi T, Omolo J, Kabeja A, Koama JB, Mukarurangwa A, Umuringa JD, Granados C, Gasana M, Moen A, Tempia S. The national burden of influenza-associated severe acute respiratory illness hospitalization in Rwanda, 2012-2014. Influenza Other Respir Viruses 2017; 12:38-45. [PMID: 29197152 PMCID: PMC5818355 DOI: 10.1111/irv.12494] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background Estimates of influenza‐associated hospitalization are severely limited in low‐ and middle‐income countries, especially in Africa. Objectives To estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Rwanda. Methods We multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012‐2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100 000 population. A sensitivity analysis using a different estimation approach was also conducted. Results SARI cases accounted for 70.6% (9759/13 813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and ≥5 years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and ≥5 years, respectively. The estimated mean annual national number of influenza‐associated SARI hospitalizations was 3663 (95% CI: 2930‐4395—rate: 34.7; 95% CI: 25.4‐47.7): 2637 (95% CI: 2110‐3164—rate: 168.7; 95% CI: 135.0‐202.4) among children aged <5 years and 1026 (95% CI: 821‐1231—rate: 11.3; 95% CI: 9.0‐13.6) among individuals aged ≥5 years. The estimates obtained from both approaches were not statistically different (overlapping CIs). Conclusions The burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.
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Affiliation(s)
- José Nyamusore
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Joseph Rukelibuga
- Influenza Program, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Mwumvaneza Mutagoma
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Andrew Muhire
- Health Management Information System Division, Ministry of Health, Kigali, Rwanda
| | - Alice Kabanda
- National Reference Laboratory, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Thelma Williams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Mutoni
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Julius Kamwesiga
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Thierry Nyatanyi
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Jared Omolo
- Influenza Program, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Adeline Kabeja
- Epidemic Surveillance and Response Division, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Jean Baptiste Koama
- Influenza Program, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Agrippine Mukarurangwa
- National Reference Laboratory, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Jeanne d'Arc Umuringa
- National Reference Laboratory, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Carolina Granados
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michel Gasana
- Institute of HIV/AIDS, Disease Prevention and Control, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
| | - Ann Moen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
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47
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Green RJ. Influenza. VIRAL INFECTIONS IN CHILDREN, VOLUME I 2017. [PMCID: PMC7121810 DOI: 10.1007/978-3-319-54033-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Influenza is one of the commonest infections in human populations, and causing substantial morbidity and mortality globally. The influenza virus is divided into different types and subtypes, three of which are currently circulating widely in humans: influenza A(H3N2) and influenza B. The virus undergoes constant evolution, leading to annual seasonal winter epidemics in temperate countries and necessitating annual updates to the vaccine. Rarely, completely new influenza viruses can emerge in human populations, giving rise to influenza pandemics. Children aged <5 years (especially those <2 years) and those with underlying illness such as cardiac, respiratory and severe neurologic disease have an increased risk of severe outcomes associated with influenza. Pregnant women have an increased risk of severe influenza. Complications may involve the respiratory tract (e.g. otitis media or pneumonia) or, less commonly, other organ systems (e.g. encephalitis or myocarditis). Specific antiviral treatment should be offered as soon as possible for hospitalized children with presumed or confirmed influenza and for influenza of any severity for children at high risk of severe complications of influenza without waiting for laboratory confirmation. Antiviral treatment is usually not warranted for uncomplicated influenza as this is usually self-limiting. Annual influenza vaccination should be offered to all individuals at increased risk for complications of influenza. Vaccine cannot be given to children aged <6 months but maternal influenza immunization during pregnancy is recommended and can confer protection to the young infant.
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Affiliation(s)
- Robin J. Green
- Department of Paediatrics and Child Health, University of Pretoria, School of Medicine, Pretoria, ZA, South Africa
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