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Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015

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  • Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015

    PLoS One. 2019 Sep 6;14(9):e0221479. doi: 10.1371/journal.pone.0221479. eCollection 2019.
    Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015.

    Palekar RS1, Rolfes MA2, Arriola CS2, Acosta BO3, Guidos PA4, Vargas XB5, Bancej C6, Ramirez JB7, Baumeister E8, Bruno A9, Cabello MA10, Chen J2,11, Couto P1, Junior FJP12, Fasce R13, Ferreira de Almeida W12, Solorzano VEF14, Ramírez CF15, Gońi N16, Isaza de Moltó Y17, Lara J18, Malo DC7, Medina Osis JL14, Mejía H19, Castillo LM17, Mustaquim D2, Nwosu A6, Ojeda J20, Samoya AP21, Pulido PA7, Ramos Hernandez HM4, Lopez RR19, Rodriguez A1, Saboui M6, Bolanos HS22, Santoro A23, Silvera JE24, Sosa P1, Sotomayor V25, Suarez L26, Von Horoch M10, Azziz-Baumgartner E2.
    Author information

    1 Pan American Health Organization/World Health Organization, Washington, DC, United States of America. 2 Centers for Disease Control and Prevention, Atlanta, GA, United States of America. 3 Department of Virology, "Pedro Kouri" Institute of Tropical Medicine, Havana, Cuba. 4 Ministry of Health, San Salvador, El Salvador. 5 Costa Rican Department of Social Security, San Jose, Costa Rica. 6 Public Health Agency of Canada, Ottawa, Canada. 7 National Institute of Health, Bogota, Colombia. 8 National Reference Laboratory for Viral Respiratory Infections and National Influenza Center, Buenos Aires, Argentina. 9 National Institute of Public Health Research, Guayaquil, Ecuador. 10 Ministry of Public Health and Social Welfare, Asuncion, Paraguay. 11 Battelle Memorial Institute, Atlanta, GA, United States of America. 12 Ministry of Health, Brasilia, Brazil. 13 Institute of Public Health, Santiago, Chile. 14 National Center of Epidemiology, Prevention, and Control of Diseases, Lima, Peru. 15 Directorate of Health Services, Guatemala City, Guatemala. 16 Department of Public Health Laboratories, Montevideo, Uruguay. 17 Ministry of Health, Panama City, Panama. 18 Costa Rican Institute of Research and Education in Nutrition and Health, Cartago, Costa Rica. 19 Health Secretariat, Tegucigalpa, Honduras. 20 Ministry of Health, Quito, Ecuador. 21 Ministry of Public Health, Guatemala City, Guatemala. 22 Ministry of Health, San Jose, Costa Rica. 23 Directorate of Statistics and Health Information, Buenos Aires, Argentina. 24 Ministry of Health, Montevideo, Uruguay. 25 Ministry of Health, Santiago, Chile. 26 Ministry of Public Health, Havana, Cuba.



    Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas.

    Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates.

    Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000).

    Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.

    PMID: 31490961 DOI: 10.1371/journal.pone.0221479
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