tetano
Editor, Senior Moderator
Ann Am Thorac Soc. 2016 Sep 9. [Epub ahead of print]
[h=1]Epidemiologic and Spatio-Temporal Characterization of Influenza and Severe Acute Respiratory Infection in Uganda, 2010-2015.[/h] Cummings MJ[SUP]1[/SUP], Bakamutumaho B[SUP]2[/SUP], Kayiwa J[SUP]3[/SUP], Byaruhanga T[SUP]4[/SUP], Owor N[SUP]5[/SUP], Namagambo B[SUP]6[/SUP], Wolf A[SUP]7[/SUP], Wamala JF[SUP]8,[/SUP][SUP]9[/SUP], Morse SS[SUP]10[/SUP], Lutwama JJ[SUP]11[/SUP], O'Donnell MR[SUP]12,[/SUP][SUP]13[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]RATIONALE:[/h] Little is known about the epidemiology of severe acute respiratory infection or influenza in sub-Saharan Africa. Characterization of influenza transmission dynamics and risk factors for severe disease and mortality is critical to inform prevention and mitigation strategies.
[h=4]OBJECTIVES:[/h] To characterize the epidemiology and transmission dynamics of influenza and risk factors for influenza-associated severe respiratory infection in Uganda.
[h=4]METHODS:[/h] Clinicians at 12 sentinel surveillance sites prospectively collected clinical data and upper respiratory tract samples from consecutive patients who met criteria for severe acute respiratory infection and influenza-like illness. Samples were tested for influenza A and B viruses using real-time reverse transcription polymerase chain reaction. Spatial and spatio-temporal cluster modeling was performed to identify loci of increased influenza transmission. Morbidity and mortality were assessed through chart review in a defined subset of patients. Univariable and multivariable analyses were used to identify risk factors for severe respiratory infection, prolonged hospitalization, and in-hospital mortality.
[h=4]MEASUREMENTS AND MAIN RESULTS:[/h] From October 2010 to June 2015, 9,978 patients met case-definitions for severe acute respiratory infection and influenza-like illness and had samples tested for influenza A and B. Of the 9,978 patient samples tested, 1,113 were positive for influenza (11.2%). Among 6,057 patients with influenza-like illness, 778 (12.8%) samples were positive and among 3,921 patients with severe acute respiratory infection, 335 (8.5%) samples were positive. Significant clustering of influenza cases was observed in urban and peri-urban areas and during rainy seasons. Among 1,405 cases of severe acute respiratory infection with available outcome data, in-hospital mortality was 1.6%. Infection with the 2009 pandemic A/H1N1 subtype and prolonged time to presentation were independently associated with severe acute respiratory infection among influenza cases.
[h=4]CONCLUSIONS:[/h] Influenza is associated with a substantial proportion of acute respiratory infection in Uganda. As influenza vaccination programs are developed in East Africa, timing campaigns to confer protection during rainy seasons should be considered, particularly among high-risk urban populations.
PMID: 27612095 DOI: 10.1513/AnnalsATS.201607-561OC
[PubMed - as supplied by publisher]
[h=1]Epidemiologic and Spatio-Temporal Characterization of Influenza and Severe Acute Respiratory Infection in Uganda, 2010-2015.[/h] Cummings MJ[SUP]1[/SUP], Bakamutumaho B[SUP]2[/SUP], Kayiwa J[SUP]3[/SUP], Byaruhanga T[SUP]4[/SUP], Owor N[SUP]5[/SUP], Namagambo B[SUP]6[/SUP], Wolf A[SUP]7[/SUP], Wamala JF[SUP]8,[/SUP][SUP]9[/SUP], Morse SS[SUP]10[/SUP], Lutwama JJ[SUP]11[/SUP], O'Donnell MR[SUP]12,[/SUP][SUP]13[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]RATIONALE:[/h] Little is known about the epidemiology of severe acute respiratory infection or influenza in sub-Saharan Africa. Characterization of influenza transmission dynamics and risk factors for severe disease and mortality is critical to inform prevention and mitigation strategies.
[h=4]OBJECTIVES:[/h] To characterize the epidemiology and transmission dynamics of influenza and risk factors for influenza-associated severe respiratory infection in Uganda.
[h=4]METHODS:[/h] Clinicians at 12 sentinel surveillance sites prospectively collected clinical data and upper respiratory tract samples from consecutive patients who met criteria for severe acute respiratory infection and influenza-like illness. Samples were tested for influenza A and B viruses using real-time reverse transcription polymerase chain reaction. Spatial and spatio-temporal cluster modeling was performed to identify loci of increased influenza transmission. Morbidity and mortality were assessed through chart review in a defined subset of patients. Univariable and multivariable analyses were used to identify risk factors for severe respiratory infection, prolonged hospitalization, and in-hospital mortality.
[h=4]MEASUREMENTS AND MAIN RESULTS:[/h] From October 2010 to June 2015, 9,978 patients met case-definitions for severe acute respiratory infection and influenza-like illness and had samples tested for influenza A and B. Of the 9,978 patient samples tested, 1,113 were positive for influenza (11.2%). Among 6,057 patients with influenza-like illness, 778 (12.8%) samples were positive and among 3,921 patients with severe acute respiratory infection, 335 (8.5%) samples were positive. Significant clustering of influenza cases was observed in urban and peri-urban areas and during rainy seasons. Among 1,405 cases of severe acute respiratory infection with available outcome data, in-hospital mortality was 1.6%. Infection with the 2009 pandemic A/H1N1 subtype and prolonged time to presentation were independently associated with severe acute respiratory infection among influenza cases.
[h=4]CONCLUSIONS:[/h] Influenza is associated with a substantial proportion of acute respiratory infection in Uganda. As influenza vaccination programs are developed in East Africa, timing campaigns to confer protection during rainy seasons should be considered, particularly among high-risk urban populations.
PMID: 27612095 DOI: 10.1513/AnnalsATS.201607-561OC
[PubMed - as supplied by publisher]