Giuseppe
Emeritus
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
2009 Pandemic Influenza A (H1N1) Virus Outbreak and Response ? Rwanda, October, 2009?May, 2010
Justin Wane<SUP>1</SUP>, Thierry Nyatanyi<SUP>2</SUP>, Richard Nkunda<SUP>3</SUP>, Joseph Rukelibuga<SUP>4</SUP>, Zara Ahmed<SUP>5</SUP>, Caitlin Biedron<SUP>5</SUP>, Adeline Kabeja<SUP>2</SUP>, Marie Aim?e Muhimpundu<SUP>2</SUP>, Alice Kabanda<SUP>3</SUP>, Simon Antara<SUP>6</SUP>, Olivier Briet<SUP>2</SUP>, Jean Baptiste Koama<SUP>5</SUP>, Andr? Rusanganwa<SUP>7</SUP>, Odette Mukabayire<SUP>3</SUP>, Corine Karema<SUP>2</SUP>, Pratima Raghunathan<SUP>5</SUP>, David Lowrance<SUP>5</SUP><SUP>*</SUP>
1 King Faisal Hospital, Kigali, Rwanda, 2 Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda, 3 National Reference Laboratory, Kigali, Rwanda, 4 Influenza Division, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda, 5 Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda, 6 African Field Epidemiology Network, Kigali, Rwanda, 7 World Health Organization, Kigali, Rwanda
Abstract
Background
In October 2009, the first case of pandemic influenza A(H1N1)pdm09 (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks. We describe clinical and epidemiological characteristics of this epidemic.
Methods
From October 2009 through May 2010, we undertook epidemiologic investigations and response to pH1N1. Respiratory specimens were collected from all patients meeting the WHO case definition for pH1N1, which were tested using CDC?s real time RT-PCR protocol at the Rwandan National Reference Laboratory (NRL). Following documented viral transmission in the community, testing focused on clinically severe and high-risk group suspect cases.
Results
From October 9, 2009 through May 31, 2010, NRL tested 2,045 specimens. In total, 26% (n = 532) of specimens tested influenza positive; of these 96% (n = 510) were influenza A and 4% (n = 22) were influenza B. Of cases testing influenza A positive, 96.8% (n = 494), 3% (n = 15), and 0.2% (n = 1) were A(H1N1)pdm09, Seasonal A(H3) and Seasonal A(non-subtyped), respectively. Among laboratory-confirmed cases, 263 (53.2%) were children <15 years and 275 (52%) were female. In total, 58 (12%) cases were hospitalized with mean duration of hospitalization of 5 days (Range: 2?15 days). All cases recovered and there were no deaths. Overall, 339 (68%) confirmed cases received oseltamivir in any setting. Among all positive cases, 26.9% (143/532) were among groups known to be at high risk of influenza-associated complications, including age <5 years 23% (122/532), asthma 0.8% (4/532), cardiac disease 1.5% (8/532), pregnancy 0.6% (3/532), diabetes mellitus 0.4% (2/532), and chronic malnutrition 0.8% (4/532).
Conclusions
Rwanda experienced a PH1N1 outbreak which was epidemiologically similar to PH1N1 outbreaks in the region. Unlike seasonal influenza, children <15 years were the most affected by pH1N1. Lessons learned from the outbreak response included the need to strengthen integrated disease surveillance, develop laboratory contingency plans, and evaluate the influenza sentinel surveillance system.
Citation: Wane J, Nyatanyi T, Nkunda R, Rukelibuga J, Ahmed Z, et al. (2012) 2009 Pandemic Influenza A (H1N1) Virus Outbreak and Response ? Rwanda, October, 2009?May, 2010. PLoS ONE 7(6): e31572. doi:10.1371/journal.pone.0031572
Editor: C?cile Viboud, National Institutes of Health, United States of America
Received: June 21, 2011; Accepted: January 11, 2012; Published: June 26, 2012
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: The authors have no support or funding to report.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: lowranced@na.cdc.gov
- -------Justin Wane<SUP>1</SUP>, Thierry Nyatanyi<SUP>2</SUP>, Richard Nkunda<SUP>3</SUP>, Joseph Rukelibuga<SUP>4</SUP>, Zara Ahmed<SUP>5</SUP>, Caitlin Biedron<SUP>5</SUP>, Adeline Kabeja<SUP>2</SUP>, Marie Aim?e Muhimpundu<SUP>2</SUP>, Alice Kabanda<SUP>3</SUP>, Simon Antara<SUP>6</SUP>, Olivier Briet<SUP>2</SUP>, Jean Baptiste Koama<SUP>5</SUP>, Andr? Rusanganwa<SUP>7</SUP>, Odette Mukabayire<SUP>3</SUP>, Corine Karema<SUP>2</SUP>, Pratima Raghunathan<SUP>5</SUP>, David Lowrance<SUP>5</SUP><SUP>*</SUP>
1 King Faisal Hospital, Kigali, Rwanda, 2 Center of Treatment and Research on HIV/AIDS, Malaria, Tuberculosis and Other Epidemic Diseases, Ministry of Health, Kigali, Rwanda, 3 National Reference Laboratory, Kigali, Rwanda, 4 Influenza Division, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda, 5 Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Kigali, Rwanda, 6 African Field Epidemiology Network, Kigali, Rwanda, 7 World Health Organization, Kigali, Rwanda
Abstract
Background
In October 2009, the first case of pandemic influenza A(H1N1)pdm09 (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks. We describe clinical and epidemiological characteristics of this epidemic.
Methods
From October 2009 through May 2010, we undertook epidemiologic investigations and response to pH1N1. Respiratory specimens were collected from all patients meeting the WHO case definition for pH1N1, which were tested using CDC?s real time RT-PCR protocol at the Rwandan National Reference Laboratory (NRL). Following documented viral transmission in the community, testing focused on clinically severe and high-risk group suspect cases.
Results
From October 9, 2009 through May 31, 2010, NRL tested 2,045 specimens. In total, 26% (n = 532) of specimens tested influenza positive; of these 96% (n = 510) were influenza A and 4% (n = 22) were influenza B. Of cases testing influenza A positive, 96.8% (n = 494), 3% (n = 15), and 0.2% (n = 1) were A(H1N1)pdm09, Seasonal A(H3) and Seasonal A(non-subtyped), respectively. Among laboratory-confirmed cases, 263 (53.2%) were children <15 years and 275 (52%) were female. In total, 58 (12%) cases were hospitalized with mean duration of hospitalization of 5 days (Range: 2?15 days). All cases recovered and there were no deaths. Overall, 339 (68%) confirmed cases received oseltamivir in any setting. Among all positive cases, 26.9% (143/532) were among groups known to be at high risk of influenza-associated complications, including age <5 years 23% (122/532), asthma 0.8% (4/532), cardiac disease 1.5% (8/532), pregnancy 0.6% (3/532), diabetes mellitus 0.4% (2/532), and chronic malnutrition 0.8% (4/532).
Conclusions
Rwanda experienced a PH1N1 outbreak which was epidemiologically similar to PH1N1 outbreaks in the region. Unlike seasonal influenza, children <15 years were the most affected by pH1N1. Lessons learned from the outbreak response included the need to strengthen integrated disease surveillance, develop laboratory contingency plans, and evaluate the influenza sentinel surveillance system.
Citation: Wane J, Nyatanyi T, Nkunda R, Rukelibuga J, Ahmed Z, et al. (2012) 2009 Pandemic Influenza A (H1N1) Virus Outbreak and Response ? Rwanda, October, 2009?May, 2010. PLoS ONE 7(6): e31572. doi:10.1371/journal.pone.0031572
Editor: C?cile Viboud, National Institutes of Health, United States of America
Received: June 21, 2011; Accepted: January 11, 2012; Published: June 26, 2012
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: The authors have no support or funding to report.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: lowranced@na.cdc.gov