Fuller, James A., Summers, Aimee, Katz, Mark A., Lindblade, Kim A., Njuguna, Henry, Arvelo, Wences, Khagayi, Sammy, Emukule, Gideon, Linares-Perez, Nivaldo, McCracken, John, Nokes, D. James, Ngama, Mwanajuma, Kazungu, Sidi, Mott, Joshua A., Olsen, Sonja J., Widdowson, Marc-Alain and Feikin, Daniel R. (2013) Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala : a novel methodology. PLoS One, Volume 8 (Mumber 2). Article number e56882. doi:10.1371/journal.pone.0056882

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Abstract

Background:
Knowing the national disease burden of severe influenza in low-income countries can inform policy decisions around influenza treatment and prevention. We present a novel methodology using locally generated data for estimating this burden.
Methods and Findings:
This method begins with calculating the hospitalized severe acute respiratory illness (SARI) incidence for children <5 years old and persons ≥5 years old from population-based surveillance in one province. This base rate of SARI is then adjusted for each province based on the prevalence of risk factors and healthcare-seeking behavior. The percentage of SARI with influenza virus detected is determined from provincial-level sentinel surveillance and applied to the adjusted provincial rates of hospitalized SARI. Healthcare-seeking data from healthcare utilization surveys is used to estimate non-hospitalized influenza-associated SARI. Rates of hospitalized and non-hospitalized influenza-associated SARI are applied to census data to calculate the national number of cases. The method was field-tested in Kenya, and validated in Guatemala, using data from August 2009–July 2011. In Kenya (2009 population 38.6 million persons), the annual number of hospitalized influenza-associated SARI cases ranged from 17,129–27,659 for children <5 years old (2.9–4.7 per 1,000 persons) and 6,882–7,836 for persons ≥5 years old (0.21–0.24 per 1,000 persons), depending on year and base rate used. In Guatemala (2011 population 14.7 million persons), the annual number of hospitalized cases of influenza-associated pneumonia ranged from 1,065–2,259 (0.5–1.0 per 1,000 persons) among children <5 years old and 779–2,252 cases (0.1–0.2 per 1,000 persons) for persons ≥5 years old, depending on year and base rate used. In both countries, the number of non-hospitalized influenza-associated cases was several-fold higher than the hospitalized cases.

Conclusions: Influenza virus was associated with a substantial amount of severe disease in Kenya and Guatemala. This
method can be performed in most low and lower-middle income countries.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Science > Life Sciences (2010- )
Library of Congress Subject Headings (LCSH):	Influenza -- Kenya, Influenza -- Guatemala, Respiratory infections -- Kenya, Respiratory infections -- Guatemala, SARS (Disease) -- Kenya, SARS (Disease) -- Guatemala
Journal or Publication Title:	PLoS One
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	2013
Dates:	Date Event 2013 Published
Volume:	Volume 8
Number:	Mumber 2
Page Range:	Article number e56882
DOI:	10.1371/journal.pone.0056882
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	Center for Disease Control (CDC), Wellcome Trust (London, England)
Grant number:	UU01 GH000028-02 (CDC)

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