Abstract
BackgroundIn 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.MethodsFrom 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.ResultsFrom 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).ConclusionsRwanda 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.
Highlights
Rwanda is a landlocked, low-income country, situated in East Africa with an estimated 2010 population of 10.4 million
Prior to the onset of the 2009 Pandemic Influenza A(H1N1)pdm09 in North America, the Rwandan Ministry of Health (MOH) in collaboration with the U.S Centers for Disease Control and Prevention established an influenza sentinel surveillance system (ISS) in July 2008 to understand the epidemiology of seasonal influenza and monitor for the emergence of a novel influenza strain with pandemic potential
Since the occurrence of the outbreak of pandemic influenza A(H1N1)pdm09 (pH1N1) in Mexico in April 2009, the MOH developed a pandemic operational plan in order to minimize the impacts of the pandemic [3,4,5]
Summary
Low-income country, situated in East Africa with an estimated 2010 population of 10.4 million. Prior to the onset of the 2009 Pandemic Influenza A(H1N1)pdm (pH1N1) in North America, the Rwandan Ministry of Health (MOH) in collaboration with the U.S Centers for Disease Control and Prevention established an influenza sentinel surveillance system (ISS) in July 2008 to understand the epidemiology of seasonal influenza and monitor for the emergence of a novel influenza strain with pandemic potential. After initial cases of A(H1N1)pdm were reported in Kenya, Tanzania and Uganda in June and July, 2009 respectively [6,7], the MOH. In October 2009, the first case of pandemic influenza A(H1N1)pdm (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks.
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