Demographic and ecological risk factors for human influenza A virus infections in rural Indonesia.

Elisabeth Dowling Root,Cissy Kartasasmita,Eric A F Simões,Dwi Agustian,Timothy M Uyeki

doi:10.1111/irv.12468

Abstract

BackgroundIndonesia has the world's highest reported mortality for human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus. Indonesia is an agriculturally driven country where human‐animal mixing is common and provides a unique environment for zoonotic influenza A virus transmission.ObjectivesTo identify potential demographic and ecological risk factors for human infection with seasonal influenza A viruses in rural Indonesia, a population‐based study was conducted in Cileunyi and Soreang subdistricts near Bandung in western Java from 2008 to 2011.MethodsPassive influenza surveillance with RT‐PCR confirmation of influenza A viral RNA in respiratory specimens was utilized for case ascertainment. A population census and mapping were utilized for population data collection. The presence of influenza A(H3N2) and A(H1N1)pdm09 virus infections in a household was modeled using Generalized Estimating Equations.ResultsEach additional child aged <5 years in a household increased the odds of H3N2 approximately 5 times (OR=4.59, 95%CI: 3.30‐6.24) and H1N1pdm09 by 3.5 times (OR=3.53, 95%CI: 2.51‐4.96). In addition, the presence of 16‐30 birds in the house was associated with an increased odds of H3N2 (OR=5.08, 95%CI: 2.00‐12.92) and H1N1pdm09 (OR=12.51 95%CI: 6.23‐25.13).ConclusionOur findings suggest an increase in influenza A virus infections in rural Indonesian households with young children and poultry.

Highlights

Influenza pandemics and seasonal influenza epidemics have caused high mortality and morbidity with devastating global economic losses.[1,2] Between 2003 and 2015, Indonesia, Vietnam, and Egypt reported the highest number of human highly pathogenic avian influenza (HPAI) A(H5N1) cases
2005.3 Tropical regions such as Indonesia are a suspected source of antigenically drifted seasonal influenza A(H3N2) virus strains which may migrate to the Southern Hemisphere and Northern Hemisphere through the global air traffic network.[4]
We focused on influenza A cases as our primary goal was to identify ecological risk factors at the human-animal interface

Summary

Introduction

Influenza pandemics and seasonal influenza epidemics have caused high mortality and morbidity with devastating global economic losses.[1,2] Between 2003 and 2015, Indonesia, Vietnam, and Egypt reported the highest number of human highly pathogenic avian influenza (HPAI) A(H5N1) cases. 2005.3 Tropical regions such as Indonesia are a suspected source of antigenically drifted seasonal influenza A(H3N2) virus strains which may migrate to the Southern Hemisphere and Northern Hemisphere through the global air traffic network.[4] Indonesia, a largely agricultural country where human-animal mixing is common, provides a unique environment for zoonotic influenza A virus transmission and an ideal ecological setting for the generation of novel influenza A viruses.[5] A significant amount of research has focused on understanding the. Conclusion: Our findings suggest an increase in influenza A virus infections in rural Indonesian households with young children and poultry

Objectives

Findings

Discussion

Conclusion