Enhancement of the Influenza Surveillance System in the Russian Federation: the Main Results of the Sentinel Surveillance for Influenza and other Acute Respiratory Viral Infections

Abstract

Existing influenza surveillance system is constantly improved to obtain comprehensive information for understanding of continuously changing situation with the influenza, which is a consequence of the highest variability of the pathogen, its ability to reassortment and the imminence of emergence a new shift-variants of the virus that could cause the next pandemic events. For this purpose, since the 2010 - 2011 epidemic season, in addition to the traditional surveillance system (TS) a new well standardized sentinel surveillance system (SS) for rapid clinical and epidemiological data obtaining was introduced in Russia. A total 7812 hospitalized patients with severe acute respiratory infection (SARI) and 9854 outpatients with influenza-like illness and acute respiratory infection (ILI/ARI) were investigated during the 6-year period in SS. Percent of SARI among all hospitalized patients ranged from 1.7 to 3.1%; about 5.3 - 7.5% SARI patients were placed in the Intensive Care Unit. Etiological monitoring using PCR showed influenza spread trends in SS similar to those registered in the TS: a clear predominance of influenza A (H1N1) pdm09 among SARI and ILI/ARI in 2010 - 2011 and 2015 - 2016 epidemic seasons, influenza A (H3N2) in the epidemic seasons 2011 - 2012 and 2014 - 2015, the co-circulation of these pathogens in 2012 - 2013, 2013 - 2014 seasons in Russia. SARI caused by influenza B virus were detected less frequently than influenza A but increased influenza B activity was registered in the epidemic of 2014 -2015, when Yamagata lineage changed suddenly for the Victorian one. The average frequency of influenza diagnosis among SARI between the seasons varied in the range 12.5 - 27.1%, at the peak of the epidemic it reached 44.8 - 73.5% and was the highest during the season with active circulation of influenza A (H1N1) pdm09 virus. The rate of influenza diagnosis among ILI/ARI has always been lower than that among SARI. Studies have also shown the importance of rhinovirus, RS-virus and parainfluenza infections in SARI development. The frequency of registration of coronaviruses, metapneumovirus and bocavirus infection was very low in SARI and ILI/ARI. It was found that in all studied seasons most of SARI patients with influenza have not been vaccinated. Among ILI/ARI outpatients with influenza, the frequency of vaccinated individuals for the entire period of the study was estimated as 10.1%, which was 4.2 times higher than that in SARI, where only 2.4% of patients were vaccinated. In addition, it was found that for all six seasons the SARI patients with influenza were treated with antivirals drugs 2 times less often compared to outpatients. Analysis of data on concomitant diseases and conditions in SARI patients with influenza confirmed the leading role of pregnancy as a risk factor for hospitalization in all influenza epidemics, irrespective of their etiology. In addition, diabetes and cardiovascular disease were recognized as risk factors for influenza associated SARI development.