Epidemiology of influenza in Ethiopia: findings from influenza sentinel surveillance and respiratory infection outbreak investigations, 2009\u20132015

Abyot Bekele Woyessa,Lucy Boulanger,Mesfin Mengesha,Workenesh Ayele,Thelma Williams,Adamu Tayachew,Desalegn Belay,Carolina Granados,Soatiana Rajatonirina,Woubayehu Kassa,Etsehiwot Zemelak,Berhanu Amare,Gelila Demissie,Berhane Beyene,Daddi Jima,Israel Tareke

doi:10.1186/s12879-018-3365-5

Abstract

BackgroundInfluenza is an acute viral disease of the respiratory tract which is characterized by fever, headache, myalgia, prostration, coryza, sore throat and cough. Globally, an estimated 3 to 5 million cases of severe influenza illness and 291 243–645 832 seasonal influenza-associated respiratory deaths occur annually. Although recent efforts from some African countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including Ethiopia. Ethiopia established influenza sentinel surveillance in 2008 aiming to determine influenza strains circulating in the country and know characteristics, trend and burden of influenza viruses.MethodsWe used influenza data from sentinel surveillance sites and respiratory disease outbreak investigations from 2009 to 2015 for this analysis. We obtained the data by monitoring patients with influenza-like illness (ILI) at three health-centers, severe acute respiratory infection (SARI) at five hospitals and investigating patients during different respiratory infection outbreaks. Throat-swab specimens in viral transport media were transported to the national reference laboratory within 72 h of collection using a cold-chain system. We extracted viral RNA from throat-swabs and subjected to real-time PCR amplification. We further subtyped and characterized Influenza A-positive specimens using CDC real-time reverse transcription PCR protocol.ResultsA total of 4962 throat-swab samples were collected and 4799 (96.7%) of them were tested. Among them 988 (20.6%) were influenza-positive and of which 349 (35.3%) were seasonal influenza A(H3N2), 321 (32.5%) influenza A(H1N1)pdm2009 and 318 (32.0%) influenza B. Positivity rate was 29.5% in persons 5–14 years followed by 26.4% in 15–44 years, 21.2% in > 44 years and 6.4% in under five children. The highest positivity rate observed in November (37.5%) followed by March (27.6%), December (26.4%), October (24.4%) and January (24.3%) while the lowest positivity rate was in August (7.7%).ConclusionIn Ethiopia, seasonal Influenza A(H3N2), Influenza A(H1N1)pdm2009 and Influenza B viruses were circulating during 2009–2015. Positivity rate and number of cases peaked in November and December. Influenza is one of public health problems in Ethiopia and the need to introduce influenza vaccine and antivirus is important to prevent and treat the disease in future.

Highlights

Influenza is an acute viral disease of the respiratory tract which is characterized by fever, headache, myalgia, prostration, coryza, sore throat and cough
From January 1, 2009 through December 31, 2015, a total of 4962 patients which fulfilled influenza-like illness (ILI) and severe acute respiratory infection (SARI) case definitions were enrolled and throat samples collected at designated influenza sentinel site health facilities and from respiratory infection outbreak investigations in different parts of the country (Fig. 1)
The findings indicated that seasonal Influenza A(H3N2), Pandemic Influenza A(H1N1) and Influenza B viruses were circulating in Ethiopia

Summary

Introduction

Influenza is an acute viral disease of the respiratory tract which is characterized by fever, headache, myalgia, prostration, coryza, sore throat and cough. Recent efforts from some African countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including Ethiopia. Ethiopia established influenza sentinel surveillance in 2008 aiming to determine influenza strains circulating in the country and know characteristics, trend and burden of influenza viruses. Influenza is an acute viral disease of the respiratory tract which is characterized by some or all of the following sign and symptoms: fever, headache, myalgia, prostration, coryza, sore-throat and cough [1]. Of the three types of influenza viruses, A, B, and C, the first two are associated with significant seasonal morbidity and mortality [2, 3]. In Africa, influenza-related incidence data remain inadequate and outcome data are still very limited despite of some surveillance information [9]

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