Abstract
BackgroundInfluenza is a major cause of respiratory illness resulting in 3–5 million severe cases and 291,243-645,832 deaths annually. Substantial health and financial burden may be averted by annual influenza vaccine application, especially for high risk groups.MethodsWe used an active facility-based surveillance platform for acute respiratory diseases in three hospitals in Guatemala, Central America, to estimate the incidence of laboratory-confirmed hospitalized influenza cases and identify risk factors associated with severe disease (defined as admission to the intensive care unit (ICU) or death). We enrolled patients presenting with signs and symptoms of acute respiratory infection (ARI) and obtained naso- and oropharyngeal samples for real-time reverse transcriptase polymerase chain reaction (RT-PCR). We used multivariable logistic regression to identify risk factors for ICU admission or death, adjusted for age and sex.ResultsFrom May 2008 to July 2012, among 6326 hospitalized ARI cases, 446 (7%) were positive for influenza: of those, 362 (81%) had influenza A and 84 (18%) had influenza B. Fifty nine percent of patients were aged ≤ 5 years, and 10% were aged ≥ 65 years. The median length of hospitalization was 5 days (interquartile range: 5). Eighty of 446 (18%) were admitted to the ICU and 28 (6%) died. Among the 28 deaths, 7% were aged ≤ 6 months, 39% 7–60 months, 21% 5–50 years, and 32% ≥ 50 years. Children aged ≤ 6 months comprised 19% of cases and 22% of ICU admissions. Women of child-bearing age comprised 6% of cases (2 admitted to ICU; 1 death). In multivariable analyses, Santa Rosa site (adjusted odds ratio [aOR] = 10, 95% confidence interval [CI] = 2–50), indigenous ethnicity (aOR = 4, 95% CI = 2–13, and radiologically-confirmed pneumonia (aOR = 5, 95% CI = 3–11) were independently associated with severe disease. Adjusted for hospital utilization rate, annual incidence of hospitalized laboratory-confirmed influenza was 24/100,000 overall, 93/100,000 for children aged < 5 years and 50/100,000 for those ≥ 65 years.ConclusionsInfluenza is a major contributor of hospitalization and death due to respiratory diseases in Guatemala. Further application of proven influenza prevention and treatment strategies is warranted.
Highlights
Influenza is a major cause of respiratory illness resulting in 3–5 million severe cases and 291,243-645,832 deaths annually
Laboratory methods Nasopharyngeal swab specimens were collected from each patient using a polyester swab that was placed in viral transport media, stored at 4-8 °C for ~ 24 h, frozen at -20 °C and sent for laboratory analysis at Centro de Estudios en Salud (CES)-Universidad del Valle de Guatemala (UVG) where they were tested using real-time reverse transcriptase polymerase chain reaction per standard Centers for Disease Control and Prevention (CDC) protocols for influenza A and B viruses
Statistical analyses We examined data from the Vigilancia Integrada Comunitaria (VICo) respiratory syndrome database for Santa Rosa department collected during June 2007 to September 2012, for Quetzaltenango department collected during February 2009 to September 2012, and for Guatemala City collected during November 2009 to December 2011
Summary
Influenza is a major cause of respiratory illness resulting in 3–5 million severe cases and 291,243-645,832 deaths annually. Despite its public health and economic importance, the incidence of influenza-related hospitalization has been estimated only in some locations [6,7,8], and there is insufficient quality data for Central America [9]. In Guatemala, Lindblade, et al, described the clinical presentations of pandemic A(H1N1)pdm and seasonal influenza A (H1N1 and H3N2) from 2008 to 2009, but did not estimate the incidence for these illnesses [11]. They concluded that each caused substantial disease in infants. A prospective study in Nicaragua confirmed higher rates in infants aged 6–11 months than in those 0–5 months [12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
