Abstract
BackgroundThe emergence of avian influenza A/H5N1 in 2003 as well as the pandemic influenza A (H1N1) pdm09 highlighted the need to establish influenza sentinel surveillance in Togo. The Ministry of Health decided to introduce Influenza to the list of diseases with epidemic potential. By April 2010, Togo was actively involved in influenza surveillance. This study aims to describe the implementation of ILI surveillance and results obtained from April 2010 to December 2012.MethodsTwo sites were selected based on their accessibility and affordability to patients, their adequate specimen storage capacity and transportation system. Patients with ILI presenting at sentinel sites were enrolled by trained medical staff based on the World Health Organization (WHO) case definitions. Oropharyngeal and nasopharyngeal samples were collected and they were tested at the National Influenza Reference Laboratory using a U.S. Centers for Disease Control and Prevention (CDC) validated real time RT-PCR protocol. Laboratory results and epidemiological data were reported weekly and shared with all sentinel sites, Ministry of Health, Division of Epidemiology, WHO and CDC/NAMRU-3.ResultsFrom April 2010 to December 2012, a total of 955 samples were collected with 52% of the study population aged between 0 and 4 years. Of the 955 samples, 236 (24.7%) tested positive for influenza viruses; with 136 (14.2%) positive for influenza A and 100 (10.5%) positive for influenza B. The highest influenza positive percentage (30%) was observed in 5–14 years old and patients aged 0–4 and >60 years had the lowest percentage (20%). Clinical symptoms such as cough and rhinorrhea were associated more with ILI patients who were positive for influenza type A than influenza type B. Influenza viruses circulated throughout the year with the positivity rate peaking around the months of January, May and again in October; corresponding respectively to the dry-dusty harmattan season and the long and then the short raining season. The pandemic A (H1N1) pdm09 was the predominantly circulating strain in 2010 while influenza B was the predominantly circulating strain in 2011. The seasonal A/H3N2 was observed throughout 2012 year.ConclusionsThis study provides information on influenza epidemiology in the capital city of Togo.
Highlights
The emergence of avian influenza A/H5N1 in 2003 as well as the pandemic influenza A (H1N1) pdm09 highlighted the need to establish influenza sentinel surveillance in Togo
The departments involved in this surveillance are the Division of Epidemiology, the National Influenza Reference Laboratory (NIL) hosted by the Institut National d’Hygiène (INH), and the sentinel sites located at the Hôpital de Bè and Military Health Services in the capital city Lomé (Figure 1)
Patients who presented at the Hôpital de Bè were significantly older compared to those who were seen at the Military Health Service (p = 0.0001)
Summary
The emergence of avian influenza A/H5N1 in 2003 as well as the pandemic influenza A (H1N1) pdm highlighted the need to establish influenza sentinel surveillance in Togo. ILI is reported throughout the year with a marked increase in cases recorded during winter periods [3]. In tropical and subtropical regions where viral transmission occurs throughout the year, the data on the burden of influenza-like-illness are limited. The emergence of new highly pathogenic influenza A/ H5N1 viruses in 2003 [6], their wide circulation in wild and domestic birds and its association with human infections which involves high mortality, has raised global concern about the risk of another influenza pandemic. Influenza surveillance helps in understanding the epidemiology and impact of the disease; providing information about seasonality and the groups at high risk of influenza infection. Influenza surveillance provides data for pandemic influenza monitoring and planning as well as for decision-making [12,13,14]
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