Abstract
BackgroundInfluenza epidemiological and virologic data from Georgia are limited. We aimed to present Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) surveillance data and characterize influenza viruses circulating in the country over three influenza seasons.MethodsWe analyzed sentinel site ILI and SARI data for the 2014–2017 seasons in Georgia. Patients’ samples were screened by real-time RT-PCR and influenza viruses isolated were characterized antigenically by haemagglutination inhibition assay and genetically by sequencing of HA and NA genes.Results32% (397/1248) of ILI and 29% (581/1997) of SARI patients tested were positive for influenza viruses. In 2014–2015 the median week of influenza detection was week 7/2015 with B/Yamagata lineage viruses dominating (79%); in 2015–2016—week 5/2016 was the median with A/H1N1pdm09 viruses prevailing (83%); and in 2016–2017 a bimodal distribution of influenza activity was observed—the first wave was caused by A/H3N2 (55%) with median week 51/2016 and the second by B/Victoria lineage viruses (45%) with median week 9/2017. For ILI, influenza virus detection was highest in children aged 5–14 years while for SARI patients most were aged >15 years and 27 (4.6%) of 581 SARI cases died during the three seasons. Persons aged 30–64 years had the highest risk of fatal outcome, notably those infected with A/H1N1pdm09 (OR 11.41, CI 3.94–33.04, p<0.001). A/H1N1pdm09 viruses analyzed by gene sequencing fell into genetic groups 6B and 6B.1; A/H3N2 viruses belonged to genetic subclades 3C.3b, 3C.3a, 3C.2a and 3C.2a1; B/Yamagata lineage viruses were of clade 3 and B/Victoria lineage viruses fell in clade1A.ConclusionIn Georgia influenza virus activity occurred mainly from December through March in all seasons, with varying peak weeks and predominating viruses. Around one third of ILI/ SARI cases were associated with influenza caused by antigenically and genetically distinct influenza viruses over the course of the three seasons.
Highlights
Influenza viruses affect people of all ages and cause mild to severe disease sometimes leading to fatal outcomes [1,2,3,4]
We aimed to present Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) surveillance data and characterize influenza viruses circulating in the country over three influenza seasons
Influenza detection median weeks and prevailing viruses varied between seasons: in 2014– 2015 the median week of total influenza detections was week 7/2015 (IQR weeks 6–9) with influenza B viruses dominating (79%); in 2015–2016 the median week of total influenza detections was week 5/2016 (IQR weeks 3–7) with A/H1N1pdm09 viruses dominating (83%); and the 2016–2017 season showed a bimodal distribution of influenza detections—the first wave was caused by A/H3N2 (55%) with a median week of 51/2016 (IQR weeks 50–52) and the second by influenza B (45%) with a median week of detections of 9/2017 (IQR weeks 7–11) (Fig 1)
Summary
Influenza viruses affect people of all ages and cause mild to severe disease sometimes leading to fatal outcomes [1,2,3,4]. Surveillance of Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) represent an important tool for tracking trends of virus spread and changes in globally circulating influenza viruses [5]. Limited data are available on influenza morbidity and mortality in Georgia [8,9,10] and none of these publications describe antigenic and genetic characteristics of seasonal influenza viruses circulating in the country. We aimed to present Influenza Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) surveillance data and characterize influenza viruses circulating in the country over three influenza seasons
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