Abstract
Influenza has long been a global public health priority because of the threat of another global pandemic. Although data are available for the annual burden of seasonal influenza in many developed countries, fewer disease burden data are available for low-income and tropical countries. In recent years, however, the surveillance systems created as part of national pandemic preparedness efforts have produced substantial data on the epidemiology and impact of influenza in countries where data were sparse. These data are leading to greater interest in seasonal influenza, including implementation of vaccination programs. However, a lack of quality data on severe influenza, nonrespiratory outcomes, and high-risk groups, as well as a need for better mathematical models and economic evaluations, are some of the major gaps that remain. These gaps are the focus of multilateral research and surveillance efforts that will strengthen global efforts in influenza control in the future.
Highlights
Influenza has long been a global public health priority because of the ever-present threat of another global pandemic
These data have confirmed that influenza is a major cause of hospitalization and severe acute respiratory disease in all settings, whether rich or poor, tropical or temperate, urban or rural [17,18,19], and that the risk for severe influenza outcomes might be higher in low- and middle-income countries (LMICs) than in high-income countries [20]
The value of risk group–specific estimates was evident during the 2009 pandemic, when data on the high risk for severe outcomes among pregnant women led to aggressive efforts to vaccinate and appropriately treat this group and convince obstetricians to recommend and offer vaccines [26,27]; this effort provided data for the World Health Organization (WHO) Strategic Advisory Group of Experts’ 2012 recommendations [25]
Summary
Most high-income countries, where substantial work to document the disease burden from annual influenza epidemics has been conducted, have longstanding and robust influenza vaccination programs [8]; in these settings, the use of influenza antiviral drugs and antibiotics to treat influenza-associated lower respiratory tract infections is relatively routine. Additional multinational collaborations are under way that will continue to develop more credible global influenza mortality and hospitalization estimates based on recent work to develop national estimates, as well as information on influenza burden among key high-risk groups (Figure) [6] These efforts take advantage of the recent increase in local- or country-level studies that have extended data beyond temperate, high-income settings.
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