Abstract
BackgroundInfluenza A virus (IAV) remains an important global public health threat with limited epidemiological information available from low-and-middle-income countries. The major objective of this study was to describe the proportions, temporal and spatial distribution, and demographic and clinical characteristics of IAV positive patients with influenza like illness (ILI) and severe acute respiratory illness (SARI) in Lahore, Pakistan.MethodsProspective surveillance was established in a sentinel hospital from October 2015 to May 2016. All eligible outpatients and inpatients with ILI or SARI were enrolled in the study. Nasal and/or throat swabs were collected along with clinico-epidemiological data. Samples were tested by real-time RT-PCR (rRT-PCR) to identify IAV and subtype. The descriptive analysis of data was done in R software.ResultsOut of 311 enrolled patients, 284 (91.3%) were ILI and 27 (8.7%) were SARI cases. A distinct peak of ILI and SARI activity was observed in February. Fifty individuals (16%) were positive for IAV with peak positivity observed in December. Of 50 IAV, 15 were seasonal H3N2, 14 were H1N1pdm09 and 21 were unable to be typed. The majority of IAV positive cases (98%) presented with current or history of fever, 88% reported cough and 82% reported sore throat. The most common comorbidities in IAV positive cases were hepatitis C (4%), obesity (4%) and tuberculosis (6%). The highest incidence of patients reporting to the hospital was seen three days post symptoms onset (66/311) with 14 of these (14/66) positive for IAV.ConclusionDistinct trends of ILI, SARI and IAV positive cases were observed which can be used to inform public health interventions (vaccinations, hand and respiratory hygiene) at appropriate times among high-risk groups. We suggest sampling from both ILI and SARI patients in routine surveillance as recommended by WHO.
Highlights
Influenza A virus (IAV) remains an important global public health threat with limited epidemiological information available from low-and-middle-income countries
Diverse seasonal trends across geographical regions are observed with annual epidemics and periodic pandemics caused by the emergence of novel IAVs to which humans have limited pre-existing immunity [2]
Characteristics of influenza like illness (ILI) and severe acute respiratory illness (SARI) cases From October 2015 to May 2016, a total of 513,126 patients reported to the Lahore General Hospital (LGH) surveillance desk designated for infectious diseases
Summary
Influenza A virus (IAV) remains an important global public health threat with limited epidemiological information available from low-and-middle-income countries. Influenza is a highly contagious pathogen causing a significant burden of morbidity and mortality worldwide [1]. Diverse seasonal trends across geographical regions are observed with annual epidemics and periodic pandemics caused by the emergence of novel IAVs to which humans have limited pre-existing immunity [2]. In temperate regions of the world, seasonal winter influenza epidemics increase overall morbidity and mortality and cause significant economic losses due to absenteeism from work [3, 4]. Comparatively limited amounts of data are available concerning the burden of influenza in tropical and subtropical countries [5]. Considering resource limitations, sentinel surveillance has been found superior to laboratory-based or population-based surveillance to estimate the viral determinants of ILI in developing countries
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