Surveillance for severe acute respiratory infections in Southern Arizona, 2010–2014

Zimy Wansaula,Laura M Erhart,Orion Z Mccotter,Catherine Golenko,Mariana G Casal,Peter Kammerer,Natalie Whitfield,Sonja J Olsen

doi:10.1111/irv.12360

Abstract

BackgroundThe Binational Border Infectious Disease Surveillance program began surveillance for severe acute respiratory infections (SARI) on the US–Mexico border in 2009. Here, we describe patients in Southern Arizona.MethodsPatients admitted to five acute care hospitals that met the SARI case definition (temperature ≥37·8°C or reported fever or chills with history of cough, sore throat, or shortness of breath in a hospitalized person) were enrolled. Staff completed a standard form and collected a nasopharyngeal swab which was tested for selected respiratory viruses by reverse transcription polymerase chain reaction.ResultsFrom October 2010–September 2014, we enrolled 332 SARI patients. Fifty‐two percent were male and 48% were white non‐Hispanic. The median age was 63 years (47% ≥65 years and 5·2% <5 years). During hospitalization, 51 of 230 (22%) patients required intubation, 120 of 297 (40%) were admitted to intensive care unit, and 28 of 278 (10%) died. Influenza vaccination was 56%. Of 309 cases tested, 49 (16%) were positive for influenza viruses, 25 (8·1%) for human metapneumovirus, 20 (6·5%) for parainfluenza viruses, 16 (5·2%) for coronavirus, 11 (3·6%) for respiratory syncytial virus, 10 (3·2%) for rhinovirus, 4 (1·3%) for rhinovirus/enterovirus, 3 (1·0%) for enteroviruses, and 3 (1·0%) for adenovirus. Among the 49 influenza‐positive specimens, 76% were influenza A (19 H3N2, 17 H1N1pdm09, and 1 not subtyped), and 24% were influenza B.ConclusionInfluenza viruses were a frequent cause of SARI in hospitalized patients in Southern Arizona. Monitoring respiratory illness in border populations will help better understand the etiologies. Improving influenza vaccination coverage may help prevent some SARI cases.

Highlights

The 2009 influenza pandemic highlighted the need for more global data on severe influenza disease, and the World Health Organization recommended Member States conduct surveillance for hospitalized severe acute respiratory infection (SARI) in addition to surveillance for influenza-like illness (ILI) in outpatients.[1]
The remaining portion of the specimens was frozen at À80°C and sent on dry ice to the Naval Health Research Center (NHRC) in San Diego for testing by real-time polymerase chain reaction for influenza virus type and subtype, respiratory syncytial virus (RSV), adenoviruses, and rhinoviruses using singleplex PCR on the ABI7500 platform (Applied Biosystems, Foster City, CA, USA).[6,7]
RSV, adenovirus, and rhinovirus results from the NHRC; all other results are from the University of Arizona laboratory

Summary

Introduction

The 2009 influenza pandemic highlighted the need for more global data on severe influenza disease, and the World Health Organization recommended Member States conduct surveillance for hospitalized severe acute respiratory infection (SARI) in addition to surveillance for influenza-like illness (ILI) in outpatients.[1]. The pandemic highlighted the importance of having surveillance on the US–Mexico border, as the first cases of influenza A(H1N1)pdm[09] virus infection were detected in southern California.[2,3]. Epidemiological data on influenza hospitalizations has been limited, and there is no established statewide surveillance for respiratory viral infections beyond influenza and RSV. In 2010, Arizona began conducting SARI surveillance as part of Centers for Disease Control and Prevention (CDC) Binational Border a 2015 The Authors. The Binational Border Infectious Disease Surveillance program began surveillance for severe acute respiratory infections (SARI) on the US–Mexico border in 2009.

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