Surveillance Of Acute Respiratory Infections Research Articles

National burden of influenza-associated hospitalizations in Cambodia, 2015 and 2016.

IntroductionThe burden of influenza in Cambodia is not well known, but it would be useful for understanding the impact of seasonal epidemics and pandemics and to design appropriate policies for influenza prevention and control. The severe acute respiratory infection (SARI) surveillance system in Cambodia was used to estimate the national burden of SARI hospitalizations in Cambodia.MethodsWe estimated age-specific influenza-associated SARI hospitalization rates in three sentinel sites in Svay Rieng, Siem Reap and Kampong Cham provinces. We used influenza-associated SARI surveillance data for one year to estimate the numerator and hospital admission surveys to estimate the population denominator for each site. A national influenza-associated SARI hospitalization rate was calculated using the pooled influenza-associated SARI hospitalizations for all sites as a numerator and the pooled catchment population of all sites as denominator. National influenza-associated SARI case counts were estimated by applying hospitalization rates to the national population.ResultsThe national annual rates of influenza-associated hospitalizations per 100 000 population was highest for the two youngest age groups at 323 for < 1 year and 196 for 1–4 years. We estimated 7547 influenza-associated hospitalizations for Cambodia with almost half of these represented by children younger than 5 years.DiscussionWe present national estimates of influenza-associated SARI hospitalization rates for Cambodia based on sentinel surveillance data from three sites. The results of this study indicate that the highest burden of severe influenza infection is borne by the younger age groups. These findings can be used to guide future strategies to reduce influenza morbidity.

1241. Surveillance for Viral Respiratory Infections in Pediatric Chronic Care Facilities

BackgroundResidents of pediatric chronic care facilities (PCCFs) are vulnerable to acute respiratory infections (ARIs) due to their underlying medical conditions and infection control challenges in congregate living.MethodsWe conducted active, prospective surveillance for ARIs (defined as ≥2 new signs/symptoms of respiratory illness) among all residents in three PCCFs near New York City from December 7, 2016 to May 7, 2017. The parents/guardians of some residents also provided consent for research specimen collection at the start of the study. In that subset, nasopharyngeal swabs were obtained ≤4 days of ARI symptom onset and weekly for 4 weeks of follow-up to assess viral shedding. Influenza, respiratory syncytial virus (RSV), rhinovirus (RV), coronavirus (229E, NL63, OC43, HKU1), parainfluenzavirus (PIV 1–4), metapneumovirus (MPV), adenovirus (AdV), bocavirus (BoV), enterovirus, parechovirus, and M. pneumoniae were tested by the Fast Track Diagnostics Respiratory Pathogens 21 real-time RT-PCR panel.ResultsSubset with research specimen collection: Among 79 residents (aged 0–20 years, median = 8), 60 ARIs were reported in 37 (47%) residents. Swabs were obtained at illness onset for 53/60 ARI episodes; among these, there were 25 single-virus detections and five co-detections. An additional 33 single- and five co-detections occurred in 175 follow-up swabs (table). Molecular typing of 32 RV+ specimens identified 13 RV types.All residents: During the 2016–2017 influenza season, 308/322 (96%) age-eligible residents received influenza vaccine and 168/364 (46%) received prophylactic antivirals for influenza exposures. Although influenza was not detected in research swabs, it was detected in 3/200 tests conducted for clinical purposes.ConclusionARIs were common among residents of three PCCFs, and a variety of respiratory viruses were detected. The rarity of influenza may reflect strong infection control practices in these facilities, including vaccination and prophylactic use of antivirals.Table: Viral Detections by Timing of Collection (n = 53 ARI Episodes)Viral DetectionsOnsetFollow-upSingle detectionsRV148229E11OC4332MPV13BoV317RSV22Co-detectionsa55Total3038Note: There were no detections for pathogens not shown. aCo-detections also included PIV3 and AdV.Disclosures All authors: No reported disclosures.

Reassessment of high prevalence human adenovirus detections among residents of two refugee centers in Kenya under surveillance for acute respiratory infections.

Human adenoviruses (HAdVs) were previously detected at high prevalence by real-time reverse transcription-polymerase chain reaction (rRT-PCR) in the upper respiratory tract of residents of two Kenyan refugee camps under surveillance for acute respiratory infection (ARI) between October 2006 and April 2008. We sought to confirm this finding and characterize the HAdVs detected. Of 2148 respiratory specimens originally tested, 511 (23.8%) screened positive for HAdV and 510 were available for retesting. Of these, 421 (82.4%) were confirmed positive by repeat rRT-PCR or PCR and sequencing. Other respiratory viruses were codetected in 55.8% of confirmed HAdV-positive specimens. Species B and C viruses predominated at 82.8%, and HAdV-C1, -C2, and -B3 were the most commonly identified types. Species A, D, and F HAdVs, which are rarely associated with ARI, comprised the remainder. Viral loads were highest among species B HAdVs, particularly HAdV-B3. Species C showed the widest range of viral loads, and species A, D, and F were most often present at low loads and more often with codetections. These findings suggest that many HAdV detections were incidental and not a primary cause of ARI among camp patients. Species/type, codetections, and viral load determinations may permit more accurate HAdV disease burden estimates in these populations.

The burden of influenza-associated respiratory hospitalizations in Bhutan, 2015-2016.

BackgroundInfluenza burden estimates help provide evidence to support influenza prevention and control programs. In this study, we estimated influenza‐associated respiratory hospitalization rates in Bhutan, a country considering influenza vaccine introduction.MethodsUsing real‐time reverse transcription‐polymerase chain reaction laboratory results from severe acute respiratory infection (SARI) surveillance, we estimated the proportion of respiratory hospitalizations attributable to influenza each month among patients aged <5, 5‐49, and ≥50 years in six Bhutanese districts for 2015 and 2016. We divided the sum of the monthly influenza‐attributed hospitalizations by the total of the six district populations to generate age‐specific rates for each year.ResultsIn 2015, 10% of SARI patients tested positive for influenza (64/659) and 18% tested positive (129/736) in 2016. The incidence of influenza‐associated hospitalizations among all age groups was 50/100 000 persons (95% confidence interval [CI]: 45‐55) in 2015 and 118/100 000 persons (95% CI: 110‐127) in 2016. The highest rates were among children <5 years: 182/100 000 (95% CI: 153‐210) in 2015 and 532/100 000 (95% CI: 473‐591) in 2016. The second highest influenza‐associated hospitalization rates were among adults ≥50 years: 110/100 000 (95% CI: 91‐130) in 2015 and 193/100 000 (95% CI: 165‐221) in 2016.ConclusionsInfluenza viruses were associated with a substantial burden of severe illness requiring hospitalization especially among children and older adults. These findings can be used to understand the potential impact of seasonal influenza vaccination in these age groups.

Surveillance for Severe Acute Respiratory Infection as one approach to enhance Global Health Security in Indonesia

Latar Belakang: Sistem surveilans nasional untuk infeksi saluran pernafasan akut berat (SARI) dapatmemberikan informasi penting tentang sirkulasi virus influenza, menyediakan sistem untuk mengendalikankejadian luar biasa yang mengancam keamanan dan keselamatan masyarakat serta menyediakandata untuk sistem surveilans influenza global (GISRS). Kemampuan Indonesia untuk mendeteksi dan mengendalikanpenyakit menular penting untuk keamanan kesehatan dunia. Penelitian ini bertujuan untukmenilai sistem surveilans ISPA berat Indonesia (SIBI) dan pemanfaatan untuk memantau patogen prioritaslainnya sebagai upaya meningkatkan keamanan kesehatan global.&#x0D; Metode: penilaian atribut surveilans melalui review laporan, analisis data dan interview staff yang terlibatdalam sistem surveilans. Semua kasus yang memenuhi kriteria SARI pada bulan Mei 2013 – April 2015 ikutserta dalam penelitian. Data epidemiologi dan virologi dianalisis. Kelengkapan dan kemudahan sistem untukmencapai tujuan surveilans influenza dan mendukung surveilans penyakit infeksi baru (emerging) dikaji.&#x0D; Hasil: Sebanyak 1,806 kasus SARI dan 1,697 (94%) spesimen dilakukan pemeriksaan virus influenza.Sebanyak 200 (12%) positif influenza, terdiri dari 46% influenza A(H3N2), 18% A(H1N1)pdm09 dan 37%influenza B. Hasil penilaian terhadap sistem surveilans didapatkan kesesuaian pelaksanaan untuk semuaatribut surveilans melebihi target &gt;80%, kelengkapan laporan online 95%, kesesuaian kasus terhadapdefinisi kasus 100%, kasus yang diambil spesimen 94% dan hasil laboratorium diinput ke database secaraonline 100%. Sistem surveilans untuk dengue dan infeksi arbovirus lainnya sudah terlaksana di unitrawat jalan dan gawat darurat di sentinel SARI surveilans.&#x0D; Kesimpulan: SIBI dapat disesuaikan untuk menggabungkan surveilans penyakit lain yang menunjukkankegunaan dan fleksibilitas dalam mendukung keamanan kesehatan global.&#x0D; Kata kunci: keamanan kesehatan global, surveilans, influenza, Indonesia&#x0D; AbstractBackground: The existing national surveillance system for severe acute respiratory infection (SARI) providescritical information on influenza virus circulation, provides a system to control influenza outbreaks that threatenthe safety and security of the population and feeds data into the global influenza surveillance and responsesystem (GISRS). Indonesia’s ability to detect and control communicable diseases is critical for global healthsecurity. The aim of this study was to assess the SARI surveillance system and utility for monitoring other prioritypathogens as an effort to enhance global health security.&#x0D; Methods: Surveillance attributes were assessed by reviewing records, data analysis and through interviewedwith staffs involved in the surveillance system. All patients at six sentinel hospitals who meet the SARI casedefinition during May 2013 – April 2015 were enrolled. Epidemiological and virological data were analyzed.The surveillance system utility for its influenza surveillance objectives and flexibility to support surveillance ofemerging infectious diseases were assessed.&#x0D; Resuts: A total of 1,806 SARI cases were reported of which 1,697 (94%) had specimens tested for influenza viruses.Of those tested, 200 (12%) were positive, of which 46% were influenza A(H3N2), 18% A(H1N1)pdm09and 37% influenza B viruses. The system exceeded the targets of &gt;80% adherence for most attributes: 95% forcompleteness of online reporting, 100% for cases adhering to the case definition, 94% for cases with specimenscollected and 100% of laboratory results uploaded to the online database. A surveillance system for dengue andother arbovirus infections was established in the outpatient/emergency units at the SARI surveillance sentinel.Conclusion: SIBI was adjusted to incorporate surveillance for other priority diseases indicating its utility andflexibility to support global health security&#x0D; Keywords: Global Health Security, surveillance, influenza, Indonesia

Precision Surveillance for Viral Respiratory Pathogens: Virome Capture Sequencing for the Detection and Genomic Characterization of Severe Acute Respiratory Infection in Uganda.

BackgroundPrecision public health is a novel set of methods to target disease prevention and mitigation interventions to high-risk subpopulations. We applied a precision public health strategy to syndromic surveillance for severe acute respiratory infection (SARI) in Uganda by combining spatiotemporal analytics with genomic sequencing to detect and characterize viral respiratory pathogens with epidemic potential.MethodsUsing a national surveillance network we identified patients with unexplained, influenza-negative SARI from 2010 to 2015. Spatiotemporal analyses were performed retrospectively to identify clusters of unexplained SARI. Within clusters, respiratory viruses were detected and characterized in naso- and oropharyngeal swab samples using a novel oligonucleotide probe capture (VirCapSeq-VERT) and high-throughput sequencing platform. Linkage to conventional epidemiologic strategies further characterized transmission dynamics of identified pathogens.ResultsAmong 2901 unexplained SARI cases, 9 clusters were detected, accounting for 301 (10.4%) cases. Clusters were more likely to occur in urban areas and during biannual rainy seasons. Within detected clusters, we identified an unrecognized outbreak of measles-associated SARI; sequence analysis implicated cocirculation of endemic genotype B3 and genotype D4 likely imported from England. We also detected a likely nosocomial SARI cluster associated with a novel picobirnavirus most closely related to swine and dromedary viruses.ConclusionsUsing a precision approach to public health surveillance, we detected and characterized the genomics of vaccine-preventable and zoonotic respiratory viruses associated with clusters of severe respiratory infections in Uganda. Future studies are needed to assess the feasibility, scalability, and impact of applying similar approaches during real-time public health surveillance in low-income settings.

Overview of three influenza seasons in Georgia, 2014-2017.

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.

Preliminary results of official influenza and acute respiratory infection surveillance in two towns of Burkina Faso, 2013\u20132015

BackgroundIn 2010, influenza, influenza-like illness (ILI) and acute respiratory infection (ARI) surveillance was established by the government of Burkina Faso. We provide preliminary descriptive results from this surveillance activity.MethodsThe study period was 2013 through 2015. Two primary healthcare facilities in Bobo-Dioulasso district reported ILI in outpatients. Influenza virology, using reverse transcription-polymerase chain reaction (rRT-PCR), was available for a proportion of ILI patients. One hospital, in the capital Ouagadougou, reported ARI in both outpatients and inpatients (hospitalized). Inpatients admitted with ARI were considered severe ARI (SARI). We estimated the proportion of primary care outpatient visits that were ILI, and the proportion of those that were due to influenza, by age. We estimated the proportion of hospital outpatient visits that were ARI and the proportion of those that were SARI, by age.ResultsAmong combined outpatient visits in the Bobo-Dioulasso facilities, 19.6% were for ILI. One half (49.9%) of outpatient visits in infants and 30.9% in 1–4 year-olds were ILI. Among ILI outpatient visits 14.8% were due to influenza virus and, of these, 58.5% were type A and 41.5% type B. At the Ouagadougou hospital, 6.7% of outpatient visits were ARI, and 22.3% of those were SARI. The highest proportions of ARI were among infants (19.8%) and 1–4 year-olds (16.0%). The proportion of ARI that was SARI was highest among ≥15 year-olds (31.5%) followed by 1–4 year-olds (22.4%). Overall, 4.1% of SARI patients died.ConclusionsThese preliminary data indicate the importance of respiratory infections among health care attendances in Burkina Faso, and influenza may be an important contributor to these.

Meditation or exercise for preventing acute respiratory infection (MEPARI-2): A randomized controlled trial.

BackgroundPractice of meditation or exercise may enhance health to protect against acute infectious illness.ObjectiveTo assess preventive effects of meditation and exercise on acute respiratory infection (ARI) illness.DesignRandomized controlled prevention trial with three parallel groups.SettingMadison, Wisconsin, USA.ParticipantsCommunity-recruited adults who did not regularly exercise or meditate.Methods1) 8-week behavioral training in mindfulness-based stress reduction (MBSR); 2) matched 8-week training in moderate intensity sustained exercise (EX); or 3) observational waitlist control. Training classes occurred in September and October, with weekly ARI surveillance through May. Incidence, duration, and area-under-curve ARI global severity were measured using daily reports on the WURSS-24 during ARI illness. Viruses were identified multiplex PCR. Absenteeism, health care utilization, and psychosocial health self-report assessments were also employed.ResultsOf 413 participants randomized, 390 completed the trial. In the MBSR group, 74 experienced 112 ARI episodes with 1045 days of ARI illness. Among exercisers, 84 had 120 episodes totaling 1010 illness days. Eighty-two of the controls had 134 episodes with 1210 days of ARI illness. Mean global severity was 315 for MBSR (95% confidence interval 244, 386), 256 (193, 318) for EX, and 336 (268, 403) for controls. A prespecified multivariate zero-inflated regression model suggested reduced incidence for MBSR (p = 0.036) and lower global severity for EX (p = 0.042), compared to control, not quite attaining the p<0.025 prespecified cut-off for null hypothesis rejection. There were 73 ARI-related missed-work days and 22 ARI-related health care visits in the MBSR group, 82 days and 21 visits for exercisers, and 105 days and 24 visits among controls. Viruses were identified in 63 ARI episodes in the MBSR group, compared to 64 for EX and 72 for control. Statistically significant (p<0.05) improvements in general mental health, self-efficacy, mindful attention, sleep quality, perceived stress, and depressive symptoms were observed in the MBSR and/or EX groups, compared to control.ConclusionsTraining in mindfulness meditation or exercise may help protect against ARI illness.LimitationsThis trial was likely underpowered.Trial registrationClinicaltrials.gov NCT01654289

Performance of Surveillance Case Definitions in Detecting Respiratory Syncytial Virus Infection Among Young Children Hospitalized With Severe Respiratory Illness-South Africa, 2009-2014.

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection (ALRTI) in young children, but data on surveillance case definition performance in estimating burdens have been limited. We enrolled children aged <5 years hospitalized for ALRTI (or neonatal sepsis in young infants) through active prospective surveillance at 5 sentinel hospitals in South Africa and collected nasopharyngeal aspirates from them for RSV molecular diagnostic testing between 2009 and 2014. Clinical data were used to characterize RSV disease and retrospectively evaluate the performance of respiratory illness case definitions (including the World Health Organization definition for severe acute respiratory infection [SARI]) in identifying hospitalized children with laboratory-confirmed RSV according to age group (<3, 3-5, 6-11, 12-23, and 24-59 months). Of 9969 hospitalized children, 2723 (27%) tested positive for RSV. Signs and symptoms in RSV-positive children varied according to age; fever was less likely to occur in children aged <3 months (57%; odds ratio [OR], 0.8 [95% CI, 0.7-0.9]) but more likely in those aged ≥12 months (82%; OR, 1.7-1.9) than RSV-negative children. The sensitivity (range, 55%-81%) and specificity (range, 27%-54%) of the SARI case definition to identify hospitalized RSV-positive children varied according to age; the lowest sensitivity was for infants aged <6 months. Using SARI as the case definition would have missed 36% of RSV-positive children aged <5 years and 49% of those aged <3 months; removing the fever requirement from the definition recovered most missed cases. Including fever in the SARI case definition lowers the sensitivity for RSV case detection among young children hospitalized with an ALRTI and likely underestimates its burden.

The potential value of crowdsourced surveillance systems in supplementing sentinel influenza networks: the case of France.

IntroductionParticipatory surveillance systems provide rich crowdsourced data, profiling individuals and their health status at a given time. We explored the usefulness of data from GrippeNet.fr, a participatory surveillance system, to estimate influenza-related illness incidence in France. Methods: GrippeNet.fr is an online cohort since 2012 averaging ca. 5,000 weekly participants reporting signs/symptoms suggestive of influenza. GrippeNet.fr has flexible criteria to define influenza-related illness. Different case definitions based on reported signs/symptoms and inclusions of criteria accounting for individuals’ reporting and participation were used to produce influenza-related illness incidence estimates, which were compared to those from sentinel networks. We focused on the 2012/13 and 2013/14 seasons when two sentinel networks, monitoring influenza-like-illness (ILI) and acute respiratory infections (ARI) existed in France. Results: GrippeNet.fr incidence estimates agreed well with official temporal trends, with a higher accuracy for ARI than ILI. The influenza epidemic peak was often anticipated by one week, despite irregular participation of individuals. The European Centre for Disease Prevention and Control ILI definition, commonly used by participatory surveillance in Europe, performed better in tracking ARI than ILI when applied to GrippeNet.fr data. Conclusion: Evaluation of the epidemic intensity from crowdsourced data requires epidemic and intensity threshold estimations from several consecutive seasons. The study provides a standardised analytical framework for crowdsourced surveillance showing high sensitivity in detecting influenza-related changes in the population. It contributes to improve the comparability of epidemics across seasons and with sentinel systems. In France, GrippeNet.fr may supplement the ILI sentinel network after ARI surveillance discontinuation in 2014.

Are we missing respiratory viral infections in infants and children? Comparison of a hospital-based quality management system with standard of care

ObjectivesHospital-based surveillance of influenza and acute respiratory infections relies on International Classification of Diseases (ICD) codes and hospital laboratory reports (Standard-of-Care). It is unclear how many cases are missed with either method, i.e. remain undiagnosed/coded as influenza and other respiratory virus infections. Various influenza-like illness (ILI) definitions co-exist with little guidance on how to use them. We compared the diagnostic accuracy of standard surveillance methods with a prospective quality management (QM) programme at a Berlin children's hospital with the Robert Koch Institute. MethodsIndependent from routine care, all patients fulfilling pre-defined ILI-criteria (QM-ILI) participated in the QM programme. A separate QM team conducted standardized clinical assessments and collected nasopharyngeal specimens for blinded real-time quantitative PCR for influenza A/B viruses, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus. ResultsAmong 6073 individuals with ILI qualifying for the QM programme, only 8.7% (528/6073) would have undergone virus diagnostics during Standard-of-Care. Surveillance based on ICD codes would have missed 61% (359/587) of influenza diagnoses. Of baseline ICD codes, 53.2% (2811/5282) were non-specific, most commonly J06 (‘acute upper respiratory infection’). Comparison of stakeholder case definitions revealed that QM-ILI and the WHO ILI case definition showed the highest overall sensitivities (84%–97% and 45%–68%, respectively) and the CDC ILI definition had the highest sensitivity for influenza infections (36%, 95% CI 31.4–40.8 for influenza A and 48%, 95% CI 40.5–54.7 for influenza B). ConclusionsDisease-burden estimates and surveillance should account for the underreporting of cases in routine care. Future studies should explore the effect of ILI screening and surveillance in various age groups and settings. Diagnostic algorithms should be based on the WHO ILI case definition combined with targeted testing.

Expanding severe acute respiratory infection (SARI) surveillance beyond influenza: The process and data from 1year of implementation in Vietnam.

BackgroundIn 2016, as a component of the Global Health Security Agenda, the Vietnam Ministry of Health expanded its existing influenza sentinel surveillance for severe acute respiratory infections (SARI) to include testing for 7 additional viral respiratory pathogens. This article describes the steps taken to implement expanded SARI surveillance in Vietnam and reports data from 1 year of expanded surveillance.MethodsThe process of expanding the suite of pathogens for routine testing by real‐time reverse transcriptase–polymerase chain reaction (rRT‐PCR) included laboratory trainings, procurement/distribution of reagents, and strengthening and aligning SARI surveillance epidemiology practices at sentinel sites and regional institutes (RI).ResultsSurveillance data showed that of 4003 specimens tested by the RI laboratories, 20.2% (n = 810) were positive for influenza virus. Of the 3193 influenza‐negative specimens, 41.8% (n = 1337) were positive for at least 1 non‐influenza respiratory virus, of which 16.2% (n = 518), 13.4% (n = 428), and 9.6% (n = 308) tested positive for respiratory syncytial virus, rhinovirus, and adenovirus, respectively.ConclusionsThe Government of Vietnam has demonstrated that expanding respiratory viral surveillance by strengthening and building upon an influenza platform is feasible, efficient, and practical.

Burden and Risk Factors for Coronavirus Infections in Infants in Rural Nepal.

Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal. Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression. Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3-286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52-4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01-1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December-February) and 1 autumn (September-November). HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.

Severe Acute Respiratory Infections with Influenza and Non-Influenza Respiratory Viruses: Yemen, 2011-2016

Background: Sentinel surveillance for severe acute respiratory infections (SARI) is an important tool to monitor influenza circulation and burden of other respiratory pathogens. In Yemen, two sites established at Sana'a and Aden city. Pharyngeal samples are tested for influenza and non- influenza by the Real-Time-PCR assay in NAMRU 3.

Nation-wide surveillance of human acute respiratory virus infections between 2013 and 2015 in Korea.

The prevalence of eight respiratory viruses detected in patients with acute respiratory infections (ARIs) in Korea was investigated through analysis of data recorded by the Korea Influenza and Respiratory Viruses Surveillance System (KINRESS) from 2013 to 2015. Nasal aspirate and throat swabs specimens were collected from 36 915 patients with ARIs, and viral nucleic acids were detected by real‐time (reverse‐transcription) polymerase chain reaction for eight respiratory viruses, including human respiratory syncytial viruses (HRSVs), influenza viruses (IFVs), human parainfluenza viruses (HPIVs), human coronaviruses (HCoVs), human rhinovirus (HRV), human adenovirus (HAdV), human bocavirus (HBoV), and human metapneumovirus (HMPV). The overall positive rate of patient specimens was 49.4% (18 236/36 915), 5% of which carried two or more viruses simultaneously. HRV (15.6%) was the most predominantly detected virus, followed by IFVs (14.6%), HAdV (7.5%), HPIVs (5.8%), HCoVs (4.2%), HRSVs (3.6%), HBoV (1.9%), and HMPV (1.6%). Most of the ARIs were significantly correlated with clinical symptoms of fever, cough, and runny nose. Although HRV and HAdV were frequently detected throughout the year in patients, other respiratory viruses showed apparent seasonality. HRSVs and IFVs were the major causative agents of acute respiratory diseases in infants and young children. Overall, this study demonstrates a meaningful relationship between viral infection and typical manifestations of known clinical features as well as seasonality, age distribution, and co‐infection among respiratory viruses. Therefore, these data could provide useful information for public health management and to enhance patient care for primary clinicians.

Influenza‐associated severe acute respiratory infections in 2 sentinel sites in Lebanon—September 2015 to August 2016

BackgroundGiven the sparse information on the burden of influenza in Lebanon, the Ministry of Public Health established a sentinel surveillance for severe acute respiratory infections (SARI) to identify the attribution of influenza to reported cases. We aim to highlight the proportion of influenza‐associated SARI from September 1st, 2015 to August 31st, 2016 in 2 Lebanese hospitals.MethodsThe study was conducted in 2 sentinel sites located in Beirut suburbs and southern province of Lebanon. WHO's 2011 standardized SARI case definition was used. Data from September 1, 2015 to August 31, 2016 were reviewed, and all‐cause hospital admission numbers were obtained. Nasopharyngeal swabs were collected and tested by RT‐PCR. Descriptive and bivariate analyses were conducted using STATA 13.ResultsThe 2 sentinel sites reported 746 SARI cases during the studied time frame: 467 from the southern province site and 279 from the Beirut suburbs site. SARI reports peaked between January and March 2016. All, except 4, cases were sampled, and a co‐dominance of influenza B (43%) and influenza A (H1N1) (41%) was evident. A high proportion of cases was reported in children <2 years 274 (37%). The proportional contribution of influenza‐associated SARI to all‐cause hospital admissions was high in children <2 years in the south (4.5% [95% CI: 3.1‐6.5]) and in children <5 years in Beirut (0.7% [95% CI: 0.6‐0.8]).ConclusionThis is the first study to highlight the proportion of influenza‐associated SARI in 2 hospitals in Lebanon. The findings will be beneficial for supporting respiratory prevention and immunization program policies.

Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010\u20132014

BackgroundFrom October 2010 through February 2016, Arizona conducted surveillance for severe acute respiratory infections (SARI) among adults hospitalized in the Arizona-Mexico border region. There are few accurate mortality estimates in SARI patients, particularly in adults ≥ 65 years old.The purpose of this study was to generate mortality estimates among SARI patients that include deaths occurring shortly after hospital discharge and identify risk factors for mortality.MethodsPatients admitted to two sentinel hospitals between 2010 and 2014 who met the SARI case definition were enrolled. Demographic data were used to link SARI patients to Arizona death certificates. Mortality within 30 days after the date of admission was calculated and risk factors were identified using logistic regression models.ResultsAmong 258 SARI patients, 47% were females, 51% were white, non-Hispanic and 39% were Hispanic. The median age was 63 years (range, 19 to 97 years) and 80% had one or more pre-existing health condition; 9% died in hospital. Mortality increased to 12% (30/258, 30% increase) when electronic vital records and a 30-day post-hospitalization time frame were used. Being age ≥ 65 years (OR = 4.0; 95% CI: 1.6–9.9) and having an intensive care unit admission (OR = 7.4; 95% CI: 3.0–17.9) were independently associated with mortality.ConclusionThe use of electronic vital records increased SARI-associated mortality estimates by 30%. These findings may help guide prevention and treatment measures, particularly in high-risk persons in this highly fluid border population.

Hospital-based Influenza Morbidity and Mortality (HIMM) Surveillance for A/H7N9 Influenza Virus Infection in Returning Travelers.

Since 2013, the Hospital-based Influenza Morbidity and Mortality (HIMM) surveillance system began a H7N9 influenza surveillance scheme for returning travelers in addition to pre-existing emergency room (ER)-based influenza-like illness (ILI) surveillance and severe acute respiratory infection (SARI) surveillance. Although limited to eastern China, avian A/H7N9 influenza virus is considered to have the highest pandemic potential among currently circulating influenza viruses. During the study period between October 1st, 2013 and April 30th, 2016, 11 cases presented with ILI within seven days of travel return. These patients visited China, Hong Kong, or neighboring Southeast Asian countries, but none of them visited a livestock market. Seasonal influenza virus (54.5%, 6 among 11) was the most common cause of ILI among returning travelers, and avian A/H7N9 influenza virus was not detected during the study period.

Estimated incidence of influenza-associated severe acute respiratory infections in Indonesia, 2013-2016.

BackgroundIndonesia's hospital‐based Severe Acute Respiratory Infection (SARI) surveillance system, Surveilans Infeksi Saluran Pernafasan Akut Berat Indonesia (SIBI), was established in 2013. While respiratory illnesses such as SARI pose a significant problem, there are limited incidence‐based data on influenza disease burden in Indonesia. This study aimed to estimate the incidence of influenza‐associated SARI in Indonesia during 2013‐2016 at three existing SIBI surveillance sites.MethodsFrom May 2013 to April 2016, inpatients from sentinel hospitals in three districts of Indonesia (Gunung Kidul, Balikpapan, Deli Serdang) were screened for SARI. Respiratory specimens were collected from eligible inpatients and screened for influenza viruses. Annual incidence rates were calculated using these SIBI‐enrolled influenza‐positive SARI cases as a numerator, with a denominator catchment population defined through hospital admission survey (HAS) to identify respiratory‐coded admissions by age to hospitals in the sentinel site districts.ResultsFrom May 2013 to April 2016, there were 1527 SARI cases enrolled, of whom 1392 (91%) had specimens tested and 199 (14%) were influenza‐positive. The overall estimated annual incidence of influenza‐associated SARI ranged from 13 to 19 per 100 000 population. Incidence was highest in children aged 0‐4 years (82‐114 per 100 000 population), followed by children 5‐14 years (22‐36 per 100 000 population).ConclusionsIncidence rates of influenza‐associated SARI in these districts indicate a substantial burden of influenza hospitalizations in young children in Indonesia. Further studies are needed to examine the influenza burden in other potential risk groups such as pregnant women and the elderly.