Epidemiological trends in notified influenza cases in Australia’s Northern Territory, 2007‐2016

Abstract

Background The Northern Territory (NT) of Australia has a mix of climates, sparsely distributed population and a large proportion of the populace are Indigenous Australians, and influenza is known to have a disproportionate impact upon this group. Understanding the epidemiology of influenza in this region would inform public health strategies. Objectives To assess if there are consistent patterns in characteristics of influenza outbreaks in the NT. Methods Laboratory confirmed influenza cases in the NT are notified to the NT Centre for Disease Control. We conducted analyses on notified cases from 2007‐2016 to determine incidence rates (by age group, Indigenous status and area), seasonality of cases and spatial distribution of influenza types. Notified cases were linked to laboratory datasets to update information on influenza type or subtype Results The disparity in Indigenous and non‐Indigenous notification rates varied by age group, with rate ratios for Indigenous versus non‐Indigenous ranging from 1.58 (95% CI:1.39, 1.80) for ages 15‐24 to 5.56 (95% CI: 4.71, 6.57) for ages 55‐64. The disparity between Indigenous and non‐Indigenous notification rates appeared higher in the Central Australia region. Indigenous versus non‐Indigenous hospitalisation and mortality rate ratios were 6.51 (95% CI: 5.91, 7.18) and 5.46 (95% CI: 2.40, 12.71) respectively. Inter‐seasonal peaks during February and March occurred in 2011, 2013 and 2014, and were due to influenza activity in the tropical north of the NT. Conclusions Our results highlight the importance of influenza vaccination across all age groups for Indigenous Australians. An early vaccination campaign targeted against outbreaks in February‐March would be best focused on the tropical north.

Influenza-associated hospitalisation and mortality rates among global Indigenous populations; a systematic review and meta-analysis

“…Thirty-six studies were included for data extraction and are summarised in Supplementary Material – Table 1 . Of the included studies, 15 (42%) were from Australia,(14-28) 10 (28%) were from the United States of America (USA),(29-38) six (17%) were from New Zealand,(39-44) and four (11%) were from Canada. (45-48) Only one (3%) was from a high-middle income country (Brazil),(49) and there were no included studies from low-middle or low-income countries.…”

“…(21, 29, 30, 35, 36) There were 10 studies (28%) with extractable data for both hospitalisation and mortality. (19, 20, 24-28, 32, 37, 45) Nearly three quarters of included studies (n=26, 72%) analysed hospitalisations and/or deaths during the 2009pH1N1,(17-20, 25-27, 29-33, 35-41, 44-49) while seven (19%) analysed hospitalisations and/or deaths from seasonal influenza(14, 15, 22, 23, 34, 42, 43) and four (11%) covered both seasonal and pandemic periods. (16, 21, 24, 28) Of the 36 included studies, 28 (78%) had no age limitations,(17-32, 34-40, 44-46, 48, 49) while others considered children,(14-16, 33, 43) adults(41) or women of reproductive age.…”

“…(19) For benchmark populations, the lowest influenza-associated mortality rate was 0•0 deaths per 100,000 person-months, observed among benchmark populations of the United States (32) and Australia. (24,28) The highest mortality rate among benchmark populations was 0•5 deaths per 100,000 person-months, observed in North Queensland, Australia during the 2009pH1N1. ( 19) (Table 2) Mortality rate ratios (MRR) tended to be greater than 1 (see Table 2), indicating an inequitable impact of influenza on Indigenous populations.…”

Descriptive Epidemiological Assessment of the Relationship between the Global Burden of Influenza from 2017-2019 and COVID-19

“…Moreover, structural factors including racism have been documented in several settings including the United States, United Kingdom, Sweden, and Canada, but likely relevant in many more settings not reporting on racial identity of those affected [47-49]. Notably, similar disparities were observed in the 2009 H1N1 pandemic in the United States though there has been limited documentation of socioeconomic disparities of influenza in most settings [22, 50]. While disparities are well documented for other infectious diseases such as HIV, these disparities evolve across cycles of transmission spanning years.…”

The Multivalent Role of Fibronectin-Binding Proteins A and B (FnBPA and FnBPB) of Staphylococcus aureus in Host Infections

“…The in silico screening approach permitted identification of FnBP-like proteins in S. argenteus and S. schweitzeri , two species closely related to S. aureus ( Weinman et al, 2020 ). Structural and functional studies on these proteins are lacking.…”