Epidemiology of respiratory viral infections in two long-term refugee camps in Kenya, 2007-2010

Abstract

BackgroundRefugees are at risk for poor outcomes from acute respiratory infections (ARI) because of overcrowding, suboptimal living conditions, and malnutrition. We implemented surveillance for respiratory viruses in Dadaab and Kakuma refugee camps in Kenya to characterize their role in the epidemiology of ARI among refugees.MethodsFrom 1 September 2007 through 31 August 2010, we obtained nasopharyngeal (NP) and oropharyngeal (OP) specimens from patients with influenza-like illness (ILI) or severe acute respiratory infections (SARI) and tested them by RT-PCR for adenovirus (AdV), respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza viruses (PIV), and influenza A and B viruses. Definitions for ILI and SARI were adapted from those of the World Health Organization. Proportions of cases associated with viral aetiology were calculated by camp and by clinical case definition. In addition, for children < 5 years only, crude estimates of rates due to SARI per 1000 were obtained.ResultsWe tested specimens from 1815 ILI and 4449 SARI patients (median age = 1 year). Proportion positive for virus were AdV, 21.7%; RSV, 12.5%; hMPV, 5.7%; PIV, 9.4%; influenza A, 9.7%; and influenza B, 2.6%; 49.8% were positive for at least one virus. The annual rate of SARI hospitalisation for 2007-2010 was 57 per 1000 children per year. Virus-positive hospitalisation rates were 14 for AdV; 9 for RSV; 6 for PIV; 4 for hMPV; 5 for influenza A; and 1 for influenza B. The rate of SARI hospitalisation was highest in children < 1 year old (156 per 1000 child-years). The ratio of rates for children < 1 year and 1 to < 5 years old was 3.7:1 for AdV, 5.5:1 for RSV, 4.4:1 for PIV, 5.1:1 for hMPV, 3.2:1 for influenza A, and 2.2:1 for influenza B. While SARI hospitalisation rates peaked from November to February in Dadaab, no distinct seasonality was observed in Kakuma.ConclusionsRespiratory viral infections, particularly RSV and AdV, were associated with high rates of illness and make up a substantial portion of respiratory infection in these two refugee settings.

Aetiology of Acute Respiratory Infections in Children under Five Years in Nakuru, Kenya

“…The above studies report respiratory viruses' detection rate of 35% to 86%, indicating the role of respiratory viruses as etiological agents of acute respiratory infections. The findings of the current study are consistent with findings found in other studies conducted within the country, in developing and in developed world especially the findings of Ahmed et al [20] in Kenya who reported detecting viruses in 49.8% clinical specimen. However, it is important to note that not all possible respiratory viruses were tested.…”

“…Gageldonk-Laafeber et al [2] reported a predominant detection of Influenza and rhino viruses in a study in Netherlands. Findings of Ahmed et al [20] detected predominantly RSV (12.5%) and others were hMPV in 5.7%; Parainfluenza in 9.4%; Influenza A, 9.7%; and Influenza B in 2.6%. Bezerra et al [24] reported detection of RSV in 37% of the subjects and hMPV in 10% while Bharaj et al [21] reported that out of 103 clinical specimen positive for respiratory viruses RSV contributed the majority (61, 59.2%).…”

“…A study conducted in Kilifi, Kenya, by Munywoki et al [19] found that 66.6% children had at least one respiratory virus detected. Ahmed et al [20] detected respiratory viruses in 49.8%of study subjects in a study conducted at a refugee camp in Kenya. Studies conducted elsewhere in the World revealed that respiratory viruses were common in children with ARI.…”

Etiology and Incidence of Viral Acute Respiratory Infections Among Refugees Aged 5 Years and Older in Hagadera Camp, Dadaab, Kenya

“…E-mail: gediim@gmail.com viruses, respiratory syncytial virus (RSV), adenovirus, parainfluenza serotypes 1, 2, and 3 (PIV 1-PIV 3), and human metapneumovirus (hMPV), as described previously. 1 The Health Information System (HIS) is a standardized tool used by UNHCR to design, monitor, and evaluate refugee public health programs with the aim of improving the health status of refugees. 8 UNHCR HIS provides campbased populations by two age groups (< 5 and ≥ 5 years) and was used for population figures for the three study years.…”

“…1 Globally, as of the end of 2013, the United Nations High Commissioner of Refugees (UNHCR) reported an estimated 11.7 million refugees worldwide. This figure represents the highest number of refugees UNHCR has seen since 2001; many of whom have been housed for years in protracted camp settings, including those in Kenya.…”