Establishing a national influenza sentinel surveillance system in a limited resource setting, experience of Sierra Leone

Abstract

BackgroundAcute respiratory infections remain a leading cause of morbidity and mortality in Sierra Leone; however, similar to other African countries, little is known regarding the contribution of influenza. Routine influenza surveillance is thus a key element to improve understanding of the burden of acute respiratory infections in Africa. In 2011, the World Health Organization (WHO) funded the Strengthening Influenza Sentinel Surveillance in Africa (SISA) project with the goal of developing and strengthening influenza surveillance in eight countries in sub-Saharan Africa, including Sierra Leone. This paper describes the process of establishing a functional Influenza Sentinel Surveillance (ISS) system in Sierra Leone, a post-conflict resource-poor country previously lacking an influenza monitoring system.MethodsSierra Leone utilized a systematic approach, including situational assessment, selection of sentinel sites, preparation of implementation plan, adaptation of the standard operating procedures, supervision and training of staff, and monitoring of influenza surveillance activities. The methods used in Sierra Leone were adapted to its specific context, using the Integrated Disease Surveillance and Response (IDSR) strategy as a platform for establishing ISS.ResultsThe ISS system started functioning in August 2011 with subsequent capacity to contribute surveillance activity data to global influenza databases, FluID and FluNet, demonstrating a functional influenza surveillance system in Sierra Leone within the period of the WHO SISA project support. Several factors were necessary for successful implementation, including a systematic approach, national ownership, appropriate timing and external support.ConclusionsThe WHO SISA project demonstrated the feasibility of building a functional influenza surveillance system in Sierra Leone, integrated into existing national IDSR system. The ISS system, if sustained long-term, would provide valuable data to determine epidemiological and virological patterns and seasonal trends to assess the influenza disease burden that will ultimately guide national control strategies.

Influenza-Associated Morbidity and Mortality in Sub-Saharan Africa

“…The burden of seasonal influenza in children under 5 years of age and those from 5 to 14 years appears far greater than in the elderly [11][12][13][14][15][16]. This corroborates findings elsewhere that younger children experience a high influenza attack rate and a higher rate of influenza-related complications [46].…”

“…In contrast to the findings in Togo and Niger, the most affected were patients within 0 -5 years (41.4%), the 6 -14 years old were the second (22.4%) [14]. In Sierra Leone also the majority (36%) of ILI and SARI cases was detected in children under the age of four [15].…”

The Hajj pilgrimage and surveillance for Middle East Respiratory syndrome coronavirus in pilgrims from African countries

“…In response to the potential threat of an influenza pandemic, several international institutions and governments, in partnership with 15 African countries, invested in the development of epidemiologic and laboratory influenza surveillance capacity in Africa, and the African Network of Influenza Surveillance and Epidemiology (ANISE) was formed (Kasolo et al 2013). The project ' Strengthening Influenza Sentinel Surveillance in Africa (SISA)' is currently generating epidemiological and virological data and developing routine national, regional and international reporting mechanisms (Kebede et al 2013) in liaison with WHO, national influenza laboratories and other stakeholders involved in influenza surveillance. This initiative must be extended to screening for MERS-CoV.…”

Avaliação da Vigilância da Síndrome Gripal: estudo de casos em unidade sentinela

“…These researches involved the evaluation of attributes such as acceptability, positive predictive value (agUilera; Paget; Van Der VelDen, 2002), sensitivity, specificity, representativeness and opportunity (SKeWeS-raMM, 2009). Other researches have evaluated the viability and long-term sustainability (KeBeDe et al, 2013). Studies that evaluated the implementation of this intervention, observing if the degree of operationalization of the actions is sensitive to the contextual variations of the sentinel health units and in the municipalities, were not found.…”