Improving influenza surveillance in sub-Saharan Africa

Steffen, Christoph; Debellut, Frédéric; Gessner, Bradford D.; Kasolo, Francis; Yahaya, Ali Ahmed; Ayebazibwe, Nicholas; Bassong, O; Cardoso, Yolanda; Kebede, Senait; Manoncourt, S; Vandemaele, Katelijn; Mounts, Anthony W.

doi:10.2471/blt.11.098244

Cited by 29 publications

(16 citation statements)

References 4 publications

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“…This will only be possible however if community- and hospital- based sentinel surveillance systems are set up and run for several years. Reliable surveillance data are not yet available for many countries in the inter-tropical belt, although there are some excellent exceptions [ 12 , 30 – 32 ]. Filling this gap should be a priority to allow vaccine recommendations in the tropics to be based on the analysis of epidemiological and virological data collected at a local level rather than educated guesses.…”

Section: Discussionmentioning

confidence: 99%

Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination?

et al. 2016

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IntroductionDetermining the optimal time to vaccinate is important for influenza vaccination programmes. Here, we assessed the temporal characteristics of influenza epidemics in the Northern and Southern hemispheres and in the tropics, and discuss their implications for vaccination programmes.MethodsThis was a retrospective analysis of surveillance data between 2000 and 2014 from the Global Influenza B Study database. The seasonal peak of influenza was defined as the week with the most reported cases (overall, A, and B) in the season. The duration of seasonal activity was assessed using the maximum proportion of influenza cases during three consecutive months and the minimum number of months with ≥80% of cases in the season. We also assessed whether co-circulation of A and B virus types affected the duration of influenza epidemics.Results212 influenza seasons and 571,907 cases were included from 30 countries. In tropical countries, the seasonal influenza activity lasted longer and the peaks of influenza A and B coincided less frequently than in temperate countries. Temporal characteristics of influenza epidemics were heterogeneous in the tropics, with distinct seasonal epidemics observed only in some countries. Seasons with co-circulation of influenza A and B were longer than influenza A seasons, especially in the tropics.DiscussionOur findings show that influenza seasonality is less well defined in the tropics than in temperate regions. This has important implications for vaccination programmes in these countries. High-quality influenza surveillance systems are needed in the tropics to enable decisions about when to vaccinate.

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Section: Discussionmentioning

confidence: 99%

Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination?

et al. 2016

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“…The SISA project was implemented in Sierra Leone using a common methodological framework including development of initial situation assessment and recommendations for improvement; drafting of relevant country-specific surveillance protocols and standard operating procedures (SOPs); training of sentinel surveillance and data management staff; and supervision of surveillance activities [9]. The methods used in Sierra Leone were adapted to its specific context, using the Integrated Disease Surveillance and Response (IDSR) strategy as a platform to establishing the ISS system.…”

Section: Methodsmentioning

confidence: 99%

“…The project was implemented by the Agence de Medicine Preventive (AMP), which deployed and supervised country and regional consultants to support influenza surveillance activities for a period of seven months, from May to December 2011 [9]. Among the eight countries selected for implementation of the SISA project, Sierra Leone was the only country that had no prior influenza surveillance activity in place.…”

Section: Introductionmentioning

confidence: 99%

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

Kebede¹,

Conteh

Steffen

et al. 2013

Health Res Policy Sys

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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.

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“…Following the 2009 influenza A(H1N1) pandemic, respiratory viral surveillance capacity has increased substantially in Africa. 5 Currently, 23 sub-Saharan African countries contribute data to the WHO Global Surveillance and Response System. 6 Emerging data suggest that influenza viruses are frequently detected in mild (6.7–40.4%) and severe (4.6–25.5%) acute respiratory presentations in the region 7 and are associated with a higher mortality compared with developed settings because of the high prevalence of HIV infection and other comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011–2013

Mallewa

Peterson

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Data on the epidemiology of severe acute respiratory illness (SARI) in adults from low-income, high human immunodeficiency virus (HIV) prevalence African settings are scarce. We conducted adult SARI surveillance in Blantyre, Malawi. From January 2011 to December 2013, individuals aged ≥ 15 years with SARI (both inpatients and outpatients) were enrolled at a large teaching hospital in Blantyre, Malawi. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses by polymerase chain reaction. We estimated hospital-attended influenza-positive SARI incidence rates and assessed factors associated with influenza positivity and clinical severity (Modified Early Warning Score > 4). We enrolled 1,126 SARI cases; 163 (14.5%) were positive for influenza. Human immunodeficiency virus prevalence was 50.3%. Annual incidence of hospital-attended influenza-associated SARI was 9.7–16.8 cases per 100,000 population. Human immunodeficiency virus was associated with a 5-fold greater incidence (incidence rate ratio 4.91, 95% confidence interval [CI]: 3.83–6.32). On multivariable analysis, female gender, as well as recruitment in hot, rainy season (December to March; adjusted odds ratios (aOR): 2.82, 95% CI: 1.57–5.06) and cool, dry season (April to August; aOR: 2.47, 95% CI: 1.35–4.15), was associated with influenza positivity, whereas influenza-positive patients were less likely to be HIV-infected (aOR: 0.59, 95% CI: 0.43–0.80) or have viral coinfection (aOR: 0.51, 95% CI: 0.36–0.73). Human immunodeficiency virus infection (aOR: 1.86; 95% CI: 1.35–2.56) and recruitment in hot, rainy season (aOR: 4.98, 95% CI: 3.17–7.81) were independently associated with clinical severity. In this high HIV prevalence population, influenza was associated with nearly 15% of hospital-attended SARI. Human immunodeficiency virus infection is an important risk factor for clinical severity in all-cause and influenza-associated SARI. Expanded access to HIV testing and antiretroviral treatment, as well as targeted influenza vaccination, may reduce the burden of SARI in Malawi and other high HIV prevalence settings.

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Improving influenza surveillance in sub-Saharan Africa

Cited by 29 publications

References 4 publications

Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination?

Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination?

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

Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011–2013

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