Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries

Abstract

Background Data on causes of death due to respiratory illness in Africa are limited. Methods From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)–associated deaths identified from influenza surveillance during 2009–2012. Results Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%–25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%–5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus–negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0–4 years, 462 (43.1%) involved people aged 5–49 years, and 209 (19.5%) involved people aged ≥50 years. Conclusions Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.

Epidemiology and molecular characterization of influenza viruses in Burkina Faso, sub‐Saharan Africa

“…They often represent the majority of patients enrolled in ILI surveillance, also in Africa . In Africa, influenza accounts for 8%‐20% of ILI cases in children below 5 years old and around 7% of SARI cases . Similarly, we found that 15.1% of ILI and 6.6% of SARI patients enrolled in our study tested positive for influenza A or B viruses over the 2 years period .…”

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

“…However, the majority of available information on influenza disease burden emanates from industrialized countries. In recent years, influenza sentinel surveillance has been established in several African countries,4 and influenza virus infection has been reported to be associated with mild and severe illness including death on the Continent 4, 5. Nonetheless, estimates of the burden of influenza‐associated hospitalization are severely limited in Africa.…”

Influenza-Associated Morbidity and Mortality in Sub-Saharan Africa

“…Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus-negative cases (P < .001) [43] [43].…”

“…The data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%-25.9%) tested positive for influenza virus [43]. There were 1073 deaths (2.8%; range by country, 0.1%-5.3%) reported, among which influenza virus was detected in 57 (5.3%) [43]. Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting.…”