Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology

James A Fuller; Aimee Summers; Mark A Katz; Kim A Lindblade; Henry Njuguna; Wences Arvelo; Sammy Khagayi; Gideon Emukule; Nivaldo Linares-Perez; John McCracken; D James Nokes; Mwanajuma Ngama; Sidi Kazungu; Joshua A Mott; Sonja J Olsen; Marc-Alain Widdowson; Daniel R Feikin

doi:10.1371/journal.pone.0056882

Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology

James A Fuller, Aimee Summers, Mark A Katz, Kim A Lindblade, Henry Njuguna, Wences Arvelo, Sammy Khagayi, Gideon Emukule, Nivaldo Linares-Perez, John McCracken, D James Nokes, Mwanajuma Ngama, Sidi Kazungu, Joshua A Mott, Sonja J Olsen, Marc-Alain Widdowson, Daniel R Feikin

Institute of Tropical Medicine

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

BACKGROUND: Knowing the national disease burden of severe influenza in low-income countries can inform policy decisions around influenza treatment and prevention. We present a novel methodology using locally generated data for estimating this burden.

METHODS AND FINDINGS: This method begins with calculating the hospitalized severe acute respiratory illness (SARI) incidence for children <5 years old and persons ≥5 years old from population-based surveillance in one province. This base rate of SARI is then adjusted for each province based on the prevalence of risk factors and healthcare-seeking behavior. The percentage of SARI with influenza virus detected is determined from provincial-level sentinel surveillance and applied to the adjusted provincial rates of hospitalized SARI. Healthcare-seeking data from healthcare utilization surveys is used to estimate non-hospitalized influenza-associated SARI. Rates of hospitalized and non-hospitalized influenza-associated SARI are applied to census data to calculate the national number of cases. The method was field-tested in Kenya, and validated in Guatemala, using data from August 2009-July 2011. In Kenya (2009 population 38.6 million persons), the annual number of hospitalized influenza-associated SARI cases ranged from 17,129-27,659 for children <5 years old (2.9-4.7 per 1,000 persons) and 6,882-7,836 for persons ≥5 years old (0.21-0.24 per 1,000 persons), depending on year and base rate used. In Guatemala (2011 population 14.7 million persons), the annual number of hospitalized cases of influenza-associated pneumonia ranged from 1,065-2,259 (0.5-1.0 per 1,000 persons) among children <5 years old and 779-2,252 cases (0.1-0.2 per 1,000 persons) for persons ≥5 years old, depending on year and base rate used. In both countries, the number of non-hospitalized influenza-associated cases was several-fold higher than the hospitalized cases.

CONCLUSIONS: Influenza virus was associated with a substantial amount of severe disease in Kenya and Guatemala. This method can be performed in most low and lower-middle income countries.

Original language	English
Journal	PLoS ONE
Volume	8
Issue number	2
Pages (from-to)	e56882
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0056882
Publication status	Published - 2013

Keywords

Demography
Guatemala/epidemiology
Hospitalization/statistics & numerical data
Humans
Incidence
Influenza, Human/complications
Kenya/epidemiology
Sentinel Surveillance
Severe Acute Respiratory Syndrome/epidemiology

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10.1371/journal.pone.0056882

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Fuller, J. A., Summers, A., Katz, M. A., Lindblade, K. A., Njuguna, H., Arvelo, W., Khagayi, S., Emukule, G., Linares-Perez, N., McCracken, J., Nokes, D. J., Ngama, M., Kazungu, S., Mott, J. A., Olsen, S. J., Widdowson, M.-A., & Feikin, D. R. (2013). Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology. PLoS ONE, 8(2), e56882. https://doi.org/10.1371/journal.pone.0056882

@article{f1d1b49de7cc4d14ad4b3b61cb4b891a,

title = "Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology",

abstract = "BACKGROUND: Knowing the national disease burden of severe influenza in low-income countries can inform policy decisions around influenza treatment and prevention. We present a novel methodology using locally generated data for estimating this burden.METHODS AND FINDINGS: This method begins with calculating the hospitalized severe acute respiratory illness (SARI) incidence for children <5 years old and persons ≥5 years old from population-based surveillance in one province. This base rate of SARI is then adjusted for each province based on the prevalence of risk factors and healthcare-seeking behavior. The percentage of SARI with influenza virus detected is determined from provincial-level sentinel surveillance and applied to the adjusted provincial rates of hospitalized SARI. Healthcare-seeking data from healthcare utilization surveys is used to estimate non-hospitalized influenza-associated SARI. Rates of hospitalized and non-hospitalized influenza-associated SARI are applied to census data to calculate the national number of cases. The method was field-tested in Kenya, and validated in Guatemala, using data from August 2009-July 2011. In Kenya (2009 population 38.6 million persons), the annual number of hospitalized influenza-associated SARI cases ranged from 17,129-27,659 for children <5 years old (2.9-4.7 per 1,000 persons) and 6,882-7,836 for persons ≥5 years old (0.21-0.24 per 1,000 persons), depending on year and base rate used. In Guatemala (2011 population 14.7 million persons), the annual number of hospitalized cases of influenza-associated pneumonia ranged from 1,065-2,259 (0.5-1.0 per 1,000 persons) among children <5 years old and 779-2,252 cases (0.1-0.2 per 1,000 persons) for persons ≥5 years old, depending on year and base rate used. In both countries, the number of non-hospitalized influenza-associated cases was several-fold higher than the hospitalized cases.CONCLUSIONS: Influenza virus was associated with a substantial amount of severe disease in Kenya and Guatemala. This method can be performed in most low and lower-middle income countries.",

keywords = "Demography, Guatemala/epidemiology, Hospitalization/statistics & numerical data, Humans, Incidence, Influenza, Human/complications, Kenya/epidemiology, Sentinel Surveillance, Severe Acute Respiratory Syndrome/epidemiology",

author = "Fuller, {James A} and Aimee Summers and Katz, {Mark A} and Lindblade, {Kim A} and Henry Njuguna and Wences Arvelo and Sammy Khagayi and Gideon Emukule and Nivaldo Linares-Perez and John McCracken and Nokes, {D James} and Mwanajuma Ngama and Sidi Kazungu and Mott, {Joshua A} and Olsen, {Sonja J} and Marc-Alain Widdowson and Feikin, {Daniel R}",

year = "2013",

doi = "10.1371/journal.pone.0056882",

language = "English",

volume = "8",

pages = "e56882",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "2",

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Fuller, JA, Summers, A, Katz, MA, Lindblade, KA, Njuguna, H, Arvelo, W, Khagayi, S, Emukule, G, Linares-Perez, N, McCracken, J, Nokes, DJ, Ngama, M, Kazungu, S, Mott, JA, Olsen, SJ, Widdowson, M-A & Feikin, DR 2013, 'Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology', PLoS ONE, vol. 8, no. 2, pp. e56882. https://doi.org/10.1371/journal.pone.0056882

TY - JOUR

T1 - Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology

AU - Fuller, James A

AU - Summers, Aimee

AU - Katz, Mark A

AU - Lindblade, Kim A

AU - Njuguna, Henry

AU - Arvelo, Wences

AU - Khagayi, Sammy

AU - Emukule, Gideon

AU - Linares-Perez, Nivaldo

AU - McCracken, John

AU - Nokes, D James

AU - Ngama, Mwanajuma

AU - Kazungu, Sidi

AU - Mott, Joshua A

AU - Olsen, Sonja J

AU - Widdowson, Marc-Alain

AU - Feikin, Daniel R

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Knowing the national disease burden of severe influenza in low-income countries can inform policy decisions around influenza treatment and prevention. We present a novel methodology using locally generated data for estimating this burden.METHODS AND FINDINGS: This method begins with calculating the hospitalized severe acute respiratory illness (SARI) incidence for children <5 years old and persons ≥5 years old from population-based surveillance in one province. This base rate of SARI is then adjusted for each province based on the prevalence of risk factors and healthcare-seeking behavior. The percentage of SARI with influenza virus detected is determined from provincial-level sentinel surveillance and applied to the adjusted provincial rates of hospitalized SARI. Healthcare-seeking data from healthcare utilization surveys is used to estimate non-hospitalized influenza-associated SARI. Rates of hospitalized and non-hospitalized influenza-associated SARI are applied to census data to calculate the national number of cases. The method was field-tested in Kenya, and validated in Guatemala, using data from August 2009-July 2011. In Kenya (2009 population 38.6 million persons), the annual number of hospitalized influenza-associated SARI cases ranged from 17,129-27,659 for children <5 years old (2.9-4.7 per 1,000 persons) and 6,882-7,836 for persons ≥5 years old (0.21-0.24 per 1,000 persons), depending on year and base rate used. In Guatemala (2011 population 14.7 million persons), the annual number of hospitalized cases of influenza-associated pneumonia ranged from 1,065-2,259 (0.5-1.0 per 1,000 persons) among children <5 years old and 779-2,252 cases (0.1-0.2 per 1,000 persons) for persons ≥5 years old, depending on year and base rate used. In both countries, the number of non-hospitalized influenza-associated cases was several-fold higher than the hospitalized cases.CONCLUSIONS: Influenza virus was associated with a substantial amount of severe disease in Kenya and Guatemala. This method can be performed in most low and lower-middle income countries.

AB - BACKGROUND: Knowing the national disease burden of severe influenza in low-income countries can inform policy decisions around influenza treatment and prevention. We present a novel methodology using locally generated data for estimating this burden.METHODS AND FINDINGS: This method begins with calculating the hospitalized severe acute respiratory illness (SARI) incidence for children <5 years old and persons ≥5 years old from population-based surveillance in one province. This base rate of SARI is then adjusted for each province based on the prevalence of risk factors and healthcare-seeking behavior. The percentage of SARI with influenza virus detected is determined from provincial-level sentinel surveillance and applied to the adjusted provincial rates of hospitalized SARI. Healthcare-seeking data from healthcare utilization surveys is used to estimate non-hospitalized influenza-associated SARI. Rates of hospitalized and non-hospitalized influenza-associated SARI are applied to census data to calculate the national number of cases. The method was field-tested in Kenya, and validated in Guatemala, using data from August 2009-July 2011. In Kenya (2009 population 38.6 million persons), the annual number of hospitalized influenza-associated SARI cases ranged from 17,129-27,659 for children <5 years old (2.9-4.7 per 1,000 persons) and 6,882-7,836 for persons ≥5 years old (0.21-0.24 per 1,000 persons), depending on year and base rate used. In Guatemala (2011 population 14.7 million persons), the annual number of hospitalized cases of influenza-associated pneumonia ranged from 1,065-2,259 (0.5-1.0 per 1,000 persons) among children <5 years old and 779-2,252 cases (0.1-0.2 per 1,000 persons) for persons ≥5 years old, depending on year and base rate used. In both countries, the number of non-hospitalized influenza-associated cases was several-fold higher than the hospitalized cases.CONCLUSIONS: Influenza virus was associated with a substantial amount of severe disease in Kenya and Guatemala. This method can be performed in most low and lower-middle income countries.

KW - Demography

KW - Guatemala/epidemiology

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Incidence

KW - Influenza, Human/complications

KW - Kenya/epidemiology

KW - Sentinel Surveillance

KW - Severe Acute Respiratory Syndrome/epidemiology

U2 - 10.1371/journal.pone.0056882

DO - 10.1371/journal.pone.0056882

M3 - A1: Web of Science-article

C2 - 23573177

SN - 1932-6203

VL - 8

SP - e56882

JO - PLoS ONE

JF - PLoS ONE

IS - 2

ER -

Estimation of the national disease burden of influenza-associated severe acute respiratory illness in Kenya and Guatemala: a novel methodology

Abstract

Keywords

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