Severe acute respiratory illness deaths in sub-Saharan Africa and the role of influenza: a case series from 8 countries

Meredith L McMorrow, Emile Okitolonda Wemakoy, Joelle Kabamba Tshilobo, Gideon O Emukule, Joshua A Mott, Henry Njuguna, Lilian Waiboci, Jean-Michel Heraud, Soatianana Rajatonirina, Norosoa H Razanajatovo, Moses Chilombe, Dean Everett, Robert S Heyderman, Amal Barakat, Thierry Nyatanyi, Joseph Rukelibuga, Adam L Cohen, Cheryl Cohen, Stefano Tempia, Juno ThomasMarietjie Venter, Elibariki Mwakapeje, Marcelina Mponela, Julius Lutwama, Jazmin Duque, Kathryn Lafond, Ndahwouh Talla Nzussouo, Thelma Williams, Marc-Alain Widdowson

Research output: Contribution to journalA1: Web of Science-articlepeer-review


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.

Original languageEnglish
JournalJournal of Infectious Diseases
Issue number6
Pages (from-to)853-60
Number of pages8
Publication statusPublished - 2015


  • Adolescent
  • Adult
  • Africa South of the Sahara/epidemiology
  • Age Distribution
  • Aged
  • Bacterial Infections/epidemiology
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza, Human/epidemiology
  • Middle Aged
  • Population Surveillance
  • Respiratory Tract Infections/epidemiology
  • Young Adult


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