Background Influenza and respiratory syncytial virus ( RSV ) infections are responsible for substantial global morbidity and mortality in young children and elderly individuals. Estimates of the burden of influenza‐ and RSV ‐associated hospitalization are limited in Africa. Methods We conducted hospital‐based surveillance for laboratory‐confirmed influenza‐ and RSV ‐associated severe acute respiratory illness ( SARI ) among patients of any age at one hospital and a retrospective review of SARI hospitalizations in five hospitals situated in Antananarivo during 2011‐2016. We estimated age‐specific rates (per 100 000 population) of influenza‐ and RSV ‐associated SARI hospitalizations for the Antananarivo region and then extrapolated these rates to the national level. Results Overall, the mean annual national number of influenza‐associated SARI hospitalizations for all age groups was 6609 (95% CI : 5381‐7835‐rate: 30.0; 95% CI : 24.4‐35.6), 4468 (95% CI : 3796‐5102‐rate: 127.6; 95% CI : 108.4‐145.7), 2141 (95% CI : 1585‐2734‐rate: 11.6; 95% CI : 8.6‐14.8), and 339 (95% CI : 224‐459‐rate: 50.0; 95% CI : 36.3‐74.4) among individuals aged <5, ≥5, and ≥65 years, respectively. For these same age groups, the mean annual number of RSV ‐associated SARI hospitalizations was 11 768 (95% CI : 10 553‐12 997‐rate: 53.4; 95% CI : 47.9‐59.0), 11 299 (95% CI : 10 350‐12 214‐rate: 322.7; 95% CI : 295.6‐348.8), 469 (95% CI : 203‐783‐rate: 2.5;95% CI : 1.1‐4.2), and 36 (95% CI : 0‐84‐rate: 5.8; 0.0‐13.5), respectively. Conclusion The burden of influenza‐ and RSV ‐associated SARI hospitalization was high among children aged <5 years. These first estimates for Madagascar will enable government to make informed evidence‐based decisions when allocating scarce resources and planning intervention strategies to limit the impact and spread of these viruses.

The burden of influenza- and RSV-associated SARI hospitalization was high among children aged <5 years. These first estimates for Madagascar will enable government to make informed evidence-based decisions when allocating scarce resources and planning intervention strategies to limit the impact and spread of these viruses. This article is protected by copyright. All rights reserved.

Background: Following the first detection of SARS-CoV-2 in passengers arriving from Europe on 19 March 2020, Madagascar took several mitigation measures to limit the spread of the virus in the country. Methods: Nasopharyngeal and/or oropharyngeal swabs were collected from travellers to Madagascar, suspected SARS-CoV-2 cases, and contact of confirmed cases. Swabs were tested at the national reference laboratory using real-time RT-PVR. Data collected from patients were entered in an electronic database for subsequent statistical analysis. All distribution of laboratory confirmed cases were mapped and six genomes of viruses were fully sequenced. Results: Overall, 26,415 individuals were tested for SARS-CoV-2 between 18 March and 18 September 2020, of whom 21.0% (5,553/26,145) returned positive. Among laboratory-confirmed SARS-CoV-2 positive patients, the median age was 39 years (CI95%: 28-52), and 56.6% (3,311/5,553) were asymptomatic at the time of sampling. The probability of testing positive increased with age with the highest adjusted odds ratio of 2.2 [95% CI: 1.9-2.5] for individuals aged 49 years and more. Viral strains sequenced belong to clades 19A, 20A, and 20B in favour of several independent introduction of viruses. Conclusions. Our study describes the first wave of the COVID-19 in Madagascar. Despite early strategies in place Madagascar could not avoid the introduction and spread of the virus. More studies are needed to estimate the true burden of disease and make public health recommendations for a better preparation to another wave.

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