The epidemiology of seasonal influenza after the 2009 influenza pandemic in Africa: a systematic review

Lagaré, Adamou; Rajatonirina, Soatiana; Testa, J.; Mamadou, Saidou

doi:10.4314/ahs.v20i4.5

Cited by 3 publications

(3 citation statements)

References 224 publications

(425 reference statements)

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“…Vaccination period extends from October to December every year. Despite widespread policy recommendations on influenza vaccination, coverage is low in Tunisia, through the Eastern Mediterranean Region [ 18 ] and also in most African countries [ 19 ]. Among Tunisian health professionals, there was a low vaccination rate: only 15.3% were vaccinated against influenza in the 2018–2019 influenza season [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features

et al. 2022

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Introduction Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia. Methods It was a single-center study, including all hospitalized patients in intensive care, between November 1st, 2009 and October 31st, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized. Results During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H1N1 pdm09 (84.2%) and H3N2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25–13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC95% [1.474–37.317]; p = 0.015), PaO2/FiO2 ≤ 95 mmHg (OR = 9.078; IC95% [1.636–50.363]; p = 0.012) and lymphocytes count ≤ 1.325 109/L (OR = 10.199; IC95% [1.550–67.101]; p = 0.016). Conclusion Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.

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Section: Discussionmentioning

confidence: 99%

Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features

et al. 2022

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“…These include A(H1N1)pdm2009, A(H3N2), A(H5N1) and influenza B viruses of the Victoria and Yamagata lineages [ 3 , 4 ]. Indeed, after the 2009 pandemic, only these four influenza viruses continued to circulate on a global scale [ 5 , 7 , 8 ]. Our work has shown that their influenza activity follows an annual and regional variation.…”

Section: Discussionmentioning

confidence: 99%

Circulation and seasonality of influenza viruses in different transmission zones in Africa

et al. 2022

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Background Influenza is responsible for more than 5 million severe cases and 290,000 to 650,000 deaths every year worldwide. Developing countries account for 99% of influenza deaths in children under 5 years of age. This paper aimed to determine the dynamics of influenza viruses in African transmission areas to identify regional seasonality for appropriate decision-making and the development of regional preparedness and response strategies. Methods We used data from the WHO FluMart website collected by National Influenza Centers for seven transmission periods (2013–2019). We calculated weekly proportions of positive influenza cases and determined transmission trends in African countries to determine the seasonality. Results From 2013 to 2019, influenza A(H1N1)pdm2009, A(H3N2), and A(H5N1) viruses, as well as influenza B Victoria and Yamagata lineages, circulated in African regions. Influenza A(H1N1)pdm2009 and A(H3N2) highly circulated in northern and southern Africa regions. Influenza activity followed annual and regional variations. In the tropical zone, from eastern to western via the middle regions, influenza activities were marked by the predominance of influenza A subtypes despite the circulation of B lineages. One season was identified for both the southern and northern regions of Africa. In the eastern zone, four influenza seasons were differentiated, and three were differentiated in the western zone. Conclusion Circulation dynamics determined five intense influenza activity zones in Africa. In the tropics, influenza virus circulation waves move from the east to the west, while alternative seasons have been identified in northern and southern temperate zones. Health authorities from countries with the same transmission zone, even in the absence of local data based on an established surveillance system, should implement concerted preparedness and control activities, such as vaccination.

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“…It is followed by a meta-analysis on seasonal flu that is highly relevant given that flu impacts the effects of Covid-19. 3 …”

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confidence: 99%

Editor’s choice: this December 2020

Tumwine¹

2020

Afr H. Sci.

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The epidemiology of seasonal influenza after the 2009 influenza pandemic in Africa: a systematic review

Cited by 3 publications

References 224 publications

Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features

Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features

Circulation and seasonality of influenza viruses in different transmission zones in Africa

Editor’s choice: this December 2020

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