Cummings Matthew J, Bakamutumaho Barnabas, Kayiwa John, Byaruhanga Timothy, Owor Nicholas, Namagambo Barbara, Wolf Allison, Wamala Joseph F, Morse Stephen S, Lutwama Julius J, O'Donnell Max R
1 Department of Medicine and.
2 National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda.
Ann Am Thorac Soc. 2016 Dec;13(12):2159-2168. doi: 10.1513/AnnalsATS.201607-561OC.
Little is known about the epidemiology of severe acute respiratory infection (SARI) or influenza in sub-Saharan Africa. Characterization of influenza transmission dynamics and risk factors for severe disease and mortality is critical to inform prevention and mitigation strategies.
To characterize the epidemiology and transmission dynamics of influenza and risk factors for influenza-associated severe respiratory infection in Uganda.
Clinicians at 12 sentinel surveillance sites prospectively collected clinical data and upper respiratory tract samples from consecutive patients who met criteria for SARI and influenza-like illness (ILI). Samples were tested for influenza A and B viruses using real-time reverse transcription-polymerase chain reaction. Spatial and spatiotemporal cluster modeling was performed to identify loci of increased influenza transmission. Morbidity and mortality were assessed through chart review in a defined subset of patients. Univariable and multivariable analyses were used to identify risk factors for severe respiratory infection, prolonged hospitalization, and in-hospital mortality.
From October 2010 to June 2015, 9,978 patients met case definitions for SARI and ILI and had samples tested for influenza A and B. Of the 9,978 patient samples tested, 1,113 (11.2%) were positive for influenza. Among 6,057 patients with ILI, 778 samples (12.8%) were positive, and among 3,921 patients with SARI, 335 samples (8.5%) were positive. Significant clustering of influenza cases was observed in urban and periurban areas and during rainy seasons. Among 1,405 cases of SARI with available outcome data, in-hospital mortality was 1.6%. Infection with the 2009 pandemic A/H1N1 subtype and prolonged time to presentation were independently associated with SARI among influenza cases.
Influenza is associated with a substantial proportion of acute respiratory infection in Uganda. As influenza vaccination programs are developed in East Africa, timing campaigns to confer protection during rainy seasons should be considered, particularly among high-risk urban populations.
关于撒哈拉以南非洲地区严重急性呼吸道感染（SARI）或流感的流行病学情况，人们了解甚少。流感传播动态以及严重疾病和死亡风险因素的特征对于制定预防和缓解策略至关重要。
描述乌干达流感的流行病学和传播动态以及与流感相关的严重呼吸道感染的风险因素。
12个哨点监测点的临床医生前瞻性地收集符合SARI和流感样疾病（ILI）标准的连续患者的临床数据和上呼吸道样本。使用实时逆转录-聚合酶链反应检测样本中的甲型和乙型流感病毒。进行空间和时空聚类建模以识别流感传播增加的地点。通过对特定患者亚组的病历审查评估发病率和死亡率。采用单变量和多变量分析来确定严重呼吸道感染、住院时间延长和院内死亡的风险因素。
2010年10月至2015年6月，9978名患者符合SARI和ILI的病例定义，并对其样本进行了甲型和乙型流感检测。在检测的9978份患者样本中，1113份（11.2%）流感呈阳性。在6057例ILI患者中，778份样本（12.8%）呈阳性，在3921例SARI患者中，335份样本（8.5%）呈阳性。在城市和城郊地区以及雨季观察到流感病例的显著聚集。在1405例有可用结局数据的SARI病例中，院内死亡率为1.6%。2009年甲型H1N1大流行亚型感染和就诊时间延长与流感病例中的SARI独立相关。
在乌干达，流感与相当一部分急性呼吸道感染有关。随着东非地区流感疫苗接种计划的开展，应考虑在雨季开展接种活动以提供保护，特别是在高危城市人群中。
