量化不同临床表现、严重程度水平和医疗保健就诊如何影响流感相关疾病负担：来自南非的建模研究。
Quantifying How Different Clinical Presentations, Levels of Severity, and Healthcare Attendance Shape the Burden of Influenza-associated Illness: A Modeling Study From South Africa.
机构信息
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
Influenza Program, Centers for Disease Control and Prevention, Pretoria.
出版信息
Clin Infect Dis. 2019 Aug 30;69(6):1036-1048. doi: 10.1093/cid/ciy1017.
BACKGROUND
Burden estimates of medically and nonmedically attended influenza-associated illness across syndromes and levels of severity are lacking.
METHODS
We estimated the national burden of medically and nonmedically attended influenza-associated illness among individuals with different clinical presentations (all-respiratory, all-circulatory, and nonrespiratory/noncirculatory) and levels of severity (mild, fatal, and severe, nonfatal) using a combination of case-based (from laboratory-confirmed influenza surveillance) and ecological studies, as well as data from healthcare utilization surveys in South Africa during 2013-2015. In addition, we compared estimates of medically attended influenza-associated respiratory illness, obtained from case-based and ecological studies. Rates were reported per 100 000 individuals in the population.
RESULTS
The estimated mean annual number of influenza-associated illness episodes was 10 737 847 (19.8% of 54 096 705 inhabitants). Of these episodes, 10 598 138 (98.7%) were mild, 128 173 (1.2%) were severe, nonfatal, and 11 536 (0.1%) were fatal. There were 2 718 140 (25.6%) mild, 56 226 (43.9%) severe, nonfatal, and 4945 (42.8%) medically attended should be after fatal episodes. Influenza-associated respiratory illness accounted for 99.2% (10 576 146) of any mild, 65.5% (83 941) of any severe, nonfatal, and 33.7% (3893) of any fatal illnesses. Ecological and case-based estimates of medically attended, influenza-associated, respiratory mild (rates: ecological, 1778.8, vs case-based, 1703.3; difference, 4.4%), severe, nonfatal (rates: ecological, 88.6, vs case-based, 75.3; difference, 15.0%), and fatal (rates: ecological, 3.8, vs case-based, 3.5; difference, 8.4%) illnesses were similar.
CONCLUSIONS
There was a substantial burden of influenza-associated symptomatic illness, including severe, nonfatal and fatal illnesses, and a large proportion was nonmedically attended. Estimates, including only influenza-associated respiratory illness, substantially underestimated influenza-associated, severe, nonfatal and fatal illnesses. Ecological and case-based estimates were found to be similar for the compared categories.
背景
缺乏对不同综合征和严重程度的有医疗和无医疗干预的流感相关疾病负担的估计。
方法
我们使用基于病例的（来自实验室确诊的流感监测）和生态学研究以及南非 2013-2015 年医疗保健利用调查的数据相结合，对不同临床表现（全呼吸道、全循环和非呼吸道/非循环）和严重程度（轻度、致命和严重、非致命）的个体中，有医疗和无医疗干预的流感相关疾病的全国负担进行了估计。此外，我们比较了基于病例和生态学研究获得的有医疗干预的流感相关呼吸道疾病的估计。报告的发生率为每 10 万人中有多少人患病。
结果
估计每年有流感相关疾病发作 10737847 例（占 54096705 居民的 19.8%）。其中，10598138 例（98.7%）为轻度，128173 例（1.2%）为严重、非致命，11536 例（0.1%）为致命。有 2718140 例（25.6%）为轻度、56226 例（43.9%）为严重、非致命，4945 例（42.8%）为有医疗干预的致命。流感相关呼吸道疾病占所有轻度（10576146 例）的 99.2%，占所有严重、非致命（83941 例）的 65.5%，占所有致命（3893 例）的 33.7%。
结论
流感相关症状疾病负担很大，包括严重、非致命和致命疾病，而且很大一部分未得到医疗干预。仅包括流感相关呼吸道疾病的估计值大大低估了流感相关的严重、非致命和致命疾病。在比较的类别中，发现基于病例和基于生态学的估计值相似。
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