南非免疫接种潜在目标风险人群中的流感疾病负担，2013-2015 年。
Influenza disease burden among potential target risk groups for immunization in South Africa, 2013-2015.
机构信息
Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; MassGenics, Duluth, GA, United States.
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Vaccine. 2020 Jun 2;38(27):4288-4297. doi: 10.1016/j.vaccine.2020.04.045. Epub 2020 May 7.
BACKGROUND
Data on influenza burden in risk groups for severe influenza are important to guide targeted influenza immunization, especially in resource limited settings. However, this information is limited overall and in particular in low- and middle-income countries. We sought to assess the mean annual national burden of medically and non-medically attended influenza-associated mild, severe-non-fatal and fatal illness among potential target groups for influenza immunization in South Africa during 2013-2015.
METHODS
We used published mean national annual estimates of mild, severe-non-fatal, and fatal influenza-associated illness in South Africa during 2013-2015 and estimated the number of such illnesses occurring among the following risk groups: (i) children aged 6-59 months; (ii) individuals aged 5-64 years with HIV, and/or pulmonary tuberculosis (PTB), and/or selected underlying medical conditions (UMC); (iii) pregnant women; and (iv) individuals aged ≥65 years. We also estimated the number of individuals among the same risk groups in the population.
RESULTS
During 2013-2015, individuals in the selected risk groups accounted for 45.3% (24,569,328/54,086,144) of the population and 43.5% (4,614,763/10,598,138), 86.8% (111,245/128,173) and 94.5% (10,903/11,536) of the mean annual estimated number of influenza-associated mild, severe-non-fatal and fatal illness episodes, respectively. The rates of influenza-associated illness were highest in children aged 6-59 months (23,983 per 100,000 population) for mild illness, in pregnant women (930 per 100,000 population) for severe-non-fatal illness and in individuals aged ≥65 years (138 per 100,000 population) for fatal illness.
CONCLUSION
Influenza immunization of the selected risk groups has the potential to prevent a substantial number of influenza-associated severe illness. Nonetheless, because of the high number of individuals at risk, South Africa, due to financial resources constrains, may need to further prioritize interventions among risk populations. Cost-burden and cost-effectiveness estimates may assist with further prioritization.
背景
严重流感高危人群的流感负担数据对于指导有针对性的流感免疫至关重要，尤其是在资源有限的环境下。然而，全球范围内，尤其是在中低收入国家，此类信息都十分有限。本研究旨在评估 2013-2015 年期间南非潜在流感免疫目标人群中，与医疗或非医疗相关的流感轻症、重症非致命和致命疾病的年均全国负担。
方法
本研究使用了 2013-2015 年期间南非与医疗或非医疗相关的流感轻症、重症非致命和致命疾病的年均全国估计值，并估计了以下风险人群中此类疾病的发生数量：（i）6-59 月龄儿童；（ii）HIV、肺结核（PTB）和/或特定基础疾病患者（5-64 岁）；（iii）孕妇；（iv）≥65 岁人群。我们还估计了在同一风险人群中，这些疾病在人群中的发生数量。
结果
2013-2015 年，所选风险人群占总人口的 45.3%（24569328/54086144）和 43.5%（4614763/10598138），占年均估计的流感轻症、重症非致命和致命疾病总发生例数的 86.8%（111245/128173）和 94.5%（10903/11536）。6-59 月龄儿童的流感轻症发生率最高（23983/100000 人），孕妇的重症非致命发生率最高（930/100000 人），≥65 岁人群的致命发生率最高（138/100000 人）。
结论
对所选风险人群进行流感免疫接种可能会预防大量的流感重症疾病。然而，由于高危人群数量庞大，南非可能需要进一步优先考虑高危人群中的干预措施，这是由其财政资源限制所致。成本负担和成本效益估计可能有助于进一步确定优先顺序。
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