Alshahrani Amal M, Okmi Ezzualdeen, Sullivan Sheena G, Tempia Stefano, Barakat Amal, Naja Hala Abou El, Aman Amir, Hamedelneil Osman, Mohamed Mutaz, Basheer Seham F, Albugami Ghaliah, Alalweet Randah, Alhazir Norah, Alwalan Lama, Alshahrani Najim Z, Alsreehi Haleema, Asiri Abdullah M
Deputyship of Population Health, Ministry of Health, Riyadh, Saudi Arabia.
Public Health Authority, Riyadh, Saudi Arabia.
J Epidemiol Glob Health. 2025 Mar 20;15(1):47. doi: 10.1007/s44197-025-00390-1.
Influenza imposes a substantial global health burden, particularly among high-risk populations such as the elderly, young children, and individuals with chronic conditions. In Saudi Arabia, a national influenza sentinel surveillance program was established in 2017 to monitor respiratory virus trends, yet comprehensive estimates of the influenza-associated burden remain limited. This study aims to address this gap by quantifying influenza-associated severe acute respiratory infection (SARI) hospitalization rates and estimating the broader influenza burden across severity levels.
Data from four sentinel hospitals in three regions of Saudi Arabia were analyzed across three influenza seasons: 2017-2018, 2018-2019, and 2022-2023. Weekly SARI case counts were combined with census population data to calculate SARI hospitalization rates per 100,000 population. Influenza positivity rates, derived from laboratory-confirmed cases, were used to estimate influenza-associated SARI hospitalization rates, stratified by age and season. The John Hopkins University/WHO Seasonal Influenza Burden Disease Estimator (Flutool) was employed to extrapolate national estimates of influenza-associated hospitalizations, deaths, and mild/moderate cases. Confidence intervals and age-specific stratifications were computed to enhance precision and comparability.
The average annual SARI hospitalization rate was 294 per 100,000 population (95% CI: 288-300). Influenza-associated SARI hospitalization rates averaged 48 per 100,000 population (95% CI: 45-50), with the highest burden observed in individuals aged 65 years and older (269 per 100,000, 95% CI: 240-301) and children aged 0-4 years (118 per 100,000, 95% CI: 107-131). Seasonal variation was noted, with the highest rates in the 2017-2018 season. National estimates suggested a substantial burden, with influenza-associated hospitalizations totaling 17,678 in 2017-2018, 7,683 in 2018-2019, and 13,982 in 2022-2023. The flutool analysis estimated annual influenza-associated deaths ranging from 30 to 4,441 and mild/moderate cases reaching up to 6.3 million in the most severe season.
This study demonstrates a significant burden of influenza-associated SARI hospitalizations in Saudi Arabia, with the highest rates observed in the elderly and young children. Seasonal variation was evident, highlighting the urgent need to enhance influenza vaccination coverage, particularly among high-risk groups such as the elderly and young children, to reduce severe outcomes. Expanding sentinel surveillance to more regions and incorporating detailed clinical and economic data are recommended to better inform public health policies. Strengthening pandemic preparedness and tailoring vaccination campaigns based on seasonality and age-specific risk will be critical for mitigating the influenza burden in Saudi Arabia.
流感给全球带来了沉重的健康负担，尤其是在老年人、幼儿和慢性病患者等高风险人群中。在沙特阿拉伯，2017年建立了全国流感哨点监测项目以监测呼吸道病毒趋势，但对流感相关负担的全面估计仍然有限。本研究旨在通过量化流感相关的严重急性呼吸道感染（SARI）住院率并估计不同严重程度的流感总体负担来填补这一空白。
分析了沙特阿拉伯三个地区四家哨点医院在2017 - 2018、2018 - 2019和2022 - 2023三个流感季节的数据。将每周的SARI病例数与人口普查数据相结合，计算每10万人口的SARI住院率。由实验室确诊病例得出的流感阳性率用于估计按年龄和季节分层的流感相关SARI住院率。采用约翰·霍普金斯大学/世界卫生组织季节性流感负担疾病估算器（Flutool）来推断全国流感相关住院、死亡以及轻度/中度病例的估计数。计算置信区间和特定年龄分层以提高精度和可比性。
平均每年每10万人口的SARI住院率为294（95%置信区间：288 - 300）。流感相关的SARI住院率平均为每10万人口48（95%置信区间：45 - 50），65岁及以上人群（每10万人口269，95%置信区间：240 - 301）和0 - 4岁儿童（每10万人口118，95%置信区间：107 - 131）的负担最高。观察到季节性变化，2017 - 2018季节的发病率最高。全国估计表明负担沉重，2017 - 2018年流感相关住院总数为17,678例，2018 - 2019年为7,683例，2022 - 2023年为13,982例。Flutool分析估计每年流感相关死亡人数在30至4,441人之间，在最严重的季节轻度/中度病例多达630万例。
本研究表明沙特阿拉伯流感相关SARI住院负担沉重，老年人和幼儿的发病率最高。季节性变化明显，突出了迫切需要提高流感疫苗接种覆盖率，特别是在老年人和幼儿等高风险群体中，以减少严重后果。建议将哨点监测扩展到更多地区并纳入详细的临床和经济数据，以更好地为公共卫生政策提供信息。加强大流行防范并根据季节性和特定年龄风险调整疫苗接种活动对于减轻沙特阿拉伯的流感负担至关重要。
