Burden of Influenza in 4 Ecologically Distinct Regions of Peru: Household Active Surveillance of a Community Cohort, 2009-2015

Yeny O. Tinoco, Eduardo Azziz-Baumgartner, Timothy M. Uyeki, Hugo R. Rázuri, Matthew R. Kasper, Candice Romero, Maria E. Silva, Mark P. Simons, Giselle M. Soto, Marc Alain Widdowson, Robert H. Gilman, Daniel G. Bausch, Joel M. Montgomery, Ernesto Ortiz, Carolina Guevara, Claudia Guezala, Carlos Figueroa, Sebastian Loli, Alberto Laguna, Eric HalseyErik Reaves, Maya Williams, Christopher Mores, Wesley Campbell, Hugo H. García, Armando E. González

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background There are limited data on the burden of disease posed by influenza in low- and middle-income countries. Furthermore, most estimates of influenza disease burden worldwide rely on passive sentinel surveillance at health clinics and hospitals that lack accurate population denominators. Methods We documented influenza incidence, seasonality, health-system utilization with influenza illness, and vaccination coverage through active community-based surveillance in 4 ecologically distinct regions of Peru over 6 years. Approximately 7200 people in 1500 randomly selected households were visited 3 times per week. Naso- and oropharyngeal swabs were collected from persons with influenza-like illness and tested for influenza virus by real-time reverse-transcription polymerase chain reaction. Results We followed participants for 35353 person-years (PY). The overall incidence of influenza was 100 per 1000 PY (95% confidence interval [CI], 97-104) and was highest in children aged 2-4 years (256/1000 PY [95% CI, 236-277]). Seasonal incidence trends were similar across sites, with 61% of annual influenza cases occurring during the austral winter (May-September). Of all participants, 44 per 1000 PY (95% CI, 42-46) sought medical care, 0.7 per 1000 PY (95% CI, 0.4-1.0) were hospitalized, and 1 person died (2.8/100000 PY). Influenza vaccine coverage was 27% among children aged 6-23 months and 26% among persons aged ≥65 years. Conclusions Our results indicate that 1 in 10 persons develops influenza each year in Peru, with the highest incidence in young children. Active community-based surveillance allows for a better understanding of the true burden and seasonality of disease that is essential to plan the optimal target groups, timing, and cost of national influenza vaccination programs.

Original languageEnglish
Pages (from-to)1532-1541
Number of pages10
JournalClinical Infectious Diseases
Volume65
Issue number9
DOIs
StatePublished - 1 Nov 2017

Bibliographical note

Funding Information:
Financial support. This work was supported by the NAMRU-6 Interagency agreement with the Centers for Disease Control and Prevention (CDC); the National Institutes of Health, Fogarty International Center (5D43TW007393-03 to Y. O. T.); and the US Department of Defense Global Emerging Infections System (I0082_09_LI).

Publisher Copyright:
© Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Keywords

  • community cohort
  • healthcare-seeking behavior
  • household-based
  • influenza
  • seasonality

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