Sentinel surveillance for influenza A viruses in Lahore District Pakistan in flu season 2015-2016

Saima Hasan; Richard J Webby; Muhammad Iqbal; Hamad Bin Rashid; Mansur-Ud-Din Ahmad; Jawad Nazir; Jennifer DeBeauchamp; Shakera Sadiq; Mamoona Chaudhry

doi:10.1186/s12879-021-07021-7

Sentinel surveillance for influenza A viruses in Lahore District Pakistan in flu season 2015-2016

BMC Infect Dis. 2022 Jan 6;22(1):38. doi: 10.1186/s12879-021-07021-7.

Authors

Affiliations

¹ Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.
² World Health Organization Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds, Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.
³ Department of Surgery and Pet Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan.
⁴ Department of Pathobiology, Riphah Veterinary College, Riphah International University, Lahore, Pakistan.
⁵ Department of Microbiology, University of Veterinary and Animal Sciences, Lahore, Pakistan.
⁶ Virology Laboratory, Treidlia Biovet, Seven Hills, Blacktown, NSW, Australia.
⁷ Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan. Mamoona.chaudhry@uvas.edu.pk.

Abstract

Background: Influenza A virus (IAV) remains an important global public health threat with limited epidemiological information available from low-and-middle-income countries. The major objective of this study was to describe the proportions, temporal and spatial distribution, and demographic and clinical characteristics of IAV positive patients with influenza like illness (ILI) and severe acute respiratory illness (SARI) in Lahore, Pakistan.

Methods: Prospective surveillance was established in a sentinel hospital from October 2015 to May 2016. All eligible outpatients and inpatients with ILI or SARI were enrolled in the study. Nasal and/or throat swabs were collected along with clinico-epidemiological data. Samples were tested by real-time RT-PCR (rRT-PCR) to identify IAV and subtype. The descriptive analysis of data was done in R software.

Results: Out of 311 enrolled patients, 284 (91.3%) were ILI and 27 (8.7%) were SARI cases. A distinct peak of ILI and SARI activity was observed in February. Fifty individuals (16%) were positive for IAV with peak positivity observed in December. Of 50 IAV, 15 were seasonal H3N2, 14 were H1N1pdm09 and 21 were unable to be typed. The majority of IAV positive cases (98%) presented with current or history of fever, 88% reported cough and 82% reported sore throat. The most common comorbidities in IAV positive cases were hepatitis C (4%), obesity (4%) and tuberculosis (6%). The highest incidence of patients reporting to the hospital was seen three days post symptoms onset (66/311) with 14 of these (14/66) positive for IAV.

Conclusion: Distinct trends of ILI, SARI and IAV positive cases were observed which can be used to inform public health interventions (vaccinations, hand and respiratory hygiene) at appropriate times among high-risk groups. We suggest sampling from both ILI and SARI patients in routine surveillance as recommended by WHO.

Keywords: Active surveillance; Influenza; Influenza like illness (ILI); Pandemic; Seasonal influenza; Severe acute respiratory illness (SARI).

MeSH terms

Humans
Infant
Influenza A Virus, H3N2 Subtype
Influenza A virus*
Influenza, Human* / epidemiology
Pakistan / epidemiology
Prospective Studies
Seasons
Sentinel Surveillance

Abstract

MeSH terms

Grants and funding