Influenza disease burden among potential target risk groups for immunization in South Africa, 2013–2015

BackgroundData 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.MethodsWe 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.ResultsDuring 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.ConclusionInfluenza 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.     

Influenza vaccine effectiveness in preventing hospitalization among Beijing residents in China, 2013–15

BackgroundEstimates of influenza vaccination effectiveness (VE) are valuable for populations where the vaccine has been promoted in order to support vaccination policy and to permit evaluation of vaccination strategies. Such studies would be important for China due to limited data available during seasons when the vaccine strains matched or mismatched the circulating viruses.MethodsWe conducted a test-negative study in hospitals in Beijing. Patients admitted to five hospitals in the city were enrolled during the winter influenza seasons of 2013–14 and 2014–15. Influenza virus infections were determined by PCR, and influenza vaccination records were extracted from a centralized electronic immunization registry. Influenza VE was estimated by logistic regression adjusting for age group, sex and chronic conditions, and matched by calendar week.ResultsA total of 2368 inpatients were recruited during the study period with a vaccination coverage in the control group of 12.8%. The overall estimate of influenza VE was 46.9% (95% CI: −20.4%, 76.6%) for the 2013–14 season and 5.0% (95% CI: −53.0%, 41.0%) for the 2014–15 season. Estimates of VE were relatively higher in children aged 6–17 years than older persons across two influenza seasons while estimates of VE for both adults and elderly were relatively low.ConclusionsOur findings were consistent with expected influenza vaccination effectiveness in seasons when the vaccine matched or mismatched circulating viruses. Strategies to increase influenza vaccine coverage could provide a public health benefit.     

Epidemiology of Influenza Virus Types and Subtypes in South Africa, 2009–2012

To determine clinical and epidemiologic differences between influenza caused bydifferent virus types and subtypes, we identified patients and tested specimens.Patients were children and adults hospitalized with confirmed influenza and severeacute respiratory illness (SARI) identified through active, prospective,hospital-based surveillance from 2009–2012 in South Africa. Respiratoryspecimens were tested, typed, and subtyped for influenza virus by PCR. Of 16,005 SARIpatients tested, 1,239 (8%) were positive for influenza virus. Patient age andco-infections varied according to virus type and subtype, but disease severity didnot. Case-patients with influenza B were more likely than patients with influenza Ato be HIV infected. A higher proportion of case-patients infected during the firstwave of the 2009 influenza pandemic were 5–24 years of age (19%) than werepatients infected during the second wave (9%). Although clinical differences exist,treatment recommendations do not differ according to subtype; prevention throughvaccination is recommended.     

Caesarean section rates in South Africa: Evidence of bias among different ‘population groups’

Objective. The aim of this study was to assess the effect of ‘population group’ classification, as a specific instance of ‘racial’ categorization, on caesarean section rates in South Africa.

Design. Information on ‘population group’ classification ('Black’, ‘Coloured’, ‘Indian’ or ‘White’, as defined under apartheid legislation) and place of delivery, together with basic obstetric, sociodemographic and perinatal data, were extracted from the birth notification forms of 5456 children who made up the birth cohort of the Birth to Ten longitudinal study. This cohort included all births that occurred to mothers resident in Soweto‐Johannesburg during a 7‐week period in 1990.

Results. After accounting for differences in maternal age, gravidity, birth weight and gestational age at delivery, the rate of caesarean sections at private facilities was more than twice that at public facilities. Although there were significant differences in the utilisation of private facilities by women from different ‘population groups’, there was an independent effect of ‘population group’ classification on caesarean section rates: caesarean section rates among women classified as ‘White’ and ‘Coloured’ were significantly higher (95% confidence intervals for odds ratios: 1.40–2.42 and 1.05–1.81, respectively) than among women classified as ‘Black’.

Conclusion. ’Population group’ differences in caesarean section rates among South African women are not explained by differences in demographic risk factors for assisted delivery, nor by differences in access to private health care. Instead, the differences in section rates may reflect the effect of bias in clinical decision‐making, and/or differences among women from different ‘population groups’ in their attitude towards assisted delivery, and their capacity to negotiate with clinicians.     

Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area,South Africa, 1998–20091

We estimated deaths attributable to influenza and respiratory syncytial virus (RSV) among persons >5 years of age in South Africa during 1998–2009 by applying regression models to monthly deaths and laboratory surveillance data. Rates were expressed per 100,000 person-years. The mean annual number of seasonal influenza–associated deaths was 9,093 (rate 21.6). Persons >65 years of age and HIV-positive persons accounted for 50% (n = 4,552) and 28% (n = 2,564) of overall seasonal influenza-associated deaths, respectively. In 2009, we estimated 4,113 (rate 9.2) influenza A(H1N1)pdm09–associated deaths. The mean of annual RSV-associated deaths during the study period was 511 (rate 1.2); no RSV-associated deaths were estimated in persons >45 years of age. Our findings support the recommendation for influenza vaccination of older persons and HIV-positive persons. Surveillance for RSV should be strengthened to clarify the public health implications and severity of illness associated with RSV infection in South Africa.     

Influenza vaccines effectiveness 2013–14 through 2015–16, a test-negative study in children

BackgroundTrivalent inactivated and live attenuated influenza vaccines (IIV3 and LAIV3) have been reformulated with an extra B strain (IIV4 and LAIV4). They were licensed based on immunogenicity and their effectiveness (VE) still must be empirically tested.MethodsChildren 1–17 years tested for influenza during 2013–16 were included and their immunization status verified. They were considered vaccinated if received ≥1 dose of an influenza vaccine ≥10 days before evaluated for a respiratory episode. Age-groups were classified as 1–4 years or 5–17 years. VE was estimated by comparing vaccination status of influenza-positive versus influenza-negative cases.Results6779 children were enrolled in the three seasons. Overall, 27.2% received an influenza vaccine (87.1% IIV3 or IIV4 and 12.9% LAIV4), and 15.6% tested positive for influenza (77.9% A). IIV3 was predominantly used in 2013–14 and IIV4 in 2014–15 and 2015–16. IIV3 and IIV4 had comparable VE over the three seasons (60%, 57% and 53%) and performed similarly against influenza A and B and both age-groups. LAIV4 performed poorly for influenza A (15%, 37% and 48%) but better for influenza B (100%, 56% and 100%), especially among children 5–17 years of age with VE = 100% (95%CI: 55, 100).ConclusionsInfluenza vaccination showed modest but consistent effectiveness over the years. The switch from IIV3 to IIV4 did not affect VE. LAIV4 did not perform as well as IIVs, yet it improved over the years and was particularly good protecting older children against influenza B. These results emphasize the regional nature of influenza and the need for local surveillance.     

Legionnaires’ Disease in South Africa, 2012–2014

During June 2012–September 2014, we tested patients with severe respiratory illness for Legionella spp. infection and conducted a retrospective epidemiologic investigation. Of 1,805 patients tested, Legionella was detected in samples of 21 (1.2%); most were adults who had HIV or tuberculosis infections and were inappropriately treated for Legionella.     

The economic burden of human papillomavirus infection-associated diseases in the Republic of Korea, 2002–2015

BackgroundThis prevalence-based, cost-of-illness study estimated the health care costs of human papillomavirus (HPV) infection-associated diseases in the era before the introduction of organized HPV vaccination for 12-year-old girls in 2016, South Korea.MethodsThe claims data provided by the National Health Insurance Service was used to estimate the prevalence of HPV-associated diseases and their direct medical costs, including costs related to hospitalizations, outpatient visits, and medications.ResultsA total of 1.3 million men and women used medical services for HPV-attributed diseases between 2002 and 2015. Among women, the most common diseases attributable to HPV were cervical dysplasia (64.4%), anogenital warts (12.9%), cervical carcinoma in situ (10.7%) and cervical cancer (2.6%), whereas anogenital warts (80.6%), benign neoplasms of larynx (14.3%), and anal cancers (8.9%) were most common among men. In 2015, the healthcare cost attributable to HPV was 124.9 million US dollars (USD) representing 69.0% of the annual cost of all HPV-associated diseases. At a cost of 75.1 million USD, cervical cancer contributed the largest economic burden in 2015 followed by cervical dysplasia (19.4 million USD) and cervical carcinoma in situ (10.7 million USD). These three conditions represented 58.2% of the total annual cost of all HPV-associated diseases, while 84.2% of the total annual cost was attributable to HPV. Annual health care costs increased from 42.6 million USD in 2002 to 180.9 million USD in 2015.ConclusionThe healthcare costs associated with HPV-related diseases in Korea are substantial and increased between 2002 and 2015 mainly caused by increased number of patients. Expanding the target age for HPV vaccination of girls and introducing HPV vaccination for boys are possible ways of reducing the economic burden of HPV-associated disease and should be considered.     

Risk Factors for Severe Influenza A–Related Pneumonia in Adult Cohort,Mexico, 2013–14

During the 2013–14 influenza season, we assessed characteristics of 102 adults with suspected influenza pneumonia in a hospital in Mexico; most were unvaccinated. More comorbidities and severity of illness were found than for patients admitted during the 2009–10 influenza pandemic. Vaccination policies should focus on risk factors.     

Influenza epidemiology among hospitalized children in Stockholm,Sweden 1998–2014

BackgroundInfluenza remains a common reason for the hospitalization of children. There is a need for long term studies that are also population based. We describe the epidemiology of severe influenza in a defined population 1998–2014.MethodRetrospective study of annually collected data of virologically confirmed influenza in hospitalized children 0–17 years living in the catchment area (230,000 children). We gathered information about comorbidity and complications from case records, and compared Influenza A, B and A(H1N1)pdm09 with respect to these factors.ResultsA total of 922 children with influenza were hospitalized. The mean rate remained unchanged at 22.5–24.2 per 100,000 children per year. There were two major outbreaks: influenza A(H3N2) in 2003–2004 and the A(H1N1) pandemic in 2009–2010. The proportion of children with influenza B increased from 8% during the first half of the study period to 28% during the second half. The highest admission rate was found in children <3 months of age, 169 per 100,000. Children with influenza B were older than those with influenza A. Comorbidity was found in 34%, complications in 41%, and 11% needed intensive care management. The mortality rate was 0.17/100,000 children.ConclusionInfluenza remains an important reason for the hospitalization of children, especially during the first years of life. The increasing proportion of influenza B may have to be considered when recommending influenza vaccines.     

Epidemiology of Serotype 1 Invasive Pneumococcal Disease,South Africa, 2003–2013

In South Africa, 7-valent pneumococcal conjugate vaccine (PCV) was introduced in April 2009 and replaced with 13-valent PCV in April 2011. We describe the epidemiology of serotype 1 Streptococcus pneumoniae disease during the pre- and post-PCV eras (2003–2013). Using laboratory-based invasive pneumococcal disease (IPD) surveillance, we calculated annual incidences, identified IPD clusters, and determined serotype 1–associated factors. Of 46,483 IPD cases, 4,544 (10%) were caused by serotype 1. Two clusters of serotype 1 infection were detected during 2003–2004 and 2008–2012, but incidence decreased after 2011. Among children <5 years of age, those who had non–serotype 1 IPD had shorter hospital stays, fewer cases of penicillin-nonsusceptible disease, and lower HIV prevalence and in-hospital death rates than did those with serotype 1 IPD; similar factors were noted for older patients. Serotype 1 IPD had distinctive clinical features in South Africa, and annual incidences fluctuated, with decreases noted after the introduction of PCV13.     

Screening for infectious diseases among unaccompanied minor refugees in Berlin, 2014–2015

European Journal of Epidemiology - Infectious diseases (except tuberculosis) were screened among 1248 unaccompanied minor refugees (UMRs) arriving in Berlin in 2014–2015; 40&nbsp;%...     

Sociocultural aspects of risk to pregnant women during the 2013–2015 multinational Ebola virus outbreak in West Africa

Researchers reflect on sociocultural aspects of the Ebola outbreak in West Africa and critically analyze the epidemic's effects on pregnant mothers and their babies. We address structural inequalities contributing to poor maternal health in lower-income countries, while reflecting on how the Ebola outbreak highlights the still-marginalized role of pregnant women. Drawing on prior research in West and East Africa, we discuss health care providers’ responses to risk of infection during maternity work under normal circumstances and in times of crisis. We end with recommendations for preventing such detrimental effects on the health of pregnant women in the case of another epidemic.     

Parechovirus Genotype 3 Outbreak among Infants,New South Wales,Australia, 2013–2014

From October 2013 through February 2014, human parechovirus genotype 3 infection was identified in 183 infants in New South Wales, Australia. Of those infants, 57% were male and 95% required hospitalization. Common signs and symptoms were fever >38°C (86%), irritability (80%), tachycardia (68%), and rash (62%). Compared with affected infants in the Northern Hemisphere, infants in New South Wales were slightly older, both sexes were affected more equally, and rash occurred with considerably higher frequency. The New South Wales syndromic surveillance system, which uses near real-time emergency department and ambulance data, was useful for monitoring the outbreak. An alert distributed to clinicians reduced unnecessary hospitalization for patients with suspected sepsis.     

Inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana, 1993–2014

BackgroundWe examined the inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana using nationally representative data from the 1993-2014 Ghana Demographic and Health Surveys (GDHSs).MethodsUsing the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993–2014 GDHSs were analyzed. We disaggregated full immunization by five equity stratifiers: wealth quintile, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. Statistical significance was pegged at 95% Uncertainty Interval.ResultsFrom 1993 to 2014, full immunization was higher among children born to mothers of the richest wealth index compared with those born to mothers of the poorest wealth index. Children with highly educated mothers dominated in full immunization coverage from 1993 (86.67%; UI = 70.38, 94.68] to 2014 (79.90%; UI = 73.94, 84.78). Within the same period, children of women without education recorded the least prevalence. Full immunization coverage was high among urban children in 1993 (71.07%; UI = 63.20, 77.84) but favoured rural children in 2008 (80.09%; UI = 74.30, 84.84) and 2014 (79.50%; UI = 74.00, 84.09) compared to urban children. More females were fully immunized in 1993 (56.68%; UI = 50.32, 62.82). In 2003, 2008 and 2014, Volta region (82.29%; UI = 70.32, 90.11), Brong Ahafo (93.94%; UI = 82.00, 98.14) and Upper East (95.27%; UI = 87.35, 98.32) regions dominated in full immunization coverage respectively.ConclusionThe inequality estimates revealed significant socio-economic inequality in full immunization coverage between 1993 and 2014 in Ghana. Similarly, urban children and children of women with secondary or higher education were predominantly fully immunized. To accelerate full immunization, policy makers should consider these disparities in the implementation of policies on childhood immunization in Ghana.     

The motivations for participation in public–private partnerships for the provision of tuberculosis treatment in South Africa

Abstract

There is increasing interest in public–private partnerships (PPPs) generally, and more specifically for the provision of tuberculosis (TB) treatment, yet little is known about the motivations for such partnerships and the nature of the incentives that are required to achieve a desirable outcome of the partnerships. Using the new institutional economics approach, this study examines the motivations for participation in existing and potential models of PPPs for the provision of TB treatment in South Africa. Fourteen semi-structured interviews were conducted with private providers and government officials. Both current and potential private partners were interviewed. The study found that private providers in existing and potential partnerships appear to have both financial and non-financial motivations for participation in partnership for the provision of TB. For a partnership to be successful, in addition to sufficient motivation, the level of competition between private providers, regulatory framework, and social and political awareness becomes increasingly important.     

Mine dumps,wheeze, asthma,and rhinoconjunctivitis among adolescents in South Africa: any association?

The study investigated the association between community proximity to mine dumps, and current wheeze, rhinoconjunctivitis, and asthma among adolescents. This study was conducted during May–November 2012 around five mine dumps in South Africa. Communities in close proximity to mine dumps had an increased likelihood of current wheeze OR 1.38 (95?% CI: 1.10–1.71), rhinoconjunctivitis OR 1.54 (95?% CI: 1.29–1.82), and a protective association with asthma OR 0.29 (95?% CI: 0.23–0.35). Factors associated with health outcomes included other indoor and outdoor pollution sources. Wheeze and rhinoconjunctivitis appear to be a public health problem in these communities. The findings of this study serve as a base for further detailed epidemiological studies for communities in close proximity to the mine dumps e.g. a planned birth cohort study.