Estimating influenza outpatients' and inpatients' incidences from 2009 to 2011 in a tropical urban setting in the Philippines

Abstract

Objectives: Although the public health significance of influenza in regions with a temperate climate has been widely recognized, information on influenza burden in tropical countries, including the Philippines, remains limited. We aimed to estimate influenza incidence rates for both outpatients and inpatients then characterized their demographic features.

Design: An enhanced surveillance was performed from January 2009 to December 2011 in an urbanized highland city. The influenza-like illness (ILI) surveillance involved all city health centers and an outpatient department of a tertiary government hospital. The severe acute respiratory infection (sARI) surveillance was also conducted with one government and four private hospitals since April 2009. Nasal and/or oropharyngeal swabs were collected and tested for influenza A, influenza B, and respiratory syncytial virus.

Results and conclusions: We obtained 5915 specimens from 13 002 ILI cases and 2656 specimens from 10 726 sARI cases throughout the study period. We observed year-round influenza activity with two possible peaks each year. The overall influenza detection rate was 23% in the ILI surveillance and 9% in the sARI surveillance. The mean annual outpatient incidence rate of influenza was 5·4 per 1000 individuals [95% confidence interval (CI), 1·83-12·7], and the mean annual incidence of influenza-associated sARI was 1·0 per 1000 individuals (95% CI, 0·03-5·57). The highest incidence rates were observed among children aged <5 years, particularly those aged 6-23 months. Influenza posed a certain disease burden among inpatients and outpatients, particularly children aged <5 years, in an urbanized tropical city of the Philippines.

Keywords: Disease burden; Philippines; influenza; influenza-like illness; severe acute respiratory infection.

Figure 1

Location map of Baguio city in the Philippines (A). Participating health centers and hospitals in Baguio city (B). The filled circles indicate 16 city health centers, the filled triangles indicate hospitals, and the diamonds indicate hospitals covering both ILI and sARI surveillance. ILI, influenza-like illness; sARI, severe acute respiratory infection.

Figure 2

The number of patients with ILI whose specimens were obtained and the total number of patients with ILI in health centers by epidemiological week (A). The weekly number of positive cases for each targeted virus, with the percentage of positive influenza cases (B) in Baguio City from January 2009 to December 2011. ILI, influenza-like illness.

Figure 3

The number of patients with sARI whose specimens were obtained and the total number of patients with sARI in hospitals by morbidity week (A). The weekly number of positive cases for each targeted virus, with the percentage of positive influenza cases (B) in Baguio City from April 2009 to December 2011. sARI, severe acute respiratory infection.