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. 2017 Jul 7;12(7):e0180890.
doi: 10.1371/journal.pone.0180890. eCollection 2017.

Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013

Gideon O Emukule  1   2 , Peter Spreeuwenberg  3 , Sandra S Chaves  1   4 , Joshua A Mott  1   4   5 , Stefano Tempia  4   6 , Godfrey Bigogo  7 , Bryan Nyawanda  7 , Amek Nyaguara  7 , Marc-Alain Widdowson  1 , Koos van der Velden  2 , John W Paget  2   3
Affiliations

Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013

Gideon O Emukule et al. PLoS One. .

Abstract

Background: Influenza and respiratory syncytial virus (RSV) associated mortality has not been well-established in tropical Africa.

Methods: We used the negative binomial regression method and the rate-difference method (i.e. deaths during low and high influenza/RSV activity months), to estimate excess mortality attributable to influenza and RSV using verbal autopsy data collected through a health and demographic surveillance system in Western Kenya, 2007-2013. Excess mortality rates were calculated for a) all-cause mortality, b) respiratory deaths (including pneumonia), c) HIV-related deaths, and d) pulmonary tuberculosis (TB) related deaths.

Results: Using the negative binomial regression method, the mean annual all-cause excess mortality rate associated with influenza and RSV was 14.1 (95% confidence interval [CI] 0.0-93.3) and 17.1 (95% CI 0.0-111.5) per 100,000 person-years (PY) respectively; and 10.5 (95% CI 0.0-28.5) and 7.3 (95% CI 0.0-27.3) per 100,000 PY for respiratory deaths, respectively. Highest mortality rates associated with influenza were among ≥50 years, particularly among persons with TB (41.6[95% CI 0.0-122.7]); and with RSV were among <5 years. Using the rate-difference method, the excess mortality rate for influenza and RSV was 44.8 (95% CI 36.8-54.4) and 19.7 (95% CI 14.7-26.5) per 100,000 PY, respectively, for all-cause deaths; and 9.6 (95% CI 6.3-14.7) and 6.6 (95% CI 3.9-11.0) per 100,000 PY, respectively, for respiratory deaths.

Conclusions: Our study shows a substantial excess mortality associated with influenza and RSV in Western Kenya, especially among children <5 years and older persons with TB, supporting recommendations for influenza vaccination and efforts to develop RSV vaccines.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Monthly percentage of influenza and respiratory syncytial virus (RSV) positive results with cut-offs for the rate-difference method.
Fig 2
Fig 2. Age-specific trends in all-causes mortality rates in Western Kenya, 2007–2013.
Fig 3
Fig 3. Excess deaths estimated using the negative binomial regression model that were associated with influenza among children aged <5 years and persons aged ≥50 years, 2007–2013.
Fig 4
Fig 4. Excess deaths estimated using the negative binomial regression model that were associated with RSV among children aged <5 years and persons aged ≥50 years, 2007–2013.
See this image and copyright information in PMC

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