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. 2017 Oct 16;65(9):1532-1541.
doi: 10.1093/cid/cix565.

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

Yeny O Tinoco  1   2 , Eduardo Azziz-Baumgartner  3 , Timothy M Uyeki  3 , Hugo R Rázuri  1 , Matthew R Kasper  1 , Candice Romero  1 , Maria E Silva  1 , Mark P Simons  1 , Giselle M Soto  1 , Marc-Alain Widdowson  3 , Robert H Gilman  2 , Daniel G Bausch  1   4 , Joel M Montgomery  1   5 ; Peru Influenza Cohorts Working Group
Collaborators, Affiliations

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

Yeny O Tinoco et al. Clin Infect Dis. .

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.

Keywords: community cohort; healthcare-seeking behavior; household-based; influenza; seasonality.

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Figures

Figure 1.
Figure 1.
Map of Peru showing ecological regions and sites for the Peru Influenza Cohort Study, 2009–2015.
Figure 2.
Figure 2.
Laboratory-confirmed influenza incidence per 1000 person-months by virus type and subtype and percentage of positives for influenza A and B, Peru Influenza Cohort Study, 2009–2015. Abbreviation: ILI, influenza-like illness.
Figure 3.
Figure 3.
Predicted influenza activity in the Peru Influenza Cohorts. The red portion of each data line indicates the seasonal epidemic period; light red line is the median (June 2011 through July 2015 for Lima, Cuzco, and Puerto Maldonado and June 2011 through July 2014 for Tumbes).
See this image and copyright information in PMC

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