Literature review of the epidemiology of influenza B disease in 15 countries in the Asia-Pacific region

Abstract

Influenza control strategies focus on the use of trivalent influenza vaccines containing two influenza A virus subtypes and one of the two circulating influenza type B lineages (Yamagata or Victoria). Mismatches between the vaccine B lineage and the circulating lineage have been regularly documented in many countries, including those in the Asia-Pacific region. We conducted a literature review with the aim of understanding the relative circulation of influenza B viruses in Asia-Pacific countries. PubMed and Western Pacific Region Index Medicus were searched for relevant articles on influenza type B published since 1990 in English language for 15 Asia-Pacific countries. Gray literature was also accessed. From 4834 articles identified, 121 full-text articles were analyzed. Influenza was reported as an important cause of morbidity in the Asia-Pacific region, affecting all age groups. In all 15 countries, influenza B was identified and associated with between 0% and 92% of laboratory-confirmed influenza cases in any one season/year. Influenza type B appeared to cause more illness in children aged between 1 and 10 years than in other age groups. Epidemiological data for the two circulating influenza type B lineages remain limited in several countries in the Asia-Pacific, although the co-circulation of both lineages was seen in countries where strain surveillance data were available. Mismatches between circulating B lineages and vaccine strains were observed in all countries with available data. The data suggest that a shift from trivalent to quadrivalent seasonal influenza vaccines could provide additional benefits by providing broader protection.

Keywords: Asia-Pacific; epidemiology; influenza B; literature review; seasonality; vaccine mismatch.

Figure 1

Countries included in the review according to climate. Northern Hemisphere: temperate = dark blue, subtropical = light blue, subtropical to tropical = yellow, tropical = orange. Southern Hemisphere: tropical = red, temperate = green

Figure 2

Article selection procedure. WPRIM: Western Pacific Region Index Medicus. Other includes studies with sample size <30, same data (or better quality data) provided in other articles, article in Korean language