Patterns of influenza B circulation in Latin America and the Caribbean, 2010-2017

Abstract

Objective: There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in Latin America and the Caribbean (LAC) and most countries have a vaccine policy that includes the use of the trivalent influenza vaccine. We analyzed influenza surveillance data to inform decision-making in LAC about prevention strategies, such as the use of the quadrivalent influenza vaccine.

Methods: There are a total of 28 reference laboratories and National Influenza Centers in LAC that conduct influenza virologic surveillance according to global standards, and on a weekly basis upload their surveillance data to the open-access World Health Organization (WHO) platform FluNet. These data include the number of specimens tested for influenza and the number of specimens positive for influenza by type, subtype and lineage, all by the epidemiologic week of specimen collection. We invited these laboratories to provide additional epidemiologic data about the hospitalized influenza B cases. We conducted descriptive analyses of patterns of influenza circulation and characteristics of hospitalized cases. We compared the predominant B lineage each season to the lineage in the vaccine applied, to determine vaccine mismatch. A Chi-square and Wilcoxan statistic were used to assess the statistical significance of differences in proportions and medians at the P<0.05 level.

Findings: During 2010-2017, the annual number of influenza B cases in LAC was ~4500 to 7000 cases. Since 2011, among the LAC-laboratories reporting influenza B lineage using molecular methods, both B/Victoria and B/Yamagata were detected annually. Among the hospitalized influenza B cases, there were statistically significant differences observed between B/Victoria and B/Yamagata cases when comparing age and the proportion with underlying co-morbid conditions and with history of oseltamivir treatment (P<0.001). The proportion deceased among B/Victoria and B/Yamagata hospitalized cases did not differ significantly. When comparing the predominant influenza B lineage detected, as part of surveillance activities during 63 seasons among 19 countries, to the lineage of the influenza B virus included in the trivalent influenza vaccine used during that season, there was a vaccine mismatch noted during 32% of the seasons analyzed.

Conclusions: Influenza B is important in LAC with both B/Victoria and B/Yamagata circulating annually in all sub regions. During approximately one-third of the seasons, an influenza B vaccine mismatch was identified. Further analyses are needed to better characterize the medical and economic burden of each influenza B lineage, to examine the potential cross-protection of one vaccine lineage against the other circulating virus lineage, and to determine the potential impact and cost-effectiveness of using the quadrivalent vaccine rather than the trivalent influenza vaccine.

Fig 1. Distribution of Influenza Cases in Latin America and the Caribbean, 2010–2017.

*Latin America and the Caribbean: Anguilla,Argentina, Aruba, Barbados, Belize, Bermuda, Bolivia (Plurinational State of), Brazil, Cayman Islands, CARPHA, Costa Rica, Colombia, Chile, Dominica, Dominican Republic, Ecuador, El Salvador, French, Guiana, Guatemala, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Suriname, Trinidad and Tobago, Uruguay and Venezuela (Bolivarian Republic of).

Fig 2. Percent Positivity for Influenza A and B in Latin America and the Caribbean, 2010–2017.

*Central American sub-region: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama Caribbean sub-region:: Anguilla, Aruba, Barbados, Belize, Bermuda, CARPHA, Cayman Islands, Dominica, Dominican Republic, French Guiana, Haiti, Jamaica, Martinique, Saint Lucia, Suriname and Trinidad and Tobago. Andean sub-region: Bolivia (Plurinational State of), Colombia, Ecuador, Peru, and Venezuela (Bolivarian Republic of) Southern Cone sub-region: Argentina, Brazil, Chile, Paraguay, and Uruguay.

Fig 3. Distribution of influenza B cases among selected Countries in Latin America and the Caribbean, 2010–2017.

*Data source Flu Net: Anguilla, Aruba, Barbados, Belize, Bermuda, Cayman Islands, Chile, Cuba, CARPHA, Dominica, Dominican Republic, Ecuador, French Guiana, Guatemala, Haiti, Honduras, Jamaica, Martinique, Nicaragua, Panama, Peru, Saint Lucia, Suriname, Trinidad and Tobago, Uruguay, Venezuela; Data source FluNet plus additional lineage data: Argentina, Brazil (states of Distrito Federal, Goias, Mato Grosso, Mato Grosso do Sui, Piaui, Rondonia, Sao Paulo, Tocantins), Colombia, Costa Rica, El Salvador, Mexico, Paraguay.

Fig 4. Comparison of influenza B lineage predominance and B lineage included in trivalent influenza vaccine used—Latin America and the Caribbean, 2010–2017.

*Data from Brazil are from the states of: Distrito Federal, Goias, Mato Grosso, Mato Grosso do Sui, Piaui, Rondonia, Sao Paulo, Tocantins.