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. 2019 Sep 6;14(9):e0221479.
doi: 10.1371/journal.pone.0221479. eCollection 2019.

Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015

Rakhee S Palekar  1 , Melissa A Rolfes  2 , C Sofia Arriola  2 , Belsy O Acosta  3 , Patricia Alberto Guidos  4 , Xiomara Badilla Vargas  5 , Christina Bancej  6 , Juliana Barbosa Ramirez  7 , Elsa Baumeister  8 , Alfredo Bruno  9 , Maria Agüeda Cabello  10 , Jufu Chen  2   11 , Paula Couto  1 , Francisco J De Paula Junior  12 , Rodrigo Fasce  13 , Walquiria Ferreira de Almeida  12 , Victor E Fiesta Solorzano  14 , Carlos Flores Ramírez  15 , Natalia Goñi  16 , Yadira Isaza de Moltó  17 , Jenny Lara  18 , Diana C Malo  7 , José L Medina Osis  14 , Homer Mejía  19 , Lourdes Moreno Castillo  17 , Desiree Mustaquim  2 , Andrea Nwosu  6 , Jenny Ojeda  20 , Antonio Paredes Samoya  21 , Paola A Pulido  7 , Hector M Ramos Hernandez  4 , Rudvelinda Rivera Lopez  19 , Angel Rodriguez  1 , Myriam Saboui  6 , Hilda Salazar Bolanos  22 , Adrián Santoro  23 , Jose Eduardo Silvera  24 , Paulina Sosa  1 , Viviana Sotomayor  25 , Lourdes Suarez  26 , Marta Von Horoch  10 , Eduardo Azziz-Baumgartner  2
Affiliations

Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015

Rakhee S Palekar et al. PLoS One. .

Abstract

Background: Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas.

Methods: Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates.

Results: Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000).

Conclusions: Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Pooled estimates of influenza-associated hospitalization rates per 100,00 people by year and age group, 2010–2015.
Fig 2
Fig 2. Estimated annual number of influenza-associated respiratory hospitalizations by country in the Americas.
See this image and copyright information in PMC

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