Prevalence and factors influencing the distribution of influenza viruses in Kenya: Seven-year hospital-based surveillance of influenza-like illness (2007-2013)

Abstract

Background: Influenza viruses remain a global threat with the potential to trigger outbreaks and pandemics. Globally, seasonal influenza viruses' mortality range from 291 243-645 832 annually, of which 17% occurs in Sub-Saharan Africa. We sought to estimate the overall prevalence of influenza infections in Kenya, identifying factors influencing the distribution of these infections, and describe trends in occurrence from 2007 to 2013.

Methods: Surveillance was conducted at eight district hospital sites countrywide. Participants who met the case definition for influenza-like illness were enrolled in the surveillance program. The nasopharyngeal specimens were collected from all participants. We tested all specimens for influenza viruses with quantitative reverse transcriptase real-time polymerase chain reaction (RT-qPCR) assay. Bivariate and multivariate log-binomial regression was performed with a statistically significant level of p<0.005. An administrative map of Kenya was used to locate the geographical distribution of surveillance sites in counties. We visualized the monthly trend of influenza viruses with a graph and chart using exponential smoothing at a damping factor of 0.5 over the study period (2007-2013).

Results: A total of 17446 participants enrolled in the program. The overall prevalence of influenza viruses was 19% (n = 3230), of which 76% (n = 2449) were type A, 21% (n = 669) type B and 3% (n = 112) A/ B coinfection. Of those with type A, 59% (n = 1451) were not subtyped. Seasonal influenza A/H3N2 was found in 48% (n = 475), influenza A/H1N1/pdm 2009 in 43% (n = 434), and seasonal influenza A/ H1N1 in 9% (n = 88) participants. Both genders were represented, whereas a large proportion of participants 55% were ≤1year age. Influenza prevalence was high, 2 times more in other age categories compared to ≤1year age. Category of occupation other than children and school attendees had a high prevalence of influenza virus (p< <0.001). The monthly trends of influenza viruses' positivity showed no seasonal pattern. Influenza types A and B co-circulated throughout the annual calendar during seven years of the surveillance.

Conclusions: Influenza viruses circulate year-round and occur among children as well as the adult population in Kenya. Occupational and school-based settings showed a higher prevalence of influenza viruses. There were no regular seasonal patterns for influenza viruses.

Fig 1. Influenza and other respiratory viruses program surveillance sites.

Fig 2. Clinical characteristics of the study participants with influenza-like illness (ILI).

*Missing values >10%.

Fig 3

a. Influenza viruses monthly trends by Influenza-like Illness (ILI) surveillance program, Kenya. b. Influenza virus A subtypes monthly trends by Influenza-like Illness (ILI) surveillance program, Kenya.