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. 2023 Dec 15;18(12):e0294960.
doi: 10.1371/journal.pone.0294960. eCollection 2023.

Epidemiology and burden of Severe Acute Respiratory Infections (SARI) in the aftermath of COVID-19 pandemic: A prospective sentinel surveillance study in a Tunisian Medical ICU, 2022/2023

Mohamed Boussarsar  1   2 , Emna Ennouri  1   2 , Naima Habbachi  1 , Nabil Bouguezzi  1   2 , Khaoula Meddeb  1   2 , Salma Gallas  1   2 , Malek Hafdhi  1 , Marwa Zghidi  1   2 , Radhouane Toumi  1   2 , Imen Ben Saida  1   2 , Salma Abid  3   4 , Ilhem Boutiba-Ben Boubaker  3   4 , Latifa Maazaoui  5 , Hakim El Ghord  5 , Ahlem Gzara  5 , Rihab Yazidi  6   7   8 , Afif Ben Salah  7   9
Affiliations

Epidemiology and burden of Severe Acute Respiratory Infections (SARI) in the aftermath of COVID-19 pandemic: A prospective sentinel surveillance study in a Tunisian Medical ICU, 2022/2023

Mohamed Boussarsar et al. PLoS One. .

Abstract

Background: Severe Acute Respiratory Infections (SARI) caused by influenza and other respiratory viruses pose significant global health challenges, and the COVID-19 pandemic has further strained healthcare systems. As the focus shifts from the pandemic to other respiratory infections, assessing the epidemiology and burden of SARI is crucial for healthcare planning and resource allocation. Aim: to understand the impact of the post-pandemic period on the epidemiology of SARI cases, clinical outcomes, and healthcare resource utilization in Tunisia.

Methods: This is a prospective study conducted in a Tunisian MICU part of a national sentinel surveillance system, focusing on enhanced SARI surveillance. SARI cases from week 39/2022, 26 September to week 19/2023, 13 May were included, according to a standardized case definition. Samples were collected for virological RT-PCR testing, and an electronic system ensured standardized and accurate data collection. Descriptive statistics were performed to assess epidemiology, trends, and outcomes of SARI cases, and univariate/multivariate analyses to assess factors associated with mortality.

Results: Among 312 MICU patients, 164 SARI cases were identified during the study period. 64(39%) RT-PCR were returned positive for at least one pathogen, with influenza A and B strains accounting for 20.7% of cases at the early stages of the influenza season. The MICU experienced a significant peak in admissions during weeks 1-11/2023, leading to resource mobilization and the creation of a surge unit. SARI cases utilized 1664/3120 of the MICU-stay days and required 1157 mechanical ventilation days. The overall mortality rate among SARI cases was 22.6%. Age, non-COPD, and ARDS were identified as independent predictors of mortality.

Conclusions: The present study identified a relatively high rate of SARI cases, with 39% positivity for at least one respiratory virus, with influenza A and B strains occurring predominantly during the early stages of the influenza season. The findings shed light on the considerable resource utilization and mortality associated with these infections, underscoring the urgency for proactive management and efficient resource allocation strategies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of SARI cases and trends of identified viruses using RT-PCR from week 39/2022 to week 19/2023 in the Medical Intensive Care Unit (MICU) of Farhat Hached University Hospital.
Fig 2
Fig 2. Weekly trends of MICU admissions and SARI cases from week 25/2022 to week 25/2023.
See this image and copyright information in PMC

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