Burden and epidemiology of influenza- and respiratory syncytial virus-associated severe acute respiratory illness hospitalization in Madagascar, 2011-2016.

ABSTRACT

BACKGROUND: Influenza and respiratory syncytial virus (RSV) infections are responsible for substantial global morbidity and mortality in young children and elderly individuals. Estimates of the burden of influenza- and RSV-associated hospitalization are limited in Africa. METHODS: We conducted hospital-based surveillance for laboratory-confirmed influenza- and RSV-associated severe acute respiratory illness (SARI) among patients of any age at one hospital and a retrospective review of SARI hospitalizations in five hospitals situated in Antananarivo during 2011-2016. We estimated age-specific rates (per 100 000 population) of influenza- and RSV-associated SARI hospitalizations for the Antananarivo region and then extrapolated these rates to the national level. RESULTS: Overall, the mean annual national number of influenza-associated SARI hospitalizations for all age groups was 6609 (95% CI 5381-7835-rate 30.0; 95% CI 24.4-35.6), 4468 (95% CI 3796-5102-rate 127.6; 95% CI 108.4-145.7), 2141 (95% CI 1585-2734-rate 11.6; 95% CI 8.6-14.8), and 339 (95% CI 224-459-rate 50.0; 95% CI 36.3-74.4) among individuals aged <5, ≥5, and ≥65 years, respectively. For these same age groups, the mean annual number of RSV-associated SARI hospitalizations was 11 768 (95% CI 10 553-12 997-rate 53.4; 95% CI 47.9-59.0), 11 299 (95% CI 10 350-12 214-rate 322.7; 95% CI 295.6-348.8), 469 (95% CI 203-783-rate 2.5;95% CI 1.1-4.2), and 36 (95% CI 0-84-rate 5.8; 0.0-13.5), respectively. CONCLUSION: The burden of influenza- and RSV-associated SARI hospitalization was high among children aged <5 years. These first estimates for Madagascar will enable government to make informed evidence-based decisions when allocating scarce resources and planning intervention strategies to limit the impact and spread of these viruses.