Modelling of seasonal influenza and estimation of the burden in Tunisia.

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness (ILI) per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A(H3N2) 15.5%; A(H1N1)pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza.

Epidemiology and medical cost of hospitalization due to rotavirus gastroenteritis among children under 5 years of age in the central-east of Tunisia.

Data on the economic burden of rotavirus infection in Tunisia are needed to inform the decision to include rotavirus in routine childhood immunizations. This study aimed to describe the epidemiological profile of rotavirus disease in central-east Tunisia and to estimate its hospital cost. In the first stage - the prospective collection of epidemiological data - we enrolled all patients < 5 years old who were hospitalized for acute diarrhoea at 5 university paediatric departments in central-east Tunisia during the period 2009-2011. Rotavirus was responsible for 65 (23.3%) of the 279 cases enrolled. In the second stage, cost data were collected retrospectively using an activity-based costing method from the medical records of the children who were positively diagnosed with rotavirus. The average cost of care per child was TD 433 (SD 134). This is a significant economic burden in Tunisia, where a safe and effective vaccine is available but not yet introduced to the immunization schedule.

Epidemiological and chronological profile of preterm birth in the region of Monastir (Tunisia) between 1994 and 2012.

Data about the profile and risk factors of premature births in Tunisia are scarce. The objective of this study was to describe the epidemiological profile of preterm births in Monastir, Tunisia, and to study the chronological trends of associated factors over the years 1994-2012. A population-based study was conducted using data from the regional births database on all deliveries in public maternity units. The overall prevalence of preterm births among the 161 116 deliveries in the 19-year period was 5.60% (95% CI: 5.13%-6.07%). The rate of preterm births and of adequate prenatal care increased significantly over the study period. Extremes of maternal age (≤ 19 and ≥ 35 years), having a twin pregnancy and the occurrence of complications during pregnancy were significant predictors of prematurity in the final regression model. Efforts should be made to improve the quality of health care in the region, especially for high-risk pregnancies.

Contrasting patterns of hepatitis C virus infection in two regions from Tunisia.

This report is a population-based study describing the pattern of hepatitis C virus (HCV) infection in two distinct regions in Tunisia. The study included a total of 11,507 individuals sampled in 1996 from both genders, all age groups, urban and rural settings belonging to 2,973 families. HCV infection was assessed by commercial enzyme immunoassay (EIA) and immunoblot assays and detection of HCV RNA by PCR. HCV genotypes and subtypes were determined by sequencing in the 5'-untranslated region (UTR) viral genomic region and the INNO-LiPA HCVII genotyping kit. Genetic relatedness between HCV strains was assessed by sequencing of a portion of the NS5B region. HCV prevalence was significantly higher in the North-Western region than in the Southern one: 1.7% versus 0.2% (P < 10(-3), chi(2) = 8,506). There was no difference in positivity according to gender or living in rural or urban settings; the only significant risk factor was advanced age. HCV prevalence among household contacts of HCV positives was not significantly higher than the prevalence in the whole study population. These results indicate a heterogeneity in the geographical distribution of HCV in Tunisia. An increased HCV transmission occurs in the North-Western region with large predominance of genotype 1b (88%) and low contribution of intrafamilial transmission.