Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries

J Infect Dis. 2015 Sep 15;212(6):853-60. doi: 10.1093/infdis/jiv100. Epub 2015 Feb 23.

Abstract

Background: Data on causes of death due to respiratory illness in Africa are limited.

Methods: From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)-associated deaths identified from influenza surveillance during 2009-2012.

Results: Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%-25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%-5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus-negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0-4 years, 462 (43.1%) involved people aged 5-49 years, and 209 (19.5%) involved people aged ≥50 years.

Conclusions: Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.

Keywords: Africa South of the Sahara; influenza, human; mortality.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Age Distribution
  • Aged
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology
  • Bacterial Infections / mortality
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Influenza, Human / epidemiology
  • Influenza, Human / mortality*
  • Influenza, Human / virology*
  • Middle Aged
  • Population Surveillance
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / mortality*
  • Respiratory Tract Infections / virology*
  • Young Adult