Research Article: Influenza in Outpatient ILI Case-Patients in National Hospital-Based Surveillance, Bangladesh, 2007–2008

Date Published: December 29, 2009

Publisher: Public Library of Science

Author(s): Rashid Uz Zaman, A. S. M. Alamgir, Mustafizur Rahman, Eduardo Azziz-Baumgartner, Emily S. Gurley, M. Abu Yushuf Sharker, W. Abdullah Brooks, Tasnim Azim, Alicia M. Fry, Stephen Lindstrom, Larisa V. Gubareva, Xiyan Xu, Rebecca J. Garten, M. Jahangir Hossain, Salah Uddin Khan, Labib Imran Faruque, Syeda Shegufta Ameer, Alexander I. Klimov, Mahmudur Rahman, Stephen P. Luby, Shabir Ahmed Madhi.

Abstract: Recent population-based estimates in a Dhaka low-income community suggest that influenza was prevalent among children. To explore the epidemiology and seasonality of influenza throughout the country and among all age groups, we established nationally representative hospital-based surveillance necessary to guide influenza prevention and control efforts.

Partial Text: Influenza is a major public health concern, annually infecting 5–15% of the global population, resulting in an estimated 250,000 to 500,000 deaths per year [1], [2]. In the United States the proportion of the population infected with influenza ranges between 5–20% resulting in an average of 36,000 annual deaths [3], [4]. The number of deaths in the United States related to these annual influenza epidemics during 1974–1994 was many times greater than the number of deaths caused by the 1957 and 1968 influenza pandemics [5]. The prevalence and burden of influenza are well described for the temperate countries in both the northern and southern hemispheres [4]–[13]. In those countries the seasonal peaks of influenza occur distinctly during the cold seasons [2], [12], [14]–[17]. Typically, elderly people and children aged under 5 years have the highest influenza morbidity and mortality and vaccination campaigns target these groups [2], [6], [7], [18].

This surveillance data confirms that influenza is prevalent throughout Bangladesh, affects all age groups, and causes considerable morbidity. These data are in agreement with recently published papers from El Salvador, Kenya, Thailand and India that also demonstrated prevalent seasonal influenza epidemics in the tropics [21], [22], [24]–[26]. Our findings strengthen the data highlighting seasonal influenza as a global contributor to respiratory disease burden and it is important to include tropical countries in global influenza prevention activities. The unimodal and distinct seasonality of human influenza in Bangladesh provides an opportunity to explore measures to prevent influenza by non-pharmaceutical interventions, such as annual handwashing campaign, respiratory hygiene campaigns and pharmaceutical interventions, such as vaccination, which is not yet introduced in Bangladesh.



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