Search

OBJECTIVE: Estimates of the burden of influenza are needed to inform prevention and control activities for seasonal influenza, including to support the development of appropriate vaccination policies. We used sentinel surveillance data on severe acute respiratory infection (SARI) to estimate the burden of influenza-associated hospitalizations in the Lao Peoples Democratic Republic. METHODS: Using methods developed by the World Health Organization, we combined data from hospital logbook reviews with epidemiological and virological data from influenza surveillance from 1 January to 31 December 2016 in defined catchment areas for two sentinel sites (Champasack and Luang Prabang provincial hospitals) to derive population-based estimates of influenza-associated SARI hospitalization rates. Hospitalization rates by age group were then applied to national age-specific population estimates using 2015 census data. RESULTS: We estimated the overall influenza-associated SARI hospitalization rate to be 48/100 000 population (95% confidence interval [CI]: 44-51) or 3097 admissions (95% CI: 2881-3313). SARI hospitalization rates were estimated to be as low as 40/100 000 population (95% CI: 37-43) and as high as 92/100 000 population (95% CI: 87-98) after accounting for SARI patient underascertainment in hospital logbooks. Influenza-associated SARI hospitalization rates were highest in children aged

Background: Global estimates showed an estimate of up to 650,000 seasonal influenza‐associated respiratory deaths annually. However, the mortality rate of seasonal influenza is unknown for most countries in the WHO Eastern Mediterranean Region, including Iran. We aimed to estimate the excess mortality attributable to seasonal influenza in Kerman province, southeast Iran for the influenza seasons 2006/2007–2011/2012. Methods: We applied a Serfling model to the weekly total pneumonia and influenza (PI) mortality rate during winter to define the epidemic periods and to the weekly age‐specific PI, respiratory, circulatory, and all‐cause deaths during non‐epidemic periods to estimate baseline mortality. The excess mortality was calculated as the difference between observed and predicted mortality. Country estimates were obtained by multiplying the estimated annual excess death rates by the populations of Iran. Results: We estimated an annual average excess of 40 PI, 100 respiratory, 94 circulatory, and 306 all‐cause deaths attributable to seasonal influenza in Kerman; corresponding to annual rates of 1.4 (95% confidence interval [CI] 1.1–1.8) PI, 3.6 (95% CI 2.6–4.8) respiratory, 3.4 (95% CI 2.1–5.2) circulatory, and 11.0 (95% CI 7.3–15.6) all‐cause deaths per 100,000 population. Adults ≥75 years accounted for 56% and 53% of all excess respiratory and circulatory deaths, respectively. At country level, we would expect an annual of 1119 PI to 8792 all‐cause deaths attributable to seasonal influenza. Conclusions: Our findings help to define the mortality burden of seasonal influenza, most of which affects adults aged ≥75 years. This study supports influenza prevention and vaccination programs in older adults. [ABSTRACT FROM AUTHOR]

August Strindberg's Inferno, pivotal work in the author's production, narrates the mental and existential crisis of its protagonist, A. S., supposedly the author's alter ego. Most of the narrative is set in Paris, in the streets and cafés of the city, in hotel rooms, a hospital dormitory, and the laboratories of the Sorbonne. In the experience of the protagonist, these spaces are perceived as oppressive and ultimately punitive, authentic places of confinement. In this contribution, I contend that Paris in its entirety (not only the abovementioned spaces) turns out to be a fragmented and multiform reality that, at the same time, is experienced as chaotic and suffocating. In his depiction of Paris at the end of the 19th century, Strindberg, drawing on Baudelaire's poems, observes and describes the city as a nightmarish place. Strindberg's Paris, therefore, functions as a surreal scenario for the individual crisis of the protagonist. Moreover, the city turns out to be a mythical space, charged with a strong symbolic significance. Finally, as the prototype of the modern metropolis, it is the ideal target of Strindberg's polemic against any optimistic idea of progress. [ABSTRACT FROM AUTHOR]

Background: No estimates of influenza‐associated mortality exist for India. Objective: To evaluate national mortality and viral surveillance data from India for assessing their appropriateness in estimating influenza‐associated mortality using varied analytic approaches. Methods: We reviewed influenza virus surveillance data from a national influenza surveillance network. We also reviewed national mortality data from Civil Registration System (CRS), Medical Certification of Cause of Death (MCCD) and the Sample Registration System (SRS). We compared and scored the different sources of mortality data using specific criteria, including the process of cause of death assignment, sample size, proportion of ill‐defined deaths, representativeness and availability of time series data. Each of these 5 parameters was scored on a scale from 1 to 5. To evaluate how to generate an influenza‐associated mortality estimate for India, we also reviewed 4 methodologic approaches to assess the appropriateness of their assumptions and requirements for these data sets. Results: The influenza virus surveillance data included year‐round sample testing for influenza virus and was found to be suitable for influenza mortality estimation modelling. Based on scoring for the 5 mortality data criteria, the SRS data had the highest score with 20 of 25 possible score, whereas MCCD and CRS scored 16 and 12, respectively. The SRS which used verbal autopsy survey methods was determined to be nationally representative and thus adequate for estimating influenza‐associated mortality. Evaluation of the modelling methods demonstrated that Poisson regression, risk difference and mortality multiplier methods could be applied to the Indian setting. Conclusion: Despite significant challenges, it is possible to estimate influenza‐associated mortality in India. [ABSTRACT FROM AUTHOR]

Background: Data about influenza mortality burden in northern China are limited. This study estimated mortality burden in Beijing associated with seasonal influenza from 2007 to 2013 and the 2009 H1N1 pandemic. Methods: We estimated influenza‐associated excess mortality by fitting a negative binomial model using weekly mortality data as the outcome of interest with the percent of influenza‐positive samples by type/subtype as predictor variables. Results: From 2007 to 2013, an average of 2375 (CI 1002‐8688) deaths was attributed to influenza per season, accounting for 3% of all deaths. Overall, 81% of the deaths attributed to influenza occurred in adults aged ≥65 years, and the influenza‐associated mortality rate in this age group was higher than the rate among those aged <65 years (113.6 [CI 49.5‐397.4] versus 4.4 [CI 1.7‐18.6] per 100 000, P < .05). The mortality rate associated with the 2009 H1N1 pandemic in 2009/2010 was comparable to that of seasonal influenza during the seasonal years (19.9 [CI 10.4‐33.1] vs 17.2 [CI 7.2‐67.5] per 100 000). People aged <65 years represented a greater proportion of all deaths during the influenza A(H1N1)pdm09 pandemic period than during the seasonal epidemics (27.0% vs 17.7%, P < .05). Conclusions: Influenza is an important contributor to mortality in Beijing, especially among those aged ≥65 years. These results support current policies to give priority to older adults for seasonal influenza vaccination and help to define the populations at highest risk for death that could be targeted for pandemic influenza vaccination. [ABSTRACT FROM AUTHOR]