Estimating the national burden of hospitalizations for influenza-associated severe acute respiratory infection in the Lao People’s Democratic Republic, 2016
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 People’s 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 <5 years (219; 95% CI: 198–241) and persons aged >=65 years (106; 95% CI: 91–121).
Discussion: Our findings have identified age groups at higher risk for influenza-associated SARI hospitalization, which will support policy decisions for influenza prevention and control strategies, including for vaccination. Further work is needed to estimate the burdens of outpatient influenza and influenza in specific high-risk subpopulations.
GBD 2017 Influenza Collaborators. Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017. Lancet Respir Med.2019 Jan;7(1):69-89. doi: 10.1016/S2213-2600(18)30496-X.
Iuliano, AD, Roguski, KM, Chang, HH et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2017; (published online Dec 13.)
Lee VJ. Ho JZM, Goh EH, et. al. Advances in measuring influenza burden of disease. Influenza Other Respi Viruses. 2018;12:3–9.
Khamphaphongphane B, Ketmayoon P, Lewis H, Phonekeo D, Sisouk T, Xayadeth S, et al. Epidemiological and virological characteristics of seasonal and pandemic influenza in Lao PDR, 2008–2010. Influenza Other Respi Viruses. 2013;7(3):304–11.
Phengxay M, Mirza S, Reyburn R, Xeuatvongsa A, Winter C, Lewis H, et al. Introducing seasonal influenza vaccine in low‐income countries: an adverse events following immunization survey in the Lao People’s Democratic Republic. Influenza Other Respi Viruses. 2015;9(2):94–8.
World Health Organization. A manual for estimating disease burden associated with seasonal influenza [Internet]. Geneva; 2015. Available from: http://apps.who.int/iris/bitstream/10665/178801/1/9789241549301_eng.pdf
WHO Global Technical Consultation: global standards and tools for influenza surveillance. Geneva: World Health Organization; 2011. Available from: http://apps.who.int/iris/bitstream/10665/70724/1/WHO_HSE_GIP_2011.1_ eng.pdf [cited June 30 2019].
Results of Population and Housing Census 2015. Available at: https://www.lsb.gov.la/pdf/PHC-ENG-FNAL-WEB.pdf [cited on 2 February 2018]
Lafond K, Nair H, Rasooly M, Valente F, Booy R, Rahman M, et al. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982-2012: A Systematic Analysis. PLoS Med / Public Libr Sci. 2016;13(3):e1001977.
Ieng, V., Tolosa, M.X., Tek, B., Sar, B., Sim, K., Seng, H., Thyl, M., Dara, C., Moniborin, M., Stewart, R.J. and Bell, L.C., 2018. National burden of influenza-associated hospitalizations in Cambodia, 2015 and 2016. Western Pacific Surveillance and Reponse, 2018; 9.
Yoshida L, Suzuki M, Yamamoto T, Nguyen H, Nguyen C, Nguyen A, et al. Viral pathogens associated with acute respiratory infections in central vietnamese children. Pediatr Infect Dis J. 2010;29(1):75–7.
Bresee, J.S., Lafond, K.E., McCarron, M., Azziz-Baumgartner, E., Chu, S.Y., Ebama, M., Hinman, A.R., Xeuatvongsa, A., Bino, S., Richardson, D. and Porter, R.M., 2019. The partnership for influenza vaccine introduction (PIVI): Supporting influenza vaccine program development in low and middle-income countries through public-private partnerships. Vaccine, 37(35), pp.5089-5095.
Xeuatvongsa A, Mott JA, Khanthamaly V, Patthammavong C, Phounphenghak K, McKinlay M, Mirza S, Lafond KE, McCarron M, Corwin A, Moen A, Olsen SJ. and Bresee JS. Progress toward sustainable influenza vaccination in the Lao Peoples' Democratic Republic, 2012–2018. Vaccine. 2019;37:3002-3005
Marcone, D.N., Durand, L.O., Azziz-Baumgartner, E., Vidaurreta, S., Ekstrom, J., Carballal, G. and Echavarria, M., 2015. Incidence of viral respiratory infections in a prospective cohort of outpatient and hospitalized children aged≤ 5 years and its associated cost in Buenos Aires, Argentina. BMC infectious diseases, 15(1), p.447.
Hirve S, Chadha M, Lele P, et al. Performance of case definitions used for influenza surveillance among hospitalized patients in a rural area of India. Bulletin of the World Health Organization 2012; 90(11): 804-12.
Gordon, A. and Reingold, A., 2018. The burden of influenza: a complex problem. Current epidemiology reports, 5(1), pp.1-9.
Bochaton A, Xayaseng V, Noy C. Health Seeking Behaviour ( HSB ) in Thailand : the case of the patients living in Vientiane. 2007. Available from: https://www.researchgate.net/publication/301892443_Health_Seeking_Behaviour_HSB_in_Thailand_the_case_of_the_patients_living_in_Vientiane [cited 4 April 2018].
Charoenmukayananya S, Sriratanaban J, Hengpraprom S, Trarathep C. Factors influencing decisions of Laotian patients to use health care services in Thailand. Asian Biomed. 2014;8(5):665–71.
© World Health Organization (WHO) 2018. Some rights reserved.
The articles in this publication are published by the World Health Organization and contain contributions by individual authors. The articles are available under the Creative Commons Attribution 3.0 IGO license (CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. In any use of these articles, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted.
Please cite the articles as follows: [Author names]. [Article title]. Western Pac Surveill Response J. [Year]; [Volume] ([Issue]). [doi number] [pmid number]
For example, Hoy D, Saketa ST, Maraka RR, Sio A, Wanyeki I, Frison P, et al. Enhanced syndromic surveillance for mass gatherings in the Pacific: a case study of the 11th Festival of Pacific Arts in Solomon Islands, 2012. Western Pac Surveill Response J. 2016;7:3. doi:10.5365/wpsar.2016.7.1.004 pmid:27766181
License: Creative Commons BY 3.0 IGO
The World Health Organization does not necessarily own each component of the content contained within these articles and does not therefore warrant that the use of any third-party-owned individual component or part contained in the articles will not infringe on the rights of those third parties. The risk of claims resulting from such infringement rests solely with you. If you wish to re-use a component of the articles attributed to a third party, it is your responsibility to determine whether permission is needed for that re-use and to obtain permission from the copyright owner. Examples of components can include, but are not limited to, tables, figures or images.
Any mediation relating to disputes arising under this license shall be conducted in accordance with the WIPO Mediation Rules (www.wipo.int/amc/en/mediation/rules). Any inquiries should be addressed to firstname.lastname@example.org.
License to publish
Western Pacific Surveillance and Response is an open access journal and requires each author of a contribution to grant the World Health Organization (the Publisher) a non-exclusive, worldwide, royalty-free license under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode) for the term of copyright and any extensions thereof. This includes to publish, re-publish, transmit, sell, distribute and otherwise use the article in the Journal, in whole or as a part. This is done by signing the WPSAR License to publish form.
The designations employed and the presentation of the information on this website do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
Links to third-party websites
The World Health Organization does not warrant that the information contained on the website is complete and correct and shall not be liable whatsoever for any damages incurred as a result of its use.