Severe Acute Respiratory Illness

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Beatrix Young
5 years ago
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Acute Respiratory Illness Hospitalization in

RABARISON, MD Clinical Research Coordinator

Madagascar 6 th African Network for Influenza

1 Burden and Epidemiology of Influenzaand Respiratory Syncytial Virus-Associated Severe Acute Respiratory Illness Hospitalization in Madagascar, Hasina Joelinotahina RABARISON, MD Clinical Research Coordinator National Influenza Center Institut Pasteur de Madagascar 6 th African Network for Influenza Surveillance and Epidemiology Meeting march 19-21, 2018

Introduction Context Influenza and RSV infections are responsible for substantial global morbidity and mortality The highest burden affect mainly young children and elderly subject SARI surveillance

2 Introduction Context Influenza and RSV infections are responsible for substantial global morbidity and mortality The highest burden affect mainly young children and elderly subject SARI surveillance in Madagascar Clinical surveillance: 18 hospitals Virological surveillance: 1 hospital Among hospitalized patients, influenza=25% But no denominator available (catchment area) Objectives To estimate the national and provincial number and rate of influenza- and RSV-associated severe acute respiratory illness (SARI) hospitalization To estimate the economic burden of influenza associated SARI hospitalization 2

3 Methodology Data sources Number of SARI hospitalizations in Antananarivo Renivohitra (D1) Anonymized retrospective records review in selected hospital Inclusion of patients meeting the WHO SARI case definition Use of hospital admission books and medical records to identify patients hospitalized Data from Influenza and RSV surveillance among patients hospitalized with SARI (D2) Prospective hospital-based surveillance for SARI Inclusion of patients meeting the WHO SARI case definition Specimens were tested for influenza A and B viruses and RSV 3

4 Methodology Data sources Prevalence of risk factors for pneumonia and healthcare seeking behavior for acute respiratory infection (ARI) (D3) Data were obtained from the Madagascar DHS Population denominators (D4) Data were obtain from projections of the 1993 census data for Madagascar 4

5 Methodology Estimation of the national number and rate of influenza- and RSV-associated SARI hospitalization 5

Methodology Estimation of the economic burden of influenza associate SARI hospitalization Cost-of-illness studies Direct costs: Direct medical costs: hospitalization, pharmaceuticals and other

6 Methodology Estimation of the economic burden of influenza associate SARI hospitalization Cost-of-illness studies Direct costs: Direct medical costs: hospitalization, pharmaceuticals and other consumable costs Direct non-medical costs: transportation costs to hospital, additional food costs and extra expense for accommodation Indirect costs: value of lost production because of reduced working time Inclusion of all patients positives for Influenza during 2016 Diagram of the scope of economic burden estimation for seasonal influenza 6

7 Results National rates of influenza- and RSV-associated SARI hospitalization Mean annual Rate < Age group (in years) Influenza rates RSV rates Estimated mean annual rate of influenza- and RSV-associated SARI hospitalization, Madagascar, (per 100,000 populations) 7

8 Results National rates of influenza- and RSV-associated SARI hospitalization Influenza RSV Mean annual estimates of Influenza and RSV associated SARI hospitalization rates (per 100,000 pop) by region, among patients of any age. 8

9 Results Estimation of the economic burden of influenza associate SARI hospitalization Mean costs of influenza associate SARI hospitalization, Madagascar 2016 Economic burden estimation results Mean Lower bound Upper bound Total direct medical costs per patient (in $ USD) Total direct non medical costs per patient (in $ USD) Total indirect costs per patient (in $ USD) Economic burden (in Millions $ USD)

10 Results Discussion Discussion Estimates were substantial with those associated with RSV infection being the highest The highest SARI hospitalization rates were observed among children aged <5 years and individuals aged 65 years whereas individuals aged years experienced the lowest rates Higher rates of influenza-associated respiratory hospitalizations among young children and the elderly have been reported (Cheryl C, et al; Kyeyagalire R, et al) 10

11 Discussion Influenza-associated SARI hospitalization among children <5 years Estimated rates of influenza-associated SARI hospitalization among children <5 years in other country (per 100,000 inhabitants) Country Authors Years Estimated rates of influenza-associated SARI hospitalization South Africa Cheryl C, et al Kenya Emukule GO, et al Ghana Ntiri MP, et al Global estimates for Africa Lafond KE, et al Madagascar Our study

12 Discussion Influenza-associated SARI hospitalization among individuals >5 years Estimated rates of influenza-associated SARI hospitalization among individuals > 5 years in other country (per 100,000 inhabitants) Country Authors Years Estimated rates of influenza-associated SARI hospitalization South Africa Cheryl C, et al Kenya Emukule GO, et al Madagascar Our study

13 Results Discussion RSV-associated SARI hospitalization among children <5 years Estimated rates of RSV-associated SARI hospitalization among children<5 years in other country (per 100,000 inhabitants) Country Authors Years Estimated rates of influenza-associated SARI hospitalization South Africa Moyes J, et al ,000 Kenya Emukule GO, et al ,360 Global study of RSV Shi T, et al Madagascar Our study

14 Discussion Limitations Adjustment factors depend on the accuracy of available national data Estimates was only doing among patients hospitalized with SARI % of SARI non hospitalized unknown Hence our rates are probably under estimate Perspective Health Care Utilization Survey Proportion of SARI missed by health system Extend virological surveillance in other regions of Madagascar 14

15 Conclusion Conclusion Influenza and RSV-associated SARI hospitalization are high in children aged <5 years and the elderly Economic burden of influenza associate SARI hospitalization is very high: Prevention strategies: vaccination If a national influenza vaccination program is implemented in Madagascar, young children and the elderly should benefit from vaccine to reduce the burden of Influenza Should a RSV vaccine become available it would reduce RSV-associated hospitalization in children. 15

Acknowledgements Institut Pasteur de Madagascar Virology Unit, NIC: Jean-Michel Heraud, Norosoa Razanajatovo Unité de Réalisation des Etudes Cliniques (UREC): Aina Harimanana Ministry of Public

16 Acknowledgements Institut Pasteur de Madagascar Virology Unit, NIC: Jean-Michel Heraud, Norosoa Razanajatovo Unité de Réalisation des Etudes Cliniques (UREC): Aina Harimanana Ministry of Public Health DVSSE: Maherisoa Ratsitorahina Hospitals: (CENHOSOA, HJRB, CHUMET,CHUA, Clinique des Soeurs Ankadifotsy) US CDC (South Africa) Stefano Tempia Institut National de la Statistique Direction des Statistiques Economiques : Eric Jean-Michel Rakotomanana World Health Organization Lamina Arthur Rakotonjanabelo, Julia Fitzner Funding: WHO, CDC Hasina Joelinotahina Rabarison Clinical Research Coordinator National Influenza Center Virology Unit rjoely@pasteur.mg 16

ANISE 2018, Antananarivo, Madagascar. US Centers for Disease Control and Prevention (CDC), Co-Ag. No: U011P

ANISE 2018, Antananarivo, Madagascar. US Centers for Disease Control and Prevention (CDC), Co-Ag. No: U011P Influenza disease burden in the Greater-Accra region of Ghana, 2013-2017 Michael Ntiri, Jazmin Duque, Meredith McMorrow, Talla Nzussouo, Elijah Paa Edu-Quansah, Kwadwo Koram, William Ampofo US Centers