Burden of influenza among hospitalized febrile children in Ghana

Influenza Other Respir Viruses. 2017 Nov;11(6):497-501. doi: 10.1111/irv.12507. Epub 2017 Oct 27.

Abstract

Background: Influenza surveillance data from Africa indicate a substantial disease burden with high mortality. However, local influenza data from district hospitals with limited laboratory facilities are still scarce.

Objectives: To identify the frequency and seasonal distribution of influenza among hospitalized febrile children in a rural hospital in Ghana and to describe differential diagnoses to other severe febrile infections.

Methods: Between January 2014 and April 2015, all children with a temperature of ≥38°C admitted to a district hospital in Ghana were screened for influenza A and B by RT-PCR and differentiated to subtypes A(H1N1)pdm09 and A(H3N2). Malaria microscopy and blood cultures were performed for each patient.

Results: A total of 1063 children with a median age of 2 years (IQR: 1-4 years) were recruited. Of those, 271 (21%) were classified as severe acute respiratory infection (SARI) and 47 (4%) were positive for influenza, namely 26 (55%) influenza B, 15 (32%) A(H1N1)pdm09, and 6 (13%) A(H3N2) cases. Influenza predominantly occurred in children aged 3-5 years and was more frequently detected in the major rainy season (OR = 2.9; 95% CI: 1.47-6.19) during the first half of the year. Two (4%) and seven (15%) influenza-positive children were co-diagnosed with an invasive bloodstream infection or malaria, respectively.

Conclusion: Influenza contributes substantially to the burden of hospitalized febrile children in Ghana being strongly dependent on age and corresponds with the major rainy season during the first half-year.

Keywords: Africa; bacteremia; children; fever; influenza; malaria.

MeSH terms

  • Bacteremia / diagnosis
  • Bacteremia / epidemiology
  • Betainfluenzavirus / genetics
  • Betainfluenzavirus / isolation & purification
  • Child, Hospitalized / statistics & numerical data*
  • Child, Preschool
  • Coinfection / diagnosis
  • Coinfection / epidemiology
  • Coinfection / microbiology
  • Coinfection / parasitology
  • Cost of Illness*
  • Female
  • Fever / epidemiology*
  • Fever / virology
  • Ghana / epidemiology
  • Humans
  • Infant
  • Influenza A Virus, H1N1 Subtype / genetics
  • Influenza A Virus, H1N1 Subtype / isolation & purification
  • Influenza A Virus, H3N2 Subtype / genetics
  • Influenza A Virus, H3N2 Subtype / isolation & purification
  • Influenza, Human / complications
  • Influenza, Human / diagnosis
  • Influenza, Human / epidemiology*
  • Influenza, Human / virology
  • Malaria / diagnosis
  • Malaria / epidemiology
  • Male
  • Polymerase Chain Reaction
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / virology
  • Seasons