title: Estimating influenza outpatients' and inpatients' incidences from 2009 to 2011 in a tropical urban setting in the Philippines.
abstract: OBJECTIVE
  Although the public health significance of influenza in regions with a temperate climate has been widely recognized, information on influenza burden in tropical countries, including the Philippines, remains limited. We aimed to estimate influenza incidence rates for both outpatients and inpatients then characterized their demographic features.
  
  
  METHODS
  An enhanced surveillance was performed from January 2009 to December 2011 in an urbanized highland city. The influenza-like illness (ILI) surveillance involved all city health centers and an outpatient department of a tertiary government hospital. The severe acute respiratory infection (sARI) surveillance was also conducted with one government and four private hospitals since April 2009. Nasal and/or oropharyngeal swabs were collected and tested for influenza A, influenza B, and respiratory syncytial virus.
  
  
  CONCLUSIONS
  We obtained 5915 specimens from 13 002 ILI cases and 2656 specimens from 10 726 sARI cases throughout the study period. We observed year-round influenza activity with two possible peaks each year. The overall influenza detection rate was 23% in the ILI surveillance and 9% in the sARI surveillance. The mean annual outpatient incidence rate of influenza was 5·4 per 1000 individuals [95% confidence interval (CI), 1·83-12·7], and the mean annual incidence of influenza-associated sARI was 1·0 per 1000 individuals (95% CI, 0·03-5·57). The highest incidence rates were observed among children aged <5 years, particularly those aged 6-23 months. Influenza posed a certain disease burden among inpatients and outpatients, particularly children aged <5 years, in an urbanized tropical city of the Philippines.
authors.affiliation: Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Department of Health, Manila, Philippines.
authors.forename: Veronica L
authors.initials: VL
authors.lastname: Tallo
authors.forename: Taro
authors.initials: T
authors.lastname: Kamigaki
authors.forename: Alvin G
authors.initials: AG
authors.lastname: Tan
authors.forename: Rochelle R
authors.initials: RR
authors.lastname: Pamaran
authors.forename: Portia P
authors.initials: PP
authors.lastname: Alday
authors.forename: Edelwisa S
authors.initials: ES
authors.lastname: Mercado
authors.forename: Jenaline B
authors.initials: JB
authors.lastname: Javier
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Oshitani
authors.forename: Remigio M
authors.initials: RM
authors.lastname: Olveda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D009980:Influenza A virus / Q000302:isolation & purification*; D009981:Influenza B virus / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000821:virology; D009960:Oropharynx / Q000821:virology; D010045:Outpatients; D010679:Philippines / Q000453:epidemiology; D014329:Tropical Climate; D014505:Urban Population; D055815:Young Adult
keywords: Disease burden; Philippines; influenza; influenza-like illness; severe acute respiratory infection