title: The burden of influenza and RSV among inpatients and outpatients in rural western Kenya, 2009-2012.
abstract: BACKGROUND
  In Kenya, detailed data on the age-specific burden of influenza and RSV are essential to inform use of limited vaccination and treatment resources.
  
  
  METHODS
  We analyzed surveillance data from August 2009 to July 2012 for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) at two health facilities in western Kenya to estimate the burden of influenza and respiratory syncytial virus (RSV). Incidence rates were estimated by dividing the number of cases with laboratory-confirmed virus infections by the mid-year population. Rates were adjusted for healthcare-seeking behavior, and to account for patients who met the SARI/ILI case definitions but were not tested.
  
  
  RESULTS
  The average annual incidence of influenza-associated SARI hospitalization per 1,000 persons was 2.7 (95% CI 1.8-3.9) among children <5 years and 0.3 (95% CI 0.2-0.4) among persons ≥5 years; for RSV-associated SARI hospitalization, it was 5.2 (95% CI 4.0-6.8) among children <5 years and 0.1 (95% CI 0.0-0.2) among persons ≥5 years. The incidence of influenza-associated medically-attended ILI per 1,000 was 24.0 (95% CI 16.6-34.7) among children <5 years and 3.8 (95% CI 2.6-5.7) among persons ≥5 years. The incidence of RSV-associated medically-attended ILI was 24.6 (95% CI 17.0-35.4) among children <5 years and 0.8 (95% CI 0.3-1.9) among persons ≥5 years.
  
  
  CONCLUSIONS
  Influenza and RSV both exact an important burden in children. This highlights the possible value of influenza vaccines, and future RSV vaccines, for Kenyan children.
authors.affiliation: Centers for Disease Control and Prevention (CDC)-Kenya Country Office, Nairobi, Kenya.
authors.forename: Gideon O
authors.initials: GO
authors.lastname: Emukule
authors.affiliation: Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khagayi
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; United States Public Health Service, Rockville, Maryland, United States of America.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: McMorrow
authors.affiliation: Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ochola
authors.affiliation: Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya.
authors.forename: Nancy
authors.initials: N
authors.lastname: Otieno
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.affiliation: Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya.
authors.forename: Melvin
authors.initials: M
authors.lastname: Ochieng
authors.affiliation: Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
authors.affiliation: Centers for Disease Control and Prevention (CDC)-Kenya Country Office, Nairobi, Kenya; Centers for Disease Control and Prevention, Port-au-Prince, Haiti.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Katz
authors.affiliation: Centers for Disease Control and Prevention (CDC)-Kenya Country Office, Nairobi, Kenya; Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; United States Public Health Service, Rockville, Maryland, United States of America.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D009980:Influenza A virus / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D007297:Inpatients; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D055815:Young Adult