title: Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries.
abstract: BACKGROUND
  Data on causes of death due to respiratory illness in Africa are limited.
  
  
  METHODS
  From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)-associated deaths identified from influenza surveillance during 2009-2012.
  
  
  RESULTS
  Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%-25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%-5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus-negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0-4 years, 462 (43.1%) involved people aged 5-49 years, and 209 (19.5%) involved people aged ≥50 years.
  
  
  CONCLUSIONS
  Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: McMorrow
authors.affiliation: Kinshasa School of Public Health.
authors.forename: Emile Okitolonda
authors.initials: EO
authors.lastname: Wemakoy
authors.affiliation: Centers for Disease Control and Prevention-Democratic Republic of the Congo, Kinshasa.
authors.forename: Joelle Kabamba
authors.initials: JK
authors.lastname: Tshilobo
authors.affiliation: Centers for Disease Control and Prevention-Kenya, Nairobi.
authors.forename: Gideon O
authors.initials: GO
authors.lastname: Emukule
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-Kenya, Nairobi.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
authors.affiliation: Centers for Disease Control and Prevention-Kenya, Nairobi.
authors.forename: Henry
authors.initials: H
authors.lastname: Njuguna
authors.affiliation: Centers for Disease Control and Prevention-Kenya, Nairobi.
authors.forename: Lilian
authors.initials: L
authors.lastname: Waiboci
authors.affiliation: National Influenza Center, Institut Pasteur de Madagascar, Antananarivo.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Heraud
authors.affiliation: National Influenza Center, Institut Pasteur de Madagascar, Antananarivo.
authors.forename: Soatianana
authors.initials: S
authors.lastname: Rajatonirina
authors.affiliation: National Influenza Center, Institut Pasteur de Madagascar, Antananarivo.
authors.forename: Norosoa H
authors.initials: NH
authors.lastname: Razanajatovo
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre.
authors.forename: Moses
authors.initials: M
authors.lastname: Chilombe
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre.
authors.forename: Dean
authors.initials: D
authors.lastname: Everett
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Heyderman
authors.affiliation: Institut National d 'Hygiene, Rabat, Morocco.
authors.forename: Amal
authors.initials: A
authors.lastname: Barakat
authors.affiliation: Division of Epidemic Infectious Diseases, Rwanda Biomedical Center.
authors.forename: Thierry
authors.initials: T
authors.lastname: Nyatanyi
authors.affiliation: Centers for Disease Control and Prevention-Rwanda, Kigali.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rukelibuga
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention US Public Health Service, Rockville, Maryland Centers for Disease Control and Prevention-South Africa.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.affiliation: Centre for Respiratory Diseases and Meningitis School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Centers for Disease Control and Prevention-South Africa.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tempia
authors.affiliation: Outbreak Response Unit, National Institute for Communicable Diseases.
authors.forename: Juno
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Centers for Disease Control and Prevention-South Africa Zoonoses Research Unit, Department of Medical Virology, University of Pretoria Centre for Respiratory Diseases and Meningitis.
authors.forename: Marietjie
authors.initials: M
authors.lastname: Venter
authors.affiliation: School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Ministry of Health and Social Welfare-Tanzania.
authors.forename: Elibariki
authors.initials: E
authors.lastname: Mwakapeje
authors.affiliation: Ministry of Health and Social Welfare-Tanzania Centers for Disease Control and Prevention-Tanzania, Dar es Salaam.
authors.forename: Marcelina
authors.initials: M
authors.lastname: Mponela
authors.affiliation: Centers for Disease Control and Prevention-Tanzania, Dar es Salaam Uganda Virus Research Institute, Entebbe.
authors.forename: Julius
authors.initials: J
authors.lastname: Lutwama
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Battelle, Atlanta, Georgia.
authors.forename: Jazmin
authors.initials: J
authors.lastname: Duque
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lafond
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
authors.forename: Ndahwouh Talla
authors.initials: NT
authors.lastname: Nzussouo
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
authors.forename: Thelma
authors.initials: T
authors.lastname: Williams
authors.affiliation: Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D017677:Age Distribution; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality* / Q000821:virology*; D008875:Middle Aged; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000401:mortality* / Q000821:virology*; D055815:Young Adult
keywords: Africa South of the Sahara; influenza, human; mortality