An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013.
Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack of confirmatory testing. Consecutive outpatients presenting to the largest tertiary care hospital in southern Sri Lanka were surveyed for influenza-like illness (ILI), defined as acute onset of fever ≥ 38.0°C and cough. Patients were administered a questionnaire and nasal/nasopharyngeal sampling for rapid influenza A/B testing. We enrolled 311 patients with ILI from March to November 2013: 170 (54.7%) children and 172 (55.3%) males. Approximately half (147, 47.3%) tested positive for influenza, but 253 (81.4%) were prescribed antibiotics. On bivariable analysis, symptoms associated with influenza included pain with breathing (P < 0.001), headache (P = 0.005), fatigue (P = 0.003), arthralgias (P = 0.003), and myalgias (P = 0.006) in children and pain with breathing (P = 0.01), vomiting (P = 0.03), and arthralgias (P = 0.03) in adults. Our final clinical predictive models had low sensitivity and fair specificity-50.0% (95% CI: 38.6-61.4%) and 83.2% (95% CI: 73.4-90.0%), respectively, in children and 52.2% (95% CI: 39.9-64.2%) and 81.4% (95% CI: 70.0-89.4%), respectively, in adults. Our study confirms the ability of rapid influenza testing to identify an influenza epidemic in a setting in which testing is not routinely available.
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina gayani.tillekeratne@dm.duke.edu.
L Gayani
LG
Tillekeratne
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Champica K
CK
Bodinayake
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Ajith
A
Nagahawatte
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Dhammika
D
Vidanagama
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Vasantha
V
Devasiri
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Wasantha Kodikara
WK
Arachchi
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Ruvini
R
Kurukulasooriya
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Aruna Dharshan
AD
De Silva
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Truls
T
Østybe
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Megan E
ME
Reller
Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina.
Christopher W
CW
Woods
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough; D003430:Cross-Sectional Studies; D058872:Epidemics; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D009980:Influenza A virus / Q000302:isolation & purification*; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009305:Nasopharynx / Q000821:virology; D010045:Outpatients; D015995:Prevalence; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014839:Vomiting; D055815:Young Adult