title: Influenza-Associated Disease Burden in Kenya: A Systematic Review of Literature.
abstract: BACKGROUND
  In Kenya data on the burden of influenza disease are needed to inform influenza control policies.
  
  
  METHODS
  We conducted a systematic review of published data describing the influenza disease burden in Kenya using surveillance data collected until December 2013. We included studies with laboratory confirmation of influenza, well-defined catchment populations, case definitions used to sample patients for testing and a description of the laboratory methods used for influenza testing. Studies with or without any adjustments on the incidence rates were included.
  
  
  RESULTS
  Ten studies reporting the incidence of medically-attended and non-medically attended influenza were reviewed. For all age groups, the influenza positive proportion ranged from 5-10% among hospitalized patients, and 5-27% among all medically-attended patients (a combination of in- and outpatients). The adjusted incidence rate of hospitalizations with influenza among children < 5 years ranged from 2.7-4.7 per 1,000 [5.7 per 1,000 in children < 6 months old], and were 7-10 times higher compared to persons aged ≥ 5 years. The adjusted incidence of all medically-attended influenza among children aged < 5 years ranged from 13.0-58.0 per 1,000 compared to 4.3-26.0 per 1,000 among persons aged ≥ 5 years.
  
  
  CONCLUSIONS
  Our review shows an expanding set of literature on disease burden associated with influenza in Kenya, with a substantial burden in children under five years of age. Hospitalizations with influenza in these children were 2-3 times higher than reported in the United States. These findings highlight the possible value of an influenza vaccination program in Kenya, with children < 5 years and pregnant women being potentially important targets.
authors.affiliation: Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya.
authors.forename: Gideon O
authors.initials: GO
authors.lastname: Emukule
authors.affiliation: Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands; Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.
authors.forename: John
authors.initials: J
authors.lastname: Paget
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
authors.affiliation: Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya; Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America; US Public Health Service, Rockville, Maryland, United States of America.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
mesh_terms: D000367:Age Factors; D016208:Databases, Factual; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007251:Influenza, Human / Q000191:economics* / Q000453:epidemiology; D007630:Kenya / Q000453:epidemiology