title: Burden of Influenza and Influenza-associated Pneumonia in the First Year of Life in a Prospective Cohort Study in Managua, Nicaragua.
abstract: BACKGROUND
  Influenza is a major public health problem worldwide; however, relatively little is known about influenza in tropical regions, especially for infants. Additional information is required to inform public health policy making, in particular vaccination guidelines.
  
  
  METHODS
  Between September 2011 and July 2013, we enrolled newborns into the Nicaraguan Birth Cohort Study. Infants were provided primary medical care and actively followed for reverse-transcription polymerase chain reaction-confirmed influenza virus infection when presenting with influenza-like illness or undifferentiated fever. This report presents data pertaining to the first year of life.
  
  
  RESULTS
  Of the 518 children enrolled in the study, 441 participated throughout their first year of life, 71 were withdrawn, and 6 died. Overall, 13% of the participants experienced at least 1 laboratory-confirmed influenza virus infection. The overall incidence of influenza was 15.5 cases per 100 person-years [95% confidence interval (CI): 12.2-19.5]. Infants aged 6-11 months experienced significantly higher rates of laboratory-confirmed influenza than infants aged 0-5 months (incidence rate ratio: 2.1; 95% CI: 1.3-3.4). The overall incidence of pneumonia was 52.6 cases per 100 person-years (95% CI: 46.3-59.6). Three percent of the pneumonia cases were influenza associated, and the incidence of influenza-associated pneumonia and hospitalization was 1.7 (95% CI: 0.9-3.5) and 0.22 (95% CI: 0.03-1.55) cases per 100 person-years, respectively.
  
  
  CONCLUSIONS
  We found a significant burden of influenza and influenza-associated severe respiratory outcomes in infants. Our results support the need to explore the potential value of vaccinating pregnant women and infants aged >6 months, as recommended by the World Health Organization in 2012.
authors.affiliation: From the *Sustainable Sciences Institute, Managua, Nicaragua; †Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua; ‡Centers for Disease Control and Prevention, Atlanta, Georgia; §Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua; ¶Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; and ‖ Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California.
authors.forename: Lionel
authors.initials: L
authors.lastname: Gresh
authors.forename: Guillermina
authors.initials: G
authors.lastname: Kuan
authors.forename: Nery
authors.initials: N
authors.lastname: Sanchez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
authors.forename: Sergio
authors.initials: S
authors.lastname: Ojeda
authors.forename: Marlon
authors.initials: M
authors.lastname: Melendez
authors.forename: Roger
authors.initials: R
authors.lastname: Lopez
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.forename: Joseph
authors.initials: J
authors.lastname: Bresee
authors.forename: Eva
authors.initials: E
authors.lastname: Harris
authors.forename: Angel
authors.initials: A
authors.lastname: Balmaseda
authors.forename: Aubree
authors.initials: A
authors.lastname: Gordon
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies