Comparison of common acute respiratory infection case definitions for identification of hospitalized influenza cases at a population-based surveillance site in Egypt

Background Multiple case definitions are used to identify hospitalized patients with community-acquired acute respiratory infections (ARI). We evaluated several commonly used hospitalized ARI case definitions to identify influenza cases. Methods The study included all patients from a population-based surveillance site in Damanhour, Egypt hospitalized for a broad set of criteria consistent with community acquired ARIs. Naso- and oropharyngeal (NP/OP) swabs were tested for influenza using RT-PCR. Sensitivity, specificity and PPV for influenza identification was compared between the 2014 WHO Severe Acute Respiratory Infection (SARI) definition (fever ≥38°C and cough with onset within 10 days), the 2011 WHO SARI definition (fever ≥38°C and cough with onset within 7 days), the 2006 PAHO SARI definition, the International Emerging Infections Program (IEIP) pneumonia case definition, and the International Management of Childhood Illness (IMCI) case definitions for moderate and severe pneumonia. Results From June 2009-December 2012, 5768 NP/OP swabs were obtained from 6113 hospitalized ARI patients; 799 (13.9%) were influenza positive. The 2014 WHO SARI case definition captured the greatest number of ARI patients, influenza positive patients and ARI deaths compared to the other case definitions examined. Sensitivity for influenza detection was highest for the 2014 WHO SARI definition with 88.6%, compared to the 2011 WHO SARI (78.2%) the 2006 PAHO SARI (15.8%) the IEIP pneumonia (61.0%) and the IMCI moderate and severe pneumonia (33.8% and 38.9%) case definitions (IMCI applies to <5 only). Conclusions Our results support use of the 2014 WHO SARI definition for identifying influenza positive hospitalized SARI cases as it captures the highest proportion of ARI deaths and influenza positive cases. Routine use of this case definition for hospital-based surveillance will provide a solid, globally comparable foundation on which to build needed response efforts for novel pandemic viruses.

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Epidemiology of Severe Acute Respiratory Infection (SARI) Cases at a sentinel site in Egypt, 2013–15

Journal of Public Health ◽

10.1093/pubmed/fdz053 ◽

2019 ◽

Vol 42 (3) ◽

pp. 525-533 ◽

Cited By ~ 2

Author(s):

Mohamed M Elhakim ◽

Sahar K Kandil ◽

Khaled M Abd Elaziz ◽

Wagida A Anwar

Keyword(s):

Respiratory Infection ◽

Acute Respiratory Infection ◽

Influenza A ◽

Case Definition ◽

Quality Data ◽

Influenza B ◽

Sentinel Site ◽

Influenza A Viruses ◽

High Quality Data ◽

Severe Acute Respiratory Infection

Abstract Background Sentinel surveillance for severe acute respiratory infection (SARI) in Egypt began in 2006 and occurs at eight sites. Avian influenza is endemic, and human cases of influenza A (H5N1) have been reported annually since 2006. This study aimed to describe the epidemiology of SARI at a major sentinel site in the country. Methods Data included in the study were collected from a major SARI sentinel site in Egypt during three consecutive years (2013–15). Results A total of 1254 SARI patients conforming to the WHO case definition were admitted to the sentinel site, representing 5.6% of admitted patients for all causes and 36.6% of acute respiratory infection patients. A total of 99.7% of the patients were tested, and 21.04% tested positive; 48.7% of cases involved influenza A viruses, while 25% involved influenza B. The predominant age group was under 5 years of age, accounting for 443 cases. The seasonality of the influenza data conformed to the Northern Hemisphere pattern. Conclusions The present study’s results show that SARI leads to substantial morbidity in Egypt. There is a great need for high-quality data from the SARI surveillance system in Egypt, especially with endemic respiratory threats such as influenza A (H5N1) in Egypt.

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Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection

Bulletin of the World Health Organization ◽

10.2471/blt.17.194514 ◽

2017 ◽

Vol 96 (2) ◽

pp. 122-128 ◽

Cited By ~ 61

Author(s):

Julia Fitzner ◽

Saba Qasmieh ◽

Anthony Wayne Mounts ◽

Burmaa Alexander ◽

Terry Besselaar ◽

...

Keyword(s):

Respiratory Infection ◽

Acute Respiratory Infection ◽

Clinical Case ◽

Case Definitions ◽

Influenza Like Illness ◽

Severe Acute Respiratory Infection

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Guide to Leading a Patient with Symptoms of an Acute Respiratory Infection during a Coronavirus Pandemic (COVID-19)

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4848 ◽

2020 ◽

Vol 8 (T1) ◽

pp. 97-102

Author(s):

Velo Markovski

Keyword(s):

Respiratory Infection ◽

Acute Respiratory Infection ◽

Respiratory Infections ◽

Diastolic Pressure ◽

Severe Pneumonia ◽

High Sensitivity ◽

Upper Respiratory Tract ◽

Peripheral Oxygen Saturation ◽

Radiographic Findings ◽

Upper Respiratory

BACKGROUND: Over 500 viruses and bacteria primarily cause respiratory infections. During COVID-19 pandemic, these respiratory infections remain; i.e., COVID-19 has no ability to suppress these infections from the circulation. Therefore, it is very important to differentiate respiratory infections from COVID-19. Proving the presence of COVID-19 with polymerase chain reaction (PCR) is not evidence that the disease was caused by this virus. Possible options are: First, a random encounter of the virus in the patient’s upper respiratory tract; second, further possible colonization with a coronavirus (or with COVID-19); the third option is to have an infection; and the fourth possibility is to have a disease or COVID-19 upper respiratory infection. Unfortunately, the method with PCR, although it is with high sensitivity and specificity, does not help us to distinguish which of these four possibilities are in question. AIM: We aimed to present a guide to leading a patient with symptoms of an acute respiratory infection during a coronavirus pandemic (COVID-19). RESULTS: A pandemic of COVID-19 shows that many patients get primary viral pneumonia, but people with normal immune system have no problem recovering. People with reduced immunity die from COVID-19, as opposed to the pandemic influenza virus. It is indirectly concluded that COVID-19 in itself is not very virulent, but it weakens the immunity of those infected who already have some condition and impaired immunity. The available scientific papers show that there is no strong cytokine response, patients have leukopenia and lymphopenia, some patients have a decrease in CD4 T-lymphocytes. From the results of the autopsies available so far, it is clear that there are very few inflammatory cells in the lungs and a lot of fluid domination. Hence, SARS-Cov-2 only somehow speeds up the decline in immunity. The previously published radiographic findings of COVID-19 patients, gave a characteristic findings of the presence of multifocal nodules, described as milky glass, very often localized in the periphery of the lung. Whether it is typical pneumonia, atypical, viral, mixed-type pneumonia, or mycotic pneumonia, it can progress to severe pneumonia. The pneumonia becomes severe when breathing is over 30/min; diastolic pressure below 60 mmHg; low partial oxygen pressure in the blood (PaO2/FiO2 <250 mmHg) (1 mmHg = 0.133 kPa); massive pneumonia, bilateral or multilayered lung X-ray; desorientation; leukopenia; and increased urea. CONCLUSION: Patients with COVID-19 placed in intensive care units should be led by a team of anesthesiologists with an infectious disease specialist or an anesthesiologist with a pulmonologist. Critical respiratory parameters should be peripheral oxygen saturation <90%, PaO2/FiO2 ratio 100 or <100, tachycardia above 110/min.

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Evaluation of the New World Health Organization Case Definition of Severe Acute Respiratory Infection for Influenza Surveillance During the Peak Weeks of Two Influenza Seasons in Quebec, Canada

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piw044 ◽

2016 ◽

pp. piw044 ◽

Cited By ~ 1

Author(s):

R. Amini ◽

R. Gilca ◽

M. Douville-Fradet ◽

N. Boulianne ◽

G. De Serres

Keyword(s):

World Health Organization ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

New World ◽

Case Definition ◽

World Health ◽

Influenza Surveillance ◽

Severe Acute Respiratory Infection ◽

Definition Of ◽

Health Organization

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Influenza Sentinel Surveillance System in Surb Astvatsamayr Medical Center, 2013-15

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v10i1.8925 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

Liana Torosyan ◽

Lilit Avetisyan ◽

Artavazd Vanyan

Keyword(s):

Respiratory Infection ◽

Surveillance System ◽

Acute Respiratory Infection ◽

Influenza Season ◽

Medical Center ◽

Case Definition ◽

Sentinel Surveillance ◽

Detection Methods ◽

Severe Acute Respiratory Infection ◽

Sentinel Surveillance System

ObjectiveThe goal of this study was to identify gaps in the severe acute respiratory infection sentinel surveillance system at Surb Astvatsamayr Medical Center.IntroductionInfluenza is a priority in Armenia. There are two influenza surveillance systems in Armenia: population and sentinel. The medical center (MC) has been included in sentinel surveillance since 2012. In 2015 a study was undertaken to identify gaps in severe acute respiratory infection (SARI) sentinel surveillance system in Surb Astvatsamayr MC.MethodsMedical records and reporting forms of SARI cases were generated for individuals meeting the case definition and analyzed for age groups, risk factors, sentinel surveillance detection methods, laboratory conformation, number of days hospitalized and reporting.ResultsIn 2014, 3016 patients were admitted in the hospital with ARI, of whom 2982 were younger than 18 years. During the 2014-2015 influenza season (week 40, 2014-week 20, 2015), 77 swabs have been taken in total, of which five were influenza positive (4 B and 1 AH1N1). Also in the 2013-2014 influenza season, five samples tested positive (all influenza A). Sixty-one (48%) patients with respiratory disease met the WHO SARI case definition (2011), 84 (66%) of all reviewed patients would have met the SARI case definition. The numbers for the ICU (25 records reviewed) do not reflect the actual percentage of patients admitted with respiratory symptoms. The 33 additional cases taken from the sampling logbook were mainly hospitalized in the ICU. Influenza tests were performed on 34 patients (mainly ICU), five were positive for influenza (four B--all adults—and one AH1N1), and four tested positives for other respiratory pathogens (two RSV, one RV, one BV). All influenza positives had fever or a history of fever and 80% met the WHO SARI case definition (2011). Non-sampled cases generally have fewer reported symptoms, but still 44% of cases fits the WHO SARI case definition (2011).ConclusionsThe percentages of patients meeting the WHO SARI 2011 case definition and the WHO SARI 2014 definition shows that mainly caused by the absence of shortness of breath in the SARI 2014 definition 52% (2011) vs 66% (2014) in Surb Asvatsamayr. A large number of children from Neonatal and Children’s departments fulfil the SARI case definition and could potentially be swabbed in addition to ICU patients. There are gaps in WHO SARI case definitions. The sentinel surveillance system should be improved.

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Severe Acute Respiratory Infection: A Case Report

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i44a32586 ◽

2021 ◽

pp. 19-22

Author(s):

Julie Vanlalsawmi ◽

Mayur Wanjari ◽

Sagar Alwadkar ◽

Deeplata Mendhe

Keyword(s):

Respiratory Infection ◽

Acute Respiratory Infection ◽

Respiratory Infections ◽

Host Factors ◽

High Grade Fever ◽

Case Presentation ◽

Symptomatic Disease ◽

Severe Acute Respiratory Infection ◽

Different Types ◽

Males And Females

Introduction: Severe Acute Respiratory Infection (SARI) is a disease of the respiratory system. It is a symptomatic disease with different types of causative agent, and whose definite treatment and cure depends on the type of pathogens, nature of onset, severity of symptoms and the host factors [1]. SARI is one of the major leading cause of disease among children and person with suppressed immunity. The National Health Profile 2019 recorded 41,996,260 cases and 3,740 deaths from Severe Acute Respiratory Infection (SARI) across India in 2018. In 2017, acute respiratory infections accounted for 69% of the total cases of communicable diseases and caused 23% of such death. There were as many as 40,810,524 and 3,164 deaths from such infections. Males and females are affected equally [2]. Case Presentation: A female patient of 72 years from Bodhadi, Kinwat, Nanded was admitted to Medicine Intensive Care Unit (MICU), Acharya Vinoba Bhave Rural Hospital on 26th March 2021 with a chief complaint of breathlessness on exertion for 4 days high grade fever for 15 days prior to the date of admission. My patient is a known case of Hypertension and Typhoid and had undergone Left Nephrectomy.

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1373Severe acute respiratory infection with high mortality rate in Sana'a city, 2018-2019 Yemen

International Journal of Epidemiology ◽

10.1093/ije/dyab168.409 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Manal Mahsoon ◽

Yasser Ghaleb ◽

Riham Al-dubaiee ◽

Mohamed Al Amad

Keyword(s):

Respiratory Infection ◽

Acute Respiratory Infection ◽

Case Fatality Rate ◽

Case Fatality ◽

Control Program ◽

Case Definition ◽

Influenza Viruses ◽

P Value ◽

Fatality Rate ◽

Severe Acute Respiratory Infection

Abstract Background The burden of influenza and severe acute respiratory infection (SARI) in conflict countries such as Yemen is exacerbated due to limited resources and the collapse of the health system. The aims are to describe epidemiology of SARI, determine influenza detection and case fatality rates among SARI patients. Methods We used a descriptive analytical study design. All SARI patients who meet WHO case definition during 2018-2019 from Sana'a city were included. Nasopharyngeal samples were examined by polymerase chain reaction. A soft copy of data that collected by surveillance staff was obtained from the National Influenza Control Program (NICP). Case fatality rate and detection rate were calculated and P value < 0.05 used for statistical significant. Results 1447 SARI patients were reported: 73% males, 54% aged 15- < 50 years. Comorbidity was among 27% (387) of them: (57% cardio-vascular diseases and 50% diabetes). Samples of 934 (64%) SARI patients were tested and influenza viruses were detected in 141 (15%) patients (13% type A and 2% type B). Higher influenza viruses were detected in winter months (November – February) (17% vs 9%, P < 0.001). Overall SARI fatality rate was 19% (276), significantly higher among patients with comorbidity (26% vs 16%, P < 0.001) confirmed influenza (30% Vs 15%, P value < 0.001) and not receiving antiviral (51% vs 17%, P < 0.001) than relevant groups. Conclusions SARI patients in Yemen had a high case-fatality rate particularly SARI patients with confirmed influenza. Introduce influenza vaccination for the risk group should be considered. Key messages Influenza and SARI cases are high in Yemen and progress to death.

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Performance of Surveillance Case Definitions in Detecting Respiratory Syncytial Virus Infection Among Young Children Hospitalized With Severe Respiratory Illness—South Africa, 2009–2014

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy055 ◽

2018 ◽

Vol 8 (4) ◽

pp. 325-333 ◽

Cited By ~ 5

Author(s):

Brian Rha ◽

Rebecca M Dahl ◽

Jocelyn Moyes ◽

Alison M Binder ◽

Stefano Tempia ◽

...

Keyword(s):

South Africa ◽

Respiratory Infection ◽

Respiratory Illness ◽

Case Definition ◽

Acute Lower Respiratory Infection ◽

Case Definitions ◽

Young Infants ◽

Severe Acute Respiratory Infection ◽

Syncytial Virus ◽

Low Sensitivity

Analyses of hospital-based sentinel surveillance for acute lower respiratory infection in children aged <5 years in South Africa revealed that a fever-based case definition for severe acute respiratory infection had low sensitivity for identifying RSV-positive cases, particularly in young infants.

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Capturing respiratory syncytial virus season in Belgium using the influenza severe acute respiratory infection surveillance network, season 2018/19

Eurosurveillance ◽

10.2807/1560-7917.es.2020.25.39.1900627 ◽

2020 ◽

Vol 25 (39) ◽

Author(s):

Lorenzo Subissi ◽

Nathalie Bossuyt ◽

Marijke Reynders ◽

Michèle Gérard ◽

Nicolas Dauby ◽

...

Keyword(s):

Older Adults ◽

Respiratory Syncytial Virus ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Case Definition ◽

World Health ◽

Surveillance Network ◽

Severe Acute Respiratory Infection ◽

Respiratory Syncytial Virus Season ◽

Syncytial Virus

Background Respiratory syncytial virus (RSV) is a common cause of severe respiratory illness in young children (< 5 years old) and older adults (≥ 65 years old) leading the World Health Organization (WHO) to recommend the implementation of a dedicated surveillance in countries. Aim We tested the capacity of the severe acute respiratory infection (SARI) hospital network to contribute to RSV surveillance in Belgium. Methods During the 2018/19 influenza season, we started the SARI surveillance for influenza in Belgium in week 40, earlier than in the past, to follow RSV activity, which usually precedes influenza virus circulation. While the WHO SARI case definition for influenza normally used by the SARI hospital network was employed, flexibility over the fever criterion was allowed, so patients without fever but meeting the other case definition criteria could be included in the surveillance. Results Between weeks 40 2018 and 2 2019, we received 508 samples from SARI patients. We found an overall RSV detection rate of 62.4% (317/508), with rates varying depending on the age group: 77.6% in children aged < 5 years (253/326) and 34.4% in adults aged ≥ 65 years (44/128). Over 90% of the RSV-positive samples also positive for another tested respiratory virus (80/85) were from children aged < 5 years. Differences were also noted between age groups for symptoms, comorbidities and complications. Conclusion With only marginal modifications in the case definition and the period of surveillance, the Belgian SARI network would be able to substantially contribute to RSV surveillance and burden evaluation in children and older adults, the two groups of particular interest for WHO.

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