Analysis of SARI (Severe Acute Respiratory Infections) severity reported from surveillance sentinel sites in Turkey, 2015-2016

  • Public health surveillance
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Background:
Sentinel SARI surveillance was first established in Turkey during the 2015-2016 influenza season to monitor respiratory diseases due to influenza and other respiratory viruses leading to hospitalizations and deaths. We aimed to evaluate the findings of sentinel SARI surveillance and investigate the risk factors for deaths.

Methods:
We evaluated 1948 SARI patients, reported to the Ministry of Health from week 40/2015 to 22/2016, from nine sentinel hospitals in five provinces. We collected data from case investigation and follow-up forms using SARI case definition of the World Health Organization. We linked laboratory data on viral respiratory pathogens to individual patient data. We conducted descriptive analysis of patients and risk factor analysis of death by age, pathogens, chronic disease, and ICU admission, using relative risks (RR) and 95% CI.

Results:
Of the SARI patients, 56% were male, 31% were under 2 years old and 24% were 65 years and older. We identified influenza in 30%, other respiratory viruses (ORV) in 22%, and influenza and ORV coexistence in 2% of the patients. Forty-six percent of the samples were negative for the viral agents. Among 23% of the patients in ICU, 23% had influenza and 25% had ORV. The highest fatality rates were respectively, among patients aged over 65 (18%), 50-64 (11%) and 15-49 (11%). Fatality rate by influenza pathogen was 14% in A/H1N1, 7.6% in A/H3N2 and 4% in B. Chronic disease was the main risk for death (RR:3.5, 95% CI:2.5-4.7). Among patients with chronic diseases, highest risk factors are influenza A H3N2 infection (RR:4.2 95% CI:1.2-14.6), and absence of transfer to ICU (RR:5.2 95% CI:2.8-9.6).

Conclusion:
Fatality rate varies by age group, and type of viral strain. SARI surveillance is essential to monitor influenza severity in order to prioritize intervention such as referral of patients with chronic diseases to ICU.

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