Percorrer por autor "Palekar, Rakhee"
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- Estimates of global seasonal influenza-associated respiratory mortality: a modelling studyPublication . Iuliano, A. Danielle; Roguski, Katherine M.; Chang, Howard H.; Muscatello, David J.; Palekar, Rakhee; Tempia, Stefano; Cohen, Cheryl; Gran, Jon Michael; Schanzer, Dena; Cowling, Benjamin J.; Wu, Peng; Kyncl, Jan; Ang, Li Wei; Park, Minah; Redlberger-Fritz, Monika; Yu, Hongjie; Espenhain, Laura; Krishnan, Anand; Emukule, Gideon; van Asten, Liselotte; Silva, Susana Pereira; Aungkulanon, Suchunya; Buchholz, Udo; Widdowson, Marc-Alain; Bresee, Joseph S.; Global Seasonal Influenza-associated Mortality Collaborator NetworkBACKGROUND: Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000-500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999-2015. METHODS: We estimated country-specific influenza-associated respiratory excess mortality rates (EMR) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data. To extrapolate estimates to countries without data, we divided countries into three analytic divisions for three age groups (<65 years, 65-74 years, and ≥75 years) using WHO Global Health Estimate (GHE) respiratory infection mortality rates. We calculated mortality rate ratios (MRR) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates. To calculate death estimates for individual countries within each age-specific analytic division, we multiplied randomly selected mean annual EMRs by the country's MRR and population. Global 95% credible interval (CrI) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year. We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods. FINDINGS: EMR-contributing countries represented 57% of the global population. The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years, 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years, and 17·9 to 223·5 per 100 000 for people older than 75 years. We estimated that 291 243-645 832 seasonal influenza-associated respiratory deaths (4·0-8·8 per 100 000 individuals) occur annually. The highest mortality rates were estimated in sub-Saharan Africa (2·8-16·5 per 100 000 individuals), southeast Asia (3·5-9·2 per 100 000 individuals), and among people aged 75 years or older (51·3-99·4 per 100 000 individuals). For 92 countries, we estimated that among children younger than 5 years, 9243-105 690 influenza-associated respiratory deaths occur annually. INTERPRETATION: These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated.
- Revision of clinical case definitions: influenza-like illness and severe acute respiratory infectionPublication . Fitzner, Julia; Qasmieh, Saba; Mounts, Anthony Wayne; Alexander, Burmaa; Besselaar, Terry; Briand, Sylvie; Brown, Caroline; Clark, Seth; Dueger, Erica; Gross, Diane; Hauge, Siri; Hirve, Siddhivinayak; Jorgensen, Pernille; Katz, Mark A; Mafi, Ali; Malik, Mamunur; McCarron, Margaret; Meerhoff, Tamara; Mori, Yuichiro; Mott, Joshua; Olivera, Maria Teresa da Costa; Ortiz, Justin R; Palekar, Rakhee; Rebelo-de-Andrade, Helena; Soetens, Loes; Yahaya, Ali Ahmed; Zhang, Wenqing; Vandemaele, KatelijnThe formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of the condition involved and improvements in diagnostic testing. Optimal case definitions also need to have a balance of sensitivity and specificity that reflects their intended use. After the 2009-2010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. This prompted improvements in the sensitivity and specificity of the case definition for influenza - i.e. a respiratory disease that lacks uniquely defining symptomology. The revision process not only modified the definition of influenza-like illness, to include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. The new definitions have been found to capture more cases without compromising specificity. Despite the challenge still posed in the clinical separation of influenza from other respiratory infections, the global use of the new WHO case definitions should help determine global trends in the characteristics and transmission of influenza viruses and the associated disease burden.
- The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st centuryPublication . Caini, Saverio; Kusznierz, Gabriela; Garate, Verònica Vera; Wangchuk, Sonam; Thapa, Binay; de Paula Júnior, Francisco José; Ferreira de Almeida, Walquiria Aparecida; Njouom, Richard; Fasce, Rodrigo A.; Bustos, Patricia; Feng, Luzhao; Peng, Zhibin; Araya, Jenny Lara; Bruno, Alfredo; de Mora, Doménica; Barahona de Gámez, Mónica Jeannette; Pebody, Richard; Zambon, Maria; Higueros, Rocio; Rivera, Rudevelinda; Kosasih, Herman; Castrucci, Maria Rita; Bella, Antonino; Kadjo, Hervé A.; Daouda, Coulibaly; Makusheva, Ainash; Bessonova, Olga; Chaves, Sandra S.; Emukule, Gideon O.; Heraud, Jean-Michel; Razanajatovo, Norosoa H.; Barakat, Amal; El Falaki, Fatima; Meijer, Adam; Donker, Gé A.; Huang, Q. Sue; Wood, Tim; Balmaseda, Angel; Palekar, Rakhee; Arévalo, Brechla Moreno; Rodrigues, Ana Paula; Guiomar, Raquel; Lee, Vernon Jian Ming; Ang, Li Wei; Cohen, Cheryl; Treurnicht, Florette; Mironenko, Alla; Holubka, Olha; Bresee, Joseph; Brammer, Lynnette; Le, Mai T.Q.; Hoang, Phuong V.M.; El Guerche-Séblain, Clotilde; Paget, John; Global Influenza B Study teamWe describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000-2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.