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Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013.

Estimating influenza and respiratory syncytial virus-associated mortality in Western Kenya using health and demographic surveillance system data, 2007-2013.
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Emukule GO, Spreeuwenberg P, Chaves SS, Mott JA, Tempia S, Bigogo G, Nyawanda B, Nyaguara A, Widdowson MA, van der Velden K, Paget JW,


Emukule GO, Spreeuwenberg P, Chaves SS, Mott JA, Tempia S, Bigogo G, Nyawanda B, Nyaguara A, Widdowson MA, van der Velden K, Paget JW, (click to view)

Emukule GO, Spreeuwenberg P, Chaves SS, Mott JA, Tempia S, Bigogo G, Nyawanda B, Nyaguara A, Widdowson MA, van der Velden K, Paget JW,

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PloS one 2017 07 0712(7) e0180890 doi 10.1371/journal.pone.0180890

Abstract
BACKGROUND
Influenza and respiratory syncytial virus (RSV) associated mortality has not been well-established in tropical Africa.

METHODS
We used the negative binomial regression method and the rate-difference method (i.e. deaths during low and high influenza/RSV activity months), to estimate excess mortality attributable to influenza and RSV using verbal autopsy data collected through a health and demographic surveillance system in Western Kenya, 2007-2013. Excess mortality rates were calculated for a) all-cause mortality, b) respiratory deaths (including pneumonia), c) HIV-related deaths, and d) pulmonary tuberculosis (TB) related deaths.

RESULTS
Using the negative binomial regression method, the mean annual all-cause excess mortality rate associated with influenza and RSV was 14.1 (95% confidence interval [CI] 0.0-93.3) and 17.1 (95% CI 0.0-111.5) per 100,000 person-years (PY) respectively; and 10.5 (95% CI 0.0-28.5) and 7.3 (95% CI 0.0-27.3) per 100,000 PY for respiratory deaths, respectively. Highest mortality rates associated with influenza were among ≥50 years, particularly among persons with TB (41.6[95% CI 0.0-122.7]); and with RSV were among <5 years. Using the rate-difference method, the excess mortality rate for influenza and RSV was 44.8 (95% CI 36.8-54.4) and 19.7 (95% CI 14.7-26.5) per 100,000 PY, respectively, for all-cause deaths; and 9.6 (95% CI 6.3-14.7) and 6.6 (95% CI 3.9-11.0) per 100,000 PY, respectively, for respiratory deaths. CONCLUSIONS
Our study shows a substantial excess mortality associated with influenza and RSV in Western Kenya, especially among children <5 years and older persons with TB, supporting recommendations for influenza vaccination and efforts to develop RSV vaccines.

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