Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults : a systematic review and meta-analysis

BACKGROUND : Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. METHODS AND FINDINGS : We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS : In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.S1 Data. CSV-formatted analysis dataset.S1 Fig. Forest plot of individual study estimates included in meta-analysis (all adults).S1 PRISMA Checklist. PRISMA checklist.S1 Table. Literature search methodology and results, by database.S2 Table. Summary of published articles included in the analyses, with reference list.S3 Table. Median number of specimens tested and percent positive for influenza, by age group, study design, and population, among all data sources.S4 Table. Regional estimates of influenza-associated lower respiratory infection (LRI) episodes and hospitalizations, by age group.S5 Table. Sensitivity analyses.Grants from the Foundation for Influenza Epidemiology, grants from Innovative Medicines Initiative, grants from the WHO, personal fees from Bill and Melinda Gates Foundation, grants and personal fees from Sanofi, grants from National Institute of Health Research, personal fees from Janssen and personal fees from AbbVie.https://journals.plos.org/plosmedicine/am2023Medical Virolog

Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis

Background: Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. Methods and findings: We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996–31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle–Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20–64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%–16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000–46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000–9,432,000) LRI hospitalizations occur each year among adults. While adults &lt;65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000–5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000–44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265–612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. Conclusions: In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide

Investigating Occupancy Using Maximum Likelihood Estimation

Ecological studies make extensive use of the concept of occupancy of species in various ecological regions of interest. This occupancy measure, given by the proportion of sites occupied, can be an important surrogate to the typical abundance measures to estimate local extinction and colonization probabilities. This project will thoroughly investigate a model of occupancy that accounts for imperfect detection of species using the concept of maximum likelihood. With a simplified occupancy model, we will look at how the precision of such measures are determined and investigate the asymptotic assumption of normality that forms an important part of the model. We will also look at how the model fares in extreme cases where site occupancy and the probability of detection are either too low or high. Finally we will explore the question of determining the appropriate sample size in various cases

The Electoral Consequences of Mass Religious Events: India’s Kumbh Mela

Mass ritualized gatherings like pilgrimages are central to religious practice globally. Do they generate votes for religious parties? The events may heighten religiosity, enlarging support for parties seen as owning religious policy issues. Such parties might also co-opt the events to organize and campaign. We evaluate the electoral impact of India’s Kumbh Mela, a Hindu festival considered the world’s biggest human assembly, leveraging its astrologically determined timing combined with districts’ proximity by rail to the festival sites. The Kumbh Mela boostsHindu nationalists’ vote share. Mechanisms tests suggest it does so by increasing religious orthodoxy—seen in the adoption of Brahminical dietary practices—and by strengthening Hindu nationalist party infrastructure. Communal violence is unaffected, but the events are electorally polarizing; they cause India’s main secular-leaning party to perform better in regions with denser concentrations of religious minorities. Our study offers a new account of how confessional parties make inroads in multiethnic democracies

The Electoral Consequences of Mass Religious Events

Mass ritualized gatherings like pilgrimages are central to religious practice globally. Do they generate votes for religious parties? Theoretically, the events may heighten religiosity, enlarging support for parties seen as “owning” religious policy issues. Such parties might also engage in “platform co-optation,” piggybacking on the events to organize and campaign. We evaluate the electoral impact of India’s Kumbh Mela, a Hindu festival considered the world’s largest human assembly, leveraging its astrologically determined timing combined with districts’ proximity by rail to the festival sites. The Kumbh Mela boosts Hindu nationalists’ vote share. Tests of mechanisms suggest it does so by fomenting identity change—evidenced by increases in communal violence and the adoption of orthodox dietary practices—and by bolstering party infrastructure. India’s main secular-leaning party loses support, but not in regions with denser concentrations of religious minorities. Our study offers a new account of how confessional parties make inroads in multiethnic democracies

Tackling post harvest loss in Ghana: Cost-effectiveness of technologies

Postharvest Loss (PHL) refers to measurable quality and quantity loss of food in the postharvest system. The postharvest system consists of inter-connected stages, from the act of harvest, to crop processing, storage, marketing and transportation, to the stage of consumption. PHL can occur at any stage in the postharvest chain. This note describes common types of PHL, approaches to mitigation, and the cost-effectiveness of technologies to achieve this. We begin with a section on common causes of loss, best practices for preventing these, and barriers to adoption of these practices. We then discuss prevention of loss during storage, for which several technological solutions have been developed and evaluated. Finally, we summarize the evidence on the cost-effectiveness of three such technologies that have been scientifically evaluated: hermetic storage bags, metal silos, and a cooling chamberNon-PRIFPRI1; 2 Promoting Healthy Diets and Nutrition for all; Capacity Strengthening;MTI

Knowledge about tuberculosis and infection prevention behavior: A nine city longitudinal study from India

Improving patients’ tuberculosis (TB) knowledge is a salient component of TB control strategies. Patient knowledge of TB may encourage infection prevention behaviors and improve treatment adherence. The purpose of this study is to examine how TB knowledge and infection prevention behaviors change over the course of treatment.PRIFPRI3; ISIMTI