Comparison of the epidemiology of laboratory-confirmed influenza A and influenza B cases in Manitoba, Canada

Aynslie M Hinds, Songul Bozat-Emre, Paul Van Caeseele, Salaheddin M Mahmud, Aynslie M Hinds, Songul Bozat-Emre, Paul Van Caeseele, Salaheddin M Mahmud

Abstract

Background: Despite the public health significance of annual influenza outbreaks, the literature comparing the epidemiology of influenza A and B infections is limited and dated and may not reflect recent trends. In Canada, the relative contribution of influenza A and B to the burden of morbidity is not well understood. We examined rates of laboratory-confirmed cases of influenza A and B (LCI-A and LCI-B) in the Canadian province of Manitoba between 1993 and 2008 and compared cases of the two types in terms of socio-demographic and clinical characteristics.

Methods: Laboratory-confirmed cases of influenza A and B in Manitoba between 1993 and 2008 were identified from the Cadham Provincial Laboratory (CPL) Database and linked to de-identified provincial administrative health records. Crude and age-adjusted incidence rates of LCI-A and LCI-B were calculated. Demographic characteristics, health status, health service use, and vaccination history were compared by influenza type.

Results: Over the study period, 1,404 of LCI-A and 445 cases of LCI-B were diagnosed, corresponding to an annual age-standardized rate of 7.2 (95% CI: 6.5-7.9) for LCI-A and 2.2 (CI: 1.5 - 3.0) per 100,000 person-years for LCI-B. Annual rates fluctuated widely but there was less variation in the LCI-B rates. For LCI-A, but not LCI-B, incidence was inversely related to household income. Older age, urban residence and past hospitalization were associated with increased detection of LCI-A whereas receipt of the influenza vaccine was associated with decreased LCI-A detection. Once socio-demographic variables were controlled, having a pre-existing chronic disease or immune suppression was not related to influenza type.

Conclusion: Influenza A and B affected different segments of the population. Older age was associated with increased LCI-A detection, but not with pre-existing chronic diseases. This information may be useful to public health professionals in planning and evaluating new and existing seasonal influenza vaccines.

Figures

Figure 1
Figure 1
Annual age-standardized rates by laboratory-confirmed influenza type, Manitoba 1993–2008.

References

    1. Cox N, Subbarao K. Global epidemiology of influenza: past and present. Annu Rev Med. 2000;51(1):407–21. doi: 10.1146/annurev.med.51.1.407.
    1. Manitoba Health, Healthy Living and Seniors. Seasonal Influenza (Flu). []
    1. Nicholson KG, Wood JM, Zambon M. Influenza. Lancet. 2003;362(9397):1733–45. doi: 10.1016/S0140-6736(03)14854-4.
    1. Jackson ML, Nelson JC, Weiss NS, Neuzil KM, Barlow W, Jackson LA. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study. Lancet. 2008;372(9636):398–405. doi: 10.1016/S0140-6736(08)61160-5.
    1. Schanzer DL, Tam TW, Langley JM, Winchester BT. Influenza-attributable deaths, Canada 1990–1999. Epidemiol Infect. 2007;135(7):1109–16. doi: 10.1017/S0950268807007923.
    1. Zambon MC. Epidemiology and pathogenesis of influenza. J Antimicrob Chemother. 1999;44(suppl 2):3–9. doi: 10.1093/jac/44.suppl_2.3.
    1. Osterhaus ADME, Rimmelzwaan GF, Martina BEE, Bestebroer TM, Fouchier RAM. Influenza B Virus in Seals. Science. 2000;288(5468):1051–3. doi: 10.1126/science.288.5468.1051.
    1. Ferguson NM, Galvani AP, Bush RM. Ecological and immunological determinants of influenza evolution. Nature. 2003;422(6930):428–33. doi: 10.1038/nature01509.
    1. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179–86. doi: 10.1001/jama.289.2.179.
    1. Irving SA, Patel DC, Kieke BA, Donahue JG, Vandermause MF, Shay DK, Belongia EA. Comparison of clinical features and outcomes of medically attended influenza A and influenza B in a defined population over four seasons: 2004–2005 through 2007–2008. Influenza Other Respir Viruses. 2012;6(1):37–43. doi: 10.1111/j.1750-2659.2011.00263.x.
    1. Singh H, Mahmud SM, Turner D, Xue L, Demers AA, Bernstein CN. Long-term use of statins and risk of colorectal cancer: a population-based study. Am J Gastroenterol. 2009;104(12):3015–23. doi: 10.1038/ajg.2009.574.
    1. Roos LL, Mustard C, Nicol J, McLerran D, Malenka D, Young T, Cohen M. Registries and administrative data: organization and accuracy. Med Care. 1993;31(3):201–12. doi: 10.1097/00005650-199303000-00002.
    1. Robinson JR, Young TK, Roos LL, Gelskey DE. Estimating the burden of disease. Comparing administrative data and self-reports. Medical care. 1997;35(9):932–47. doi: 10.1097/00005650-199709000-00006.
    1. Roos LL, Nicol JP. A research registry: uses, development, and accuracy. J Clin Epidemiol. 1999;52(1):39–47. doi: 10.1016/S0895-4356(98)00126-7.
    1. Mahmud S, Hammond G, Elliott L, Hilderman T, Kurbis C, Caetano P, et al. Effectiveness of the pandemic H1N1 influenza vaccines against laboratory-confirmed H1N1 infections: Population-based case–control study. Vaccine. 2011;29(45):7975–81. doi: 10.1016/j.vaccine.2011.08.068.
    1. Mahmud SM, Van Caeseele P, Hammond G, Kurbis C, Hilderman T, Elliott L. No association between 2008–09 influenza vaccine and influenza A(H1N1)pdm09 virus infection, Manitoba, Canada, 2009. Emerg Infect Dis. 2012;18(5):801–10. doi: 10.3201/eid1805.111596.
    1. Malik MT, Gumel A, Thompson LH, Strome T, Mahmud SM. “Google flu trends” and emergency department triage data predicted the 2009 pandemic H1N1 waves in Manitoba. Can J Publ Health. 2011;102(4):294–7.
    1. Lix LM, Azimaee M, Dahl M, Nicol P, Burchill C, Burland E, Goh CY, Schultz J, Bailly A. A systematic investigation of Manitoba’s provincial laboratory data. Winnipeg, MB: Manitoba Centre for Health Policy; 2012.
    1. Canadian Institute for Health Information . ICD-10-CA International statistical classification of diseases and related health problems. Ottawa, Ontario, Canada: Tenth Revision: Canadian coding standard for version 2009 ICD-10-CA; 2009.
    1. World Health Organization . International statistical classification of diseases and related health problems. Geneva, Switzerland: Tenth Revision: World Health Organization; 1993.
    1. Canadian Institute for Health Information . Canadian Classification of Health Interventions. Ottawa, Ontario, Canada: Canadian coding standards for ICD-10-CA and CCI 2006; 2006.
    1. Lix L, Yogendran M, Burchill C, Metge C, McKeen N, Moore D, Bond R. Defining and validating chronic diseases: an administrative data approach. Winnipeg: Manitoba Centre for Health Policy; 2006.
    1. Brownell MD, Yogendran MS. Attention-deficit hyperactivity disorder in manitoba children: medical diagnosis and psychostimulant treatment rates. Can J Psychiatry. 2001;46(3):264–72.
    1. Dublin S, Jackson ML, Nelson JC, Weiss NS, Larson EB, Jackson LA. Statin use and risk of community acquired pneumonia in older people: population based case-control study. BMJ. 2009;338:b2137. doi: 10.1136/bmj.b2137.
    1. Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived from ICD-9-CCM administrative data. Med Care. 2002;40(8):675–85. doi: 10.1097/00005650-200208000-00007.
    1. Roberts J, Roos L, Poffenroth L, Hassard T, Bebchuk J, Carter A, Law B. Surveillance of vaccine-related adverse events in the first year of life: a Manitoba cohort study. J Clin Epidemiol. 1996;49(1):51. doi: 10.1016/0895-4356(95)00522-6.
    1. Hilderman T, Katz A, Derksen S, McGowan K, Chateau D, Kurbis C, et al. Manitoba Immunization Study. Winnipeg: Manitoba Centre for Health Policy; 2011.
    1. Eick-Cost AA, Tastad KJ, Guerrero AC, Johns MC, Lee S-e, MacIntosh VH, Burke RL, Blazes DL, Russell KL, Sanchez JL. Effectiveness of seasonal influenza vaccines against influenza-associated illnesses among US military personnel in 2010–11: a case-control approach. PLoS One. 2012;7(7):e41435. doi: 10.1371/journal.pone.0041435.
    1. Kelly HA, Sullivan SG, Grant KA, Fielding JE. Moderate influenza vaccine effectiveness with variable effectiveness by match between circulating and vaccine strains in Australian adults aged 20–64 years, 2007–2011. Influenza Other Respir Viruses. 2013;7(5):729–37. doi: 10.1111/irv.12018.
    1. Belongia EA, Kieke BA, Donahue JG, Coleman LA, Irving SA, Meece JK, Vandermause M, Lindstrom S, Gargiullo P, Shay DK. Influenza vaccine effectiveness in Wisconsin during the 2007–08 season: Comparison of interim and final results. Vaccine. 2011;29(38):6558–63. doi: 10.1016/j.vaccine.2011.07.002.
    1. Ambrose CS, Levin MJ. The rationale for quadrivalent influenza vaccines. Human Vaccines & Immunotherapeutics. 2012;8(1):81–8. doi: 10.4161/hv.8.1.17623.
    1. Garske T, Legrand J, Donnelly CA, Ward H, Cauchemez S, Fraser C, Ferguson NM, Ghani AC. Assessing the severity of the novel influenza A/H1N1 pandemic. BMJ. 2009;339:b2840. doi: 10.1136/bmj.b2840.
    1. Freitas FT. Sentinel surveillance of influenza and other respiratory viruses, Brazil, 2000–2010. Braz J Infect Dis. 2013;17(1):62–8. doi: 10.1016/j.bjid.2012.09.001.
    1. Skowronski DM, De Serres G, Dickinson J, Petric M, Mak A, Fonseca K, Kwindt TL, Chan T, Chan T, Bastien N, et al. Component-specific effectiveness of trivalent influenza vaccine as monitored through a sentinel surveillance network in Canada, 2006–2007. J Infect Dis. 2009;199(2):168–79. doi: 10.1086/595862.
    1. Skowronski DM, Janjua NZ, De Serres G, Hottes TS, Dickinson JA, Crowcroft N, Kwindt TL, Tang P, Charest H, Fonseca K, et al. Effectiveness of AS03 adjuvanted pandemic H1N1 vaccine: case-control evaluation based on sentinel surveillance system in Canada, autumn 2009. BMJ. 2011;342:c7297. doi: 10.1136/bmj.c7297.
    1. Dijkstra F, Donker GA, Wilbrink B, Van Gageldonk-Lafeber AB, Van Der Sande MA. Long time trends in influenza-like illness and associated determinants in The Netherlands. Epidemiol Infect. 2009;137(4):473–9. doi: 10.1017/S095026880800126X.
    1. Savy V, Ciapponi A, Bardach A, Glujovsky D, Aruj P, Mazzoni A, Gibbons L, Ortega-Barria E, Colindres RE. Burden of influenza in Latin America and the Caribbean: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2013;7(6):1017–32. doi: 10.1111/irv.12036.
    1. Belshe RB, Coelingh K, Ambrose CS, Woo JC, Wu X. Efficacy of live attenuated influenza vaccine in children against influenza B viruses by lineage and antigenic similarity. Vaccine. 2010;28(9):2149–56. doi: 10.1016/j.vaccine.2009.11.068.
    1. Esposito S, Cantarutti L, Molteni CG, Daleno C, Scala A, Tagliabue C, Pelucchi C, Giaquinto C, Principi N. Clinical manifestations and socio-economic impact of influenza among healthy children in the community. J Infect. 2011;62(5):379–87. doi: 10.1016/j.jinf.2011.02.015.
    1. Schillberg E, Isaac M, Deng X, Peirano G, Wylie JL, Van Caeseele P, et al. Outbreak of invasive Streptococcus pneumoniae Serotype 12F among a marginalized inner-city population in Winnipeg, Canada (2009–2011) Clin Infect Dis. 2014;59(5):651–7. doi: 10.1093/cid/ciu366.
    1. Mahmud SM, Becker M, Keynan Y, Elliott L, Thompson LH, Fowke K, Avery L, Van Caeseele P, Harlos S, Blanchard J, et al. Estimated cumulative incidence of pandemic (H1N1) influenza among pregnant women during the first wave of the 2009 pandemic. CMAJ. 2010;182(14):1522–4. doi: 10.1503/cmaj.100488.
    1. Thompson LH, Mahmud SM, Keynan Y, Blanchard JF, Slater J, Dawood M, Fowke K, Van Caeseele P, Becker M. Serological survey of the novel influenza A H1N1 in inner city Winnipeg, Manitoba, 2009. Can J Infect Dis Med Microbiol. 2012;23(2):65–70.
    1. Embree J. Pandemic 2009 (A)H1N1 influenza (swine flu) - the Manitoba experience. Biochem Cell Biol. 2010;88(4):589–93. doi: 10.1139/O10-025.
    1. Zarychanski R, Stuart TL, Kumar A, Doucette S, Elliott L, Kettner J, Plummer F. Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection. CMAJ. 2010;182(3):257–64. doi: 10.1503/cmaj.091884.
    1. Forshey BM, Laguna-Torres VA, Vilcarromero S, Bazan I, Rocha C, Morrison AC, Stoddard ST, Alegre Y, Gomez J, Scott TW, et al. Epidemiology of influenza-like illness in the Amazon Basin of Peru, 2008–2009. Influenza Other Respir Viruses. 2010;4(4):235–43. doi: 10.1111/j.1750-2659.2010.00139.x.
    1. Roberts JD, Poffenroth LA, Roos LL, Bebchuk JD, Carter AO. Monitoring childhood immunizations: a Canadian approach. Am J Public Health. 1994;84(10):1666–8. doi: 10.2105/AJPH.84.10.1666.
    1. LeBlanc JJ, Li Y, Bastien N, Forward KR, Davidson RJ, Hatchette TF. Switching gears for an influenza pandemic: validation of a duplex reverse transcriptase PCR assay for simultaneous detection and confirmatory identification of pandemic (H1N1) 2009 influenza virus. J Clin Microbiol. 2009;47(12):3805–13. doi: 10.1128/JCM.01344-09.

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