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Lessons learned from identifying clusters of severe acute respiratory infections with influenza sentinel surveillance, Bangladesh, 2009--2020
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  • Ariful Islam,
  • Zakiul Hassan,
  • Mohammad Abdul Aleem,
  • Zubair Akhtar,
  • Sukanta Chowdhury,
  • Mustafizur Rahman,
  • Mohammed Rahman,
  • MD AHMMED,
  • Syeda Mah-E-Muneer,
  • A.S.M. Alamgir,
  • Shah Niaz Anwar,
  • Ahmed Alam ,
  • Tahmina Shirin,
  • Mahmudur Rahman,
  • William Davis,
  • Joshua Mott,
  • Eduardo Azziz-Baumgartner,
  • Fahmida Chowdury
Ariful Islam
International Centre for Diarrhoeal Disease Research Bangladesh

Corresponding Author:arif@icddrb.org

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Zakiul Hassan
International Centre for Diarrhoeal Disease Research Bangladesh
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Mohammad Abdul Aleem
International Centre for Diarrhoeal Disease Research
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Zubair Akhtar
International Centre for Diarrhoeal Disease Research Bangladesh
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Sukanta Chowdhury
International Centre for Diarrhoeal Disease Research
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Mustafizur Rahman
International Centre for Diarrhoeal Disease Research Bangladesh
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Mohammed Rahman
International Centre for Diarrhoeal Disease Research Bangladesh
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MD AHMMED
International Centre for Diarrhoeal Disease Research Bangladesh
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Syeda Mah-E-Muneer
International Centre for Diarrhoeal Disease Research Bangladesh
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A.S.M. Alamgir
Institute of Epidemiology Disease Control and Research and National Influenza Centre
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Shah Niaz Anwar
Institute of Epidemiology Disease Control and Research and National Influenza Centre
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Ahmed Alam
Institute of Epidemiology Disease Control and Research and National Influenza Centre
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Tahmina Shirin
IEDCR
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Mahmudur Rahman
EMPHNET
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William Davis
Centers for Disease Control and Prevention Office of the Associate Director for Communication
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Joshua Mott
CDC
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Eduardo Azziz-Baumgartner
CDC
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Fahmida Chowdury
International Centre for Diarrhoeal Disease Research Bangladesh
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Abstract

Background We explored whether hospital-based surveillance is useful in detecting severe acute respiratory infection (SARI) clusters and how often these events result in outbreak investigation and community mitigation. Methods During May 2009– December 2020, physicians at 14 sentinel hospitals prospectively identified SARI clusters (i.e., ≥2 SARI cases who developed symptoms ≤10 days of each other and lived <30 minute walk or <3 km from each other). Oropharyngeal and nasopharyngeal swabs were tested for influenza and other respiratory viruses by rRT-PCR. We describe the demographic of persons within clusters, laboratory results, and outbreak investigations. Results Physicians identified 464 clusters comprising 1,427 SARI cases (range 0–13 clusters per month). Sixty percent of clusters had three, 23% had 2, and 17% had ≥4 cases. Their median age was 2 years (interquartile [IQR] 0.4–25) and 63% were male. Laboratory results were available for the 464 clusters a median 9 days (IQR = 6–13 days) after cluster identification. Less than one in five clusters had cases that tested positive for the same virus: RSV in 58 (13%), influenza viruses in 24 (5%), HMPV in 5 (1%), HPIV in 3 (0.6%), adenovirus in 2 (0.4%). While 102/464 (22%) had poultry exposure, none tested positive for influenza A(H5N1) or A(H7N9). None of the 464 clusters led to field deployments for outbreak response. Conclusions For 11 years, none of the hundreds of identified clusters led to emergency response. The value of this event-based surveillance might be improved by seeking larger clusters, with stronger epidemiologic ties or decedents.
28 Oct 2022Submitted to Influenza and other respiratory viruses
01 Nov 2022Submission Checks Completed
01 Nov 2022Assigned to Editor
17 Nov 2022Reviewer(s) Assigned
26 Jul 2023Review(s) Completed, Editorial Evaluation Pending
27 Jul 2023Editorial Decision: Revise Minor
26 Aug 20231st Revision Received
30 Aug 2023Submission Checks Completed
30 Aug 2023Assigned to Editor
31 Aug 2023Editorial Decision: Accept