BMC Infectious Diseases (Jul 2021)

Influenza in Malaysian adult patients hospitalized with community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease or asthma: a multicenter, active surveillance study

  • Yong Kek Pang,
  • Ahmad Izuanuddin Ismail,
  • Yoke Fun Chan,
  • Adelina Cheong,
  • Yoong Min Chong,
  • Paras Doshi,
  • Joanne Zhi Han Lau,
  • Jean Khor,
  • Lilian Phei Lian Wang,
  • Chee Loon Leong,
  • Aisya Natasya Musa,
  • Kee Sing Ng,
  • Mau Ern Poh,
  • I-Ching Sam,
  • Jiunn Liang Tan,
  • Mohd Arif Mohd Zim,
  • Anne-Frieda Taurel

DOI
https://doi.org/10.1186/s12879-021-06360-9
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 14

Abstract

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Abstract Background Available data on influenza burden across Southeast Asia are largely limited to pediatric populations, with inconsistent findings. Methods We conducted a multicenter, hospital-based active surveillance study of adults in Malaysia with community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute exacerbation of asthma (AEBA), who had influenza-like illness ≤10 days before hospitalization. We estimated the rate of laboratory-confirmed influenza and associated complications over 13 months (July 2018–August 2019) and described the distribution of causative influenza strains. We evaluated predictors of laboratory-confirmed influenza and severe clinical outcomes using multivariate analysis. Results Of 1106 included patients, 114 (10.3%) were influenza-positive; most were influenza A (85.1%), with A/H1N1pdm09 being the predominant circulating strain during the study following a shift from A/H3N2 from January–February 2019 onwards. In multivariate analyses, an absence of comorbidities (none versus any comorbidity [OR (95%CI), 0.565 (0.329–0.970)], p = 0.038) and of dyspnea (0.544 (0.341–0.868)], p = 0.011) were associated with increased risk of influenza positivity. Overall, 184/1106 (16.6%) patients were admitted to intensive care or high-dependency units (ICU/HDU) (13.2% were influenza positive) and 26/1106 (2.4%) died (2.6% were influenza positive). Males were more likely to have a severe outcome (ICU/HDU admission or death). Conclusions Influenza was a significant contributor to hospitalizations associated with CAP, AECOPD and AEBA. However, it was not associated with ICU/HDU admission in this population. Study registration, NMRR ID: NMRR-17-889-35,174.

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