Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bb9c88b65-x9fsb Total loading time: 0 Render date: 2025-07-23T17:43:07.869Z Has data issue: false hasContentIssue false

Chapter 45 - Influenza

from Section 6 - Viral Infections

Published online by Cambridge University Press:  18 June 2025

By
Nginache Nampota-Nkomba  and
Antonia Ho
Edited by
David Mabey ,
Martin W. Weber ,
Moffat Nyirenda ,
Dorothy Yeboah-Manu ,
Jackson Orem ,
Laura Benjamin ,
Michael Marks  and
Nicholas A. Feasey
David Mabey
Affiliation:
London School of Hygiene and Tropical Medicine
Martin W. Weber
Affiliation:
World Health Organization
Moffat Nyirenda
Affiliation:
London School of Hygiene and Tropical Medicine
Dorothy Yeboah-Manu
Affiliation:
Noguchi Memorial Institute for Medical Research, University of Ghana
Jackson Orem
Affiliation:
Uganda Cancer Institute, Kampala
Laura Benjamin
Affiliation:
University College London
Michael Marks
Affiliation:
London School of Hygiene and Tropical Medicine
Nicholas A. Feasey
Affiliation:
Liverpool School of Tropical Medicine
Get access

Summary

Influenza viruses A, B and C cause a contagious, acute respiratory tract infection in humans. Influenza ranges from an uncomplicated self-limiting upper respiratory tract infection to severe pneumonia leading to hospitalization, and even death. Morbidity and mortality in Africa are highest in children under 5 years of age, adults over 65 years, and those with underlying chronic conditions including HIV and active tuberculosis infection. Until recently, the burden of influenza was thought to be negligible. However, expansion of influenza surveillance in Africa over the last decade demonstrates a substantial disease burden in the continent during seasonal epidemics as well as global pandemics. In fact, the highest mortality rates in the world were estimated to be in sub-Saharan Africa (SSA) and may be as high as 16.5 per 100,000 population (Iuliano et al. 2018).

Information

Type
Chapter
Information
Principles of Medicine in Africa , pp. 479 - 484
Publisher: Cambridge University Press
Print publication year: 2025

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Aston, SJ, Ho, A, Jary, H et al. Etiology and risk factors for mortality in an adult community-acquired pneumonia cohort in Malawi. Am J Resp Crit Care Med. 2019;200:359–69.Google Scholar
Barr IG, Subbarao K. Implications of the apparent extinction of B/Yamagata-lineage human influenza viruses. Nature. 2024;9:219.Google Scholar
Bonacina F, Boelle P-Y, Colizza V et al. Global patterns and drivers of influenza decline during the COVID-19 pandemic. Int J Infect Dis. 2023;128:132–9.10.1016/j.ijid.2022.12.042CrossRefGoogle Scholar
Centers for Disease Control and Prevention. Different Types of Flu Vaccines. CDC. 2019. www.cdc.gov/flu/prevent/different-flu-vaccines.htm.Google Scholar
Cohen, C, Simonsen, L, Kang, JW et al. Elevated influenza-related excess mortality in South African elderly individuals, 1998–2005. Clin Infect Dis. 2010;51(12):1362–9.CrossRefGoogle ScholarPubMed
Cohen, C, Moyes, J, Tempia, S et al. Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009–2011. Emerg Infect Dis. 2013;19(11):1766–74.CrossRefGoogle ScholarPubMed
Cohen, C, Walaza, S, Moyes, J et al. Epidemiology of severe acute respiratory illness (SARI) among adults and children aged ≥5 years in a high HIV-prevalence setting, 2009–2012. PLoS ONE 2015a;10(2):2009–12.Google Scholar
Cohen, C, Moyes, J, Tempia, S, Groome, M et al. Mortality amongst patients with influenza-associated severe acute respiratory illness, South Africa, 2009–2013. PLoS ONE 2015b;10(3):e0118884.CrossRefGoogle ScholarPubMed
Cohen, C, Walaza, S, Treurnicht, FK et al. In and out-of-hospital mortality associated with seasonal and pandemic influenza and respiratory syncytial virus in South Africa, 2009–2013. Clin Infect Dis. 2018;66(1):95–103.10.1093/cid/cix740CrossRefGoogle ScholarPubMed
Cohen, C, Tshangela, A, Valley-Omar, Z et al. Household transmission of seasonal influenza from HIV-infected and HIV-uninfected individuals in South Africa, 2013–2014. J Infect Dis. 2019;219(10):1605–15.10.1093/infdis/jiy702CrossRefGoogle ScholarPubMed
Cohen, C, Kleynhans, J, Moyes, J et al. Asymptomatic transmission and high community burden of seasonal influenza in an urban and a rural community in South Africa, 2017–18 (PHIRST): a population cohort study. 2021;18:863–74.Google Scholar
Dawa, JA, Chaves, SS, Nyawanda, B et al. National burden of hospitalized and non-hospitalized influenza-associated severe acute respiratory illness in Kenya, 2012–2014. Influenza Other Respi Viruses. 2018;12(1):30–7.10.1111/irv.12488CrossRefGoogle ScholarPubMed
Dia, N, Richard, V, Kiori, D et al. Respiratory viruses associated with patients older than 50 years presenting with ILI in Senegal, 2009 to 2011. BMC Infect Dis. 2014;14(1):2–7.10.1186/1471-2334-14-189CrossRefGoogle ScholarPubMed
Duque, J, McMorrow, ML, Cohen, AL. Influenza vaccines and influenza antiviral drugs in Africa: are they available and do guidelines for their use exist? BMC Public Health 2014;14(1):1–5.CrossRefGoogle Scholar
Ebell, MH, White, LL, Casault, T. A systematic review of the history and physical examination to diagnose influenza. J Am Board Fam Pract. 2004;17(1):1–5.CrossRefGoogle ScholarPubMed
Green, A. Progress in influenza surveillance in Africa. Lancet 2018;391(10128):1345–6. http://dx.doi.org/10.1016/S0140-6736(18)30713-X.CrossRefGoogle ScholarPubMed
Hirve, S, Newman, LP, Paget, J, Azziz-Baumgartner, E. Influenza seasonality in the tropics and subtropics – when to vaccinate? PLoS ONE 2016. doi.org/10.1371/journal.pone.0153003.CrossRefGoogle Scholar
Ho, A, Aston, SJ, Jary, H et al. Impact of human immunodeficiency virus on the burden and severity of influenza illness in Malawian adults: a prospective cohort and parallel case-control study. Clin Infect Dis. 2018;66(6):865–76.CrossRefGoogle ScholarPubMed
Iuliano, AD, Roguski, KM, Chang, HH et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet 2018;391(10127):1285–300.CrossRefGoogle ScholarPubMed
Kim, H, Webster, RG, Webby, RJ. Influenza virus: dealing with a drifting and shifting pathogen. Viral Immunol. 2018;31(2):174–83.10.1089/vim.2017.0141CrossRefGoogle ScholarPubMed
Klein, EY, Monteforte, B, Gupta, A et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Resp Viruses 2016;10(5):394–403.CrossRefGoogle ScholarPubMed
Koegelenberg, CFN, Irusen, EM, Cooper, R et al. High mortality from respiratory failure secondary to swine-origin influenza A (H1N1) in South Africa. QJM. 2010;103(5):319–25.10.1093/qjmed/hcq022CrossRefGoogle ScholarPubMed
Lamb, YN. Cell-based quadrivalent inactivated influenza virus vaccine (Flucelvax® Tetra/Flucelvax Quadrivalent®): a review in the prevention of influenza. Drugs 2019;79(12):1337–48. doi.org/10.1007/s40265-019-01176-z.Google ScholarPubMed
Long, JS, Mistry, B, Haslam, SM, Barclay, WS. Host and viral determinants of influenza A virus species specificity. Nat Rev Microbiol. 2019;17(2):67–81. doi.org/10.1038/s41579-018-0115-z.CrossRefGoogle ScholarPubMed
Maartens, G, Griesel, R, Dube, F, Nicol, M, Mendelson, M. Etiology of pulmonary infections in human immunodeficiency virus – infected inpatients using sputum multiplex real-time polymerase chain reaction. Clin Infect Dis. 2019. doi: 10.1093/cid/ciz332.CrossRefGoogle Scholar
Merckx, J, Wali, R, Schiller, I et al. Diagnostic accuracy of novel and traditional rapid tests for influenza infection compared with reverse transcriptase polymerase chain reaction. Ann Intern Med. 2017;167(6):395–409.10.7326/M17-0848CrossRefGoogle ScholarPubMed
Ope, MO, Katz, MA, Aura, B et al. Risk factors for hospitalized seasonal influenza in rural Western Kenya. PLoS ONE 2011. doi.org/10.1371/journal.pone.0020111.CrossRefGoogle Scholar
Petrova, VN, Russell, CA. The evolution of seasonal influenza viruses. Nat Rev Microbiol. 2018;16(1):47–60. doi.org/10.1038/nrmicro.2017.118.CrossRefGoogle ScholarPubMed
Radin, JM, Katz, MA, Tempia, S et al. Influenza surveillance in 15 countries in Africa, 2006–2010. J Infect Dis. 2012;206(Suppl. 1):2006–10.Google ScholarPubMed
Rajaram, S, Boikos, C, Gelone, DK. Influenza vaccines: the potential benefits of cell-culture isolation and manufacturing. Ther Adv Vaccines Immunother. 2020. doi: 10.1177/2515135520908121.CrossRefGoogle Scholar
Richard, M, Fouchier, RAM. Influenza A virus transmission via respiratory aerosols or droplets as it relates to pandemic potential. FEMS Microbiol Rev. 2015;40(1):68–85.10.1093/femsre/fuv039CrossRefGoogle ScholarPubMed
Schoen, K, Horvat, N, Guerreiro, NFC, De Castro, I, De Giassi, KS. Spectrum of clinical and radiographic findings in patients with diagnosis of H1N1 and correlation with clinical severity. BMC Infect Dis. 2019;19(1). doi.org/10.1186/s12879-019-4592-0.CrossRefGoogle ScholarPubMed
Scott, JAG, Hall, AJ, Muyodi, C et al. Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya. Lancet 2000;355:1225–30. doi: 10.1016/s0140-6736(00)02089-4.Google ScholarPubMed
Sellers, SA, Hagan, RS, Hayden, FG, Fischer, WA. The hidden burden of influenza: a review of the extra-pulmonary complications of influenza infection. Influenza Other Resp Viruses 2017;11(5):372–93.CrossRefGoogle ScholarPubMed
Steffen, C, Diop, OM, Gessner, BD et al. Afriflu – International conference on influenza disease burden in Africa, 1–2 June 2010, Marrakech, Morocco. Vaccine 2011;29(3):363–9.10.1016/j.vaccine.2010.11.029CrossRefGoogle ScholarPubMed
Talbot, HK. Influenza in older adults. Infect Dis Clin North Am. 2017;31(4):757–66. doi.org/10.1016/j.idc.2017.07.005.CrossRefGoogle ScholarPubMed
Tan, J, Asthagiri Arunkumar, G, Krammer, F. Universal influenza virus vaccines and therapeutics: where do we stand with influenza B virus? Curr Opin Immunol. 2018; 53:45–50.10.1016/j.coi.2018.04.002CrossRefGoogle ScholarPubMed
Tang, S, Zhu, W, Wang, BZ. Influenza vaccines toward universality through nanoplatforms and given by microneedle patches. Viruses 2020. doi: 10.3390/v12111212.CrossRefGoogle Scholar
Tempia, S, Walaza, S, Moyes, J et al. Risk factors for influenza-associated severe acute respiratory illness hospitalization in South Africa, 2012–2015. Open Forum Infect Dis. 2017;4(1):2012–15.CrossRefGoogle ScholarPubMed
Tempia, S, Walaza, S, Viboud, C et al. Mortality associated with seasonal and pandemic influenza and respiratory syncytial virus among children 5 years of age in a high HIV prevalence setting – South Africa, 1998–2009. Clin Infect Dis. 2014;58(9):1241–9.10.1093/cid/ciu095CrossRefGoogle Scholar
Troeger, CE, Blacker, BF, Khalil, IA et al. Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017. Lancet Respir Med. 2019;7(1):69–89.CrossRefGoogle Scholar
Uyeki, TM, Bernstein, HH, Bradley, JS et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):e1–47. doi.org/10.1093/cid/ciy866.CrossRefGoogle Scholar
Walaza, S, Tempia, S, Dawood, H et al. The impact of influenza and tuberculosis interaction on mortality among individuals aged ≥15 years hospitalized with severe respiratory illness in South Africa, 2010–2016. Open Forum Infect Dis. 2019;6(3):2010–16.10.1093/ofid/ofz020CrossRefGoogle ScholarPubMed
WHO. A revision of the system of nomenclature for influenza viruses: a WHO memorandum. Bull World Health Organ. 1980;58(4):585–91.Google Scholar
WHO. Weekly epidemiological record: vaccines against influenza WHO position paper – November 2012. Wkly Epidemiol Rec. 2012;87(47):461–76. http://orton.catie.ac.cr/cgi-bin/wxis.exe/?IsisScript=KARDEX.xis&method=post&formato=2&cantidad=1&expresion=mfn=003687.Google Scholar
Yamayoshi, S, Kawaoka, Y. Current and future influenza vaccines. Nat Med. 2019;25(2):212–20. doi.org/10.1038/s41591-018-0340-z.CrossRefGoogle ScholarPubMed

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge-org.demo.remotlog.com is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×