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Introduction:
Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru.
Methods:
We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identif...
Contexts in source publication
Context 1
... persons with influenza illness (n = 1041, 79%) incurred expense (Tabe S1). The total median cost to patients' families for influenza episodes was $22 [interquar- tile range (IQR) $31], of which $3 was direct (IQR 8) and $15 indirect (IQR 25) ( Table 2). Medications accounted for the largest proportion of direct costs (63%), followed by transportation and other costs (17%), physician fees (15%), and diagnostic tests (4%) ( Table 2). ...
Context 2
... total median cost to patients' families for influenza episodes was $22 [interquar- tile range (IQR) $31], of which $3 was direct (IQR 8) and $15 indirect (IQR 25) ( Table 2). Medications accounted for the largest proportion of direct costs (63%), followed by transportation and other costs (17%), physician fees (15%), and diagnostic tests (4%) ( Table 2). Total indirect costs were consistently higher than direct costs for all levels of medical care sought and were significantly higher among cases (median $6, IQR 21) than among caregivers (median $2; IQR 13) (P < 0Á0005). ...
Context 3
... overall influenza rates within the cohort (Table 6), 7 the median costs from this study (Table 2) and the Peruvian census, we estimated an annual cost of influenza illness of $83 million in 2009 and $85 million in 2010 (Table 6). Influenza-associated cost represented approximately 0Á06- 0Á07% of gross domestic product. ...
Citations
... Influenza causes substantive economic and disease burden in Peru that results in high rates of hospitalizations and deaths [1][2][3][4]. To mitigate this burden, each year Peru's government purchases one trivalent inactivated influenza vaccine product though the Pan American Health Organization and provides doses free of charge for target groups identified by the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) [5]; these target groups include young children, pregnant women, older adults, individuals with comorbidities, and healthcare personnel (HCP). ...
Introduction:
Despite a government-subsidized vaccination program, healthcare personnel (HCP) influenza vaccination uptake remains low in Peru. Using three years of cross-sectional surveys and an additional five years of prior vaccination history of HCP in Peru, we explored HCP knowledge, attitudes, and practices (KAP) of influenza illness and its impact on vaccination frequency.
Methods:
In 2016, the Estudio Vacuna de Influenza Peru (VIP) cohort was initiated in Lima, Peru, which collected information about HCP KAP and influenza vaccination history from 2011─2018. HCP were classified by their 8-year influenza vaccination history as never (0 years), infrequently (1─4 years), or frequently (5─8 years) vaccinated. Logistic regression models were used to describe KAP associated with frequent compared to infrequent influenza vaccination, adjusted for each HCP's healthcare workplace, age, sex, preexisting medical conditions, occupation, and length of time providing direct patient care.
Results:
From 2016─2018, 5131 HCP were recruited and 3120 fully enrolled in VIP; 2782 consistently reported influenza vaccination status and became our analytic sample. From 2011─2018, 14.3% of HCP never, 61.4% infrequently, and 24.4% frequently received influenza vaccines. Compared to HCP who were infrequently vaccinated, frequently vaccinated HCP were more likely to believe they were susceptible to influenza (adjusted odds ratio [aOR]:1.49, 95% confidence interval [CI]:1.22─1.82), perceived vaccination to be effective (aOR:1.92, 95%CI:1.59─2.32), were knowledgeable about influenza and vaccination (aOR:1.37, 95%CI:1.06─1.77), and believed vaccination had emotional benefits like reduced regret or anger if they became ill with influenza (aOR:1.96, 95%CI:1.60─2.42). HCP who reported vaccination barriers like not having time or a convenient place to receive vaccines had reduced odds of frequent vaccination (aOR:0.74, 95%CI:0.61─0.89) compared to those without reported barriers.
Conclusion:
Few HCP frequently received influenza vaccines during an eight-year period. To increase HCP influenza vaccination in middle-income settings like Peru, campaigns could strengthen influenza risk perception, vaccine knowledge, and accessibility.
... The benefits of influenza vaccines accrue as more individuals become vaccinated and are associated with illness prevention and attenuation [22], decreased presenteeism and absenteeism, and direct and indirect economic benefits [23][24][25][26]. Besides effectively preventing influenza illness and illness complications among women [4,18], influenza vaccination during pregnancy has an added benefit of protecting against adverse birth outcomes, including preterm birth, low birthweight, and death. ...
Background
Few studies have examined influenza vaccine effectiveness (VE) among women during pregnancy in middle-income countries. We used data from a prospective cohort of women who were pregnant in Peru to estimate effectiveness of the 2018 Southern Hemisphere influenza vaccine.
Methods
Women at <28 weeks gestation were enrolled from four tertiary level hospitals in Lima, Peru at the start of the 2018 influenza season and followed until the end of their pregnancies. Participants had mid-turbinate nasal swabs collected and tested for influenza by RT-PCR with onset of >1 of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing. Time-varying Cox proportional hazard regression models were used to estimate the risk of RT-PCR-confirmed influenza infection after adjusting for inverse probability treatment weight.
Results
We followed 1,896 women for a median of 127 days (IQR; 86-174). Participants had a median age of 29 years (IQR: 24–34). Among the 1,896 women, 49% were vaccinated with the 2018 influenza vaccine and 1,039 (55%) developed influenza-like illness of which, 76 (7%) had RT-PCR-confirmed influenza. Incidence rates of RT-PCR-confirmed influenza were 36.6 and 15.3 per 100,000 person-days among women who were unvaccinated and vaccinated, respectively. Adjusted influenza VE was 22% (95% CI: -64.1%, 62.9%).
Conclusion
Participants vaccinated against influenza had more than 50% lower incidence of RT-PCR-confirmed influenza illness. While the VE estimated through propensity weight-adjusted time-varying Cox regression did not reach statistical significance, our findings provide additional evidence about the value of maternal influenza vaccination in middle-income countries.
... Macroeconomic impacts of pandemics of respiratory diseases were expressed in 53 of 62 studies in different ways in the reviewed articles: impacts on economic indices, welfare and well-being, productivity loss, broader additional costs or burden, and projected economic impacts. Paying attention to the economic indices, [11,16,19,25,[30][31][32]34,37,41,44,48,49,55] gross domestic product (GDP) percentage loss is the most common reported economic impacts in reviewed studies. In the USA, the UK, Peru, Thailand, Southeast Asia, South Africa, and Uganda, GDP loss was reported <1% because of disease such as flu and H1N1 between 2001 and 2015. ...
... In the USA, the UK, Peru, Thailand, Southeast Asia, South Africa, and Uganda, GDP loss was reported <1% because of disease such as flu and H1N1 between 2001 and 2015. [19,23,49,60] In China, by averaging the first, third, and fourth quarters of 2003, the second-quarter loss was estimated as a 3.1% decrease in GDP for the quarter, resulting an estimated loss of USD 12.3-28.4 billion for the whole year. ...
... On the other hand, welfare and well-being impacts were reported in 20 studies. [22,23,[25][26][27][30][31][32]36,38,40,41,43,45,48,49,51,53,54,59,66] For instance the estimated welfare impact by avian influenza in Minnesota, USA, in 2019 was $13.6 million. [48] Furthermore, by considering revenue loss, SARS disease, in 2003, caused a decline in the average annual household income to $175.44, a 22.36% reduction in what was expected. ...
Background:
The economic impact of acute respiratory disease pandemics has yet to be specifically systematically reviewed. The aim of this scoping review is to identify and classify the economic impacts and its values and ranges.
Materials and methods:
We conducted a literature search across three key databases using an extensive list of keywords. Then, we included studies which explored direct and indirect costs as well as broader economic impact associated with different nine acute respiratory diseases, i.e., pandemic and seasonal influenza, avian influenza, equine influenza, swine influenza, severe acute respiratory syndrome, coronavirus disease 2019, Middle East respiratory syndrome, H1N1, and H7N9.
Results:
We included 62 studies in English language between 1987 and 2020, mostly from the countries of East Asia and Pacific pertinent. We classified the economic impact into 5 main categories and 18 subcategories. The main categories were macroeconomic impacts, impacts on health cost, industry, businesses and trade, and education.
Conclusion:
Respiratory disease pandemics have widely impacted different sectors of economy such as the direct cost on macroeconomic, providing and receiving health services, disease management, industries, business and trade, education, and indirect costs due to productivity losses. However, lots of the reviewed studies were unable to quantify the actual economic cost of these impacts. This made it challenging to conduct any kind of quantitative comparison of the results. A key priority for future research is to develop standard methods to quantify the broader economic costs of respiratory disease pandemics. Understanding the total economic impact of respiratory disease pandemics is a key step to inform national and international priority setting for disease prevention and pandemic control interventions.
... Brazilian Journal of Development, Curitiba, v.8, n.6, p. 45634-45644, jun.,20223 RESULTADOSConsiderando o número relativamente pequeno de estudos, inconsistências entre eles, diferenças nas medidas de resultados e heterogeneidade das doenças, desfechos, metodologias empregadas e populações entre os países, fizemos uma síntese narrativa, mas com uma grande diversidade de resultados, dada também a extensão das IATR.Identificou-se 10 estudos envolvendo custos das IR em países da AL, que inclui o subcontinente sul-americano(AUGUSTOVSKI et al., 2009;BAHIA et al., 2013;BERNAL-AGUIRRE;ALVIS-ZAKZUK, 2017;CHICAIZA-AYALA et al., 2018;CHOEZ et al., 2020;ISTURIZ;LUNA;RAMIREZ, 2010;JAMOTTE et al., 2017;JARA et al., 2019;MARRERO ARAÚJO;GARCÍA FARIÑAS;GÁLVEZ GÓNZALES, 2020;TINOCO et al., 2016). Dois deles abarcavam toda AL(BAHIA et al., 2013;ISTURIZ;LUNA;RAMIREZ, 2010). ...
... Um terceiro foi realizado com dados do Brasil, Colômbia e Panamá, mas imputou-se o termo AL (JAMOTTE et al., 2017). Os demais foram feitos na Argentina, um no Peru, um na Colômbia e dois no Equador (AUGUSTOVSKI et al., 2009; BERNAL-AGUIRRE; ALVIS-ZAKZUK, 2017; CHICAIZA-AYALA et al., 2018;CHOEZ et al., 2020;TINOCO et al., 2016). Os dois restantes são de países que que nãopertencem à AS, mas a AL: um estudo de Cuba e outro do Panamá e El Salvador (JARA et al., 2019; MARRERO ARAÚJO; GARCÍA FARIÑAS; GÁLVEZ GÓNZALES, 2020). ...
As infecções agudas do trato respiratório (IATR) têm elevada morbimortalidade mundial, com importante perda de produtividade em países da América Latina e Caribe (ALC) e, em particular, da América do Sul (AS). Esta revisão não sistemática da literatura objetiva organizar os estudos sobre a estimativa da produtividade perdida devido a mortalidade por IATR em países da AS. Levantou-se publicações de 2012 a 2022 presentes no PubMed, Portal Regional da Biblioteca Virtual em Saúde (BVS) e no Science Direct. Identificou-se 10 estudos envolvendo custos das IATR em países da AL, que inclui o subcontinente sul-americano. Duas revisões sistemáticas foram recuperadas. Pneumonia, Influenza e outras infecções do trato superior e inferior foram abordadas em estudos que usaram modelos de simulação, Markov, e dados primários e secundários para o cálculo de custos diretos e indiretos relacionados a produtividade perdida. Outros desfechos encontrados relacionavam-se a dados epidemiológicos e clínicos, como duração da doença. São necessários mais estudos de qualidade sobre a temática, a fim de apoiar decisões sobre a alocação de recursos destinados ao planejamento de políticas e intervenções sanitárias, para sua prevenção.
... Even in the tropical climate of the Peruvian Amazon rainforest, influenza has been found to be a major cause of illness, accounting for 16.5 episodes of symptomatic illness per 1,000 person-years [3]. As such, influenza places a major economic burden on Peru, with one study estimating the impact to be $85 million USD per year and with the highest burden falling on the poorest families [4]. ...
Background
Influenza is a major source of morbidity and mortality with an annual global attack rate estimated at 5–10% in adults and 20–30% in children. Influenza vaccination is the main strategy for reducing influenza-related morbidity and mortality. Like several other countries, Peru has low vaccination coverage, estimated at 25–50% among young children and older adults. Therefore, the study objective was to explore the knowledge, beliefs, attitudes, and practices related to influenza vaccination among populations at higher risk for infection and/or complications and health professionals in Peru, and their perspectives on health communication channels.
Methods
This qualitative study was carried out in three cities. We held nine focus groups with pregnant and postpartum women, parents of young children, and older adults. We carried out 25 in-depth interviews with health professionals (HPs) working in, leading or advising immunization-related programs.
Results
HPs correctly identified the causes of influenza and HPs and at risk community members identified major symptoms. Community members had poor awareness of the potential severity of influenza and were generally unaware of influenza-related mortality. Both HPs and community members greatly underestimated the prevalence of influenza in Peru. HPs in our study overestimated major side effects of the influenza vaccine and community members perceived that the vaccine caused illness. HPs missed important opportunities to promote vaccination in patients with minor illness (runny nose, allergies, colds) and community members did not understand that the vaccine should be received annually.
Conclusions
There is no single strategy that will increase influenza vaccination rates to World Health Organization recommended levels. Instead, it requires multi-faceted commitment from HPs, other healthcare authorities and the government. Addressing important knowledge barriers, specifically negative views regarding the influenza vaccine and the severe morbidity and mortality associated with influenza illness, both in the community and especially among HPs, could have significant impacts.
... Influenza also causes a substantial economic burden. During 2010, the total median cost of treatment of laboratory-confirmed influenza was US$17 in children <5 years and US$36 in people >65 years, generating an annual burden of US$ 85 million in direct and indirect treatment costs for Peru [5]. ...
Background:
Although Peru provides safe and effective influenza vaccines free-of-charge, coverage among vaccine target groups like pregnant women and older adults remains low. To improve risk communication messages and vaccine uptake, we explored knowledge, perceptions and practices about influenza illness and vaccination.
Methods:
A cross-sectional, community-based survey with a three-stage cluster sampling design was conducted in three cities in Peru. We included mothers of young children, pregnant women and persons ≥65 years. Participants completed a questionnaire about knowledge, perceptions and practices about influenza illness and vaccination against influenza during the past year. Generalized linear models were used to explore factors associated with vaccination in the past year.
Results:
624/645 (97%) mothers, 54/55 (98%) pregnant women and 622/673 (92%) older adults approached provided informed consent and were surveyed. While most mothers, pregnant women and older adults (94%, 96% and 91%, respectively) perceived influenza as a potentially serious illness, few pregnant women (13%) and older adults (34%) self-identified themselves as a target group for influenza vaccination. Only 28% of mothers, 19% pregnant women, and 27% older adults were vaccinated against influenza during the previous year. Among the participants that did not get vaccinated against influenza in the previous year, "being afraid of vaccination and its effects" was the most commonly cited barrier. Knowledge of the recommendation for annual vaccination was significantly associated with vaccination status among pregnant women (p = 0.048) and older adults (p = 0.004).
Conclusion:
Despite a government subsidized vaccine program, vaccine utilization remained low among pregnant women and older adults, who seemed typically unaware of their status as high-risk groups targeted for vaccination. Those aware of the recommendations for annual vaccination were more likely to be vaccinated. Information campaigns addressing fears and highlighting populations at risk for severe influenza illness that are targeted for vaccination might increase vaccine coverage in Peru.
... For example, viruses like HIV (Ortblad et al. 2013), hepatitis (Lavanchy 2009), Zika (Alfaro-Murillo et al. 2016), or viruses of respiratory system (Pavia, 2011) and influenza (Fischer et al. 2014) become endemics and affect all members of the populations worldwide. Viral diseases not only places high pressure on health expenditures (Tinoco et al. 2016), it also causes work absenteeism and reduced work activity (Akazawa et al. 2003). Additionally, viral infections cause fatigue, myalgia, arthralgia, headache, fever, anorexia, nausea, vomiting, diarrhea, electrolyte abnormalities, abdominal pain, or organ damages (Leligdowicz et al. 2016). ...
This study aimed to investigate the effects of maternal viral infection during a critical time window of fetal hypothalamic development on timing of puberty in the female offspring. For that purpose, a viral mimetic (i.e. synthetic double strand RNA, namely, polyinosinic:polycytidylic acid, Poly (I:C)) or saline was injected (i.p.) to the pregnant rats during the beginning (day 12 of pregnancy, n=5 for each group) or at the end of this time window (day 14 of pregnancy, n=5 for each group). Four study groups were formed from the female pups (n=9 or 10 pups/group). Following weaning of pups, vaginal opening and vaginal smearing was studied daily until two sequential estrous cycles were observed. During the second diestrus phase, blood samples were taken for progesterone, leptin, corticosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH). Maternal poly (I:C) injection on day 12 of pregnancy increased body weight and reduced the time to puberty in the female offspring. Neither poly (I:C) nor timing of injection affected other parameters studied (p > 0.05). In conclusion, it has been shown for the first time that maternal viral infection during the beginning of fetal hypothalamic development might hasten puberty by increasing body weight in rat offspring.
... Peru is a country with a wide range of ecosystems: desert, semiarid, highland valleys, and tropical rainforest [12]. Recent studies suggest that the economic burden caused by influenza in Peru is substantial among WHO-SAGE target groups [14]. Current policy in Peru recommends annual influenza vaccination of pregnant women, children aged 7-23 months, health workers, the elderly (≥65 years), and people with comorbidities [15]. ...
... We speculate these differences might be due to lower healthcare seeking among older adults in Peru compared with those in high-income settings. Despite these overall low rates of influenza-associated hospitalization and death, the high morbidity in children and resultant associated economic costs [14] nevertheless strongly support the WHO-SAGE recommendation for targeting young children for annual influenza vaccination [10]. Peru might also explore the potential value of expanding influenza vaccination to school-aged children (eg, 5-11 years) in hopes of an overall reduction of influenza-associated illness among all ages by indirect protection [34,35]. ...
Background:
There are limited data on the burden of disease posed by influenza in low- and middle-income countries. Furthermore, most estimates of influenza disease burden worldwide rely on passive sentinel surveillance at health clinics and hospitals that lack accurate population denominators.
Methods:
We documented influenza incidence, seasonality, health-system utilization with influenza illness, and vaccination coverage through active community-based surveillance in 4 ecologically distinct regions of Peru over 6 years. Approximately 7200 people in 1500 randomly selected households were visited 3 times per week. Naso- and oropharyngeal swabs were collected from persons with influenza-like illness and tested for influenza virus by real-time reverse-transcription polymerase chain reaction.
Results:
We followed participants for 35353 person-years (PY). The overall incidence of influenza was 100 per 1000 PY (95% confidence interval [CI], 97-104) and was highest in children aged 2-4 years (256/1000 PY [95% CI, 236-277]). Seasonal incidence trends were similar across sites, with 61% of annual influenza cases occurring during the austral winter (May-September). Of all participants, 44 per 1000 PY (95% CI, 42-46) sought medical care, 0.7 per 1000 PY (95% CI, 0.4-1.0) were hospitalized, and 1 person died (2.8/100000 PY). Influenza vaccine coverage was 27% among children aged 6-23 months and 26% among persons aged ≥65 years.
Conclusions:
Our results indicate that 1 in 10 persons develops influenza each year in Peru, with the highest incidence in young children. Active community-based surveillance allows for a better understanding of the true burden and seasonality of disease that is essential to plan the optimal target groups, timing, and cost of national influenza vaccination programs.
... about/) and prospectively collected weekly adjusted influenza incidence data from 2 community-based cohorts in Lima and Cusco, Peru, available from 1 January 2011 to 26 July 2014. The details of these community-based surveillance studies are described elsewhere [23,24]. ...
BACKGROUND
?Latin America has a substantial burden of influenza and rising Internet access and could thus benefit from real-time influenza epidemic prediction web-tools such as Google Flu Trends (GFT) to assist in risk communication and resource allocation during epidemics. However, there has never been a published assessment of GFT's accuracy in most of the Latin American countries nor in any low-middle income country. We aimed to evaluate GFT in Argentina, Bolivia, Brazil, Chile, Mexico, Paraguay, Peru and Uruguay.
METHODS
?Weekly influenza-test positive proportions for the eight countries were obtained from FluNet for the period January 2011 - December 2014. Concurrent weekly Google-predicted influenza activity in the same countries were abstracted from GFT. Pearson correlation coefficients between observed and Google-predicted influenza activity trends were determined for each country. Permutation tests were used to examine background seasonal correlation between FluNet and GFT by country.
RESULTS
?There were frequent GFT prediction errors, with correlation ranging from r=-0.53 to 0.91. GFT-predicted influenza activity best correlated with FluNet data in Mexico follow by Uruguay, Argentina, Chile, Brazil, Peru, Bolivia and Paraguay. Correlation was generally highest in the more temperate countries with more regular influenza seasonality and lowest in tropical regions. A substantial amount of autocorrelation was noted, suggestive that GFT is not fully specific of influenza virus activity.
CONCLUSIONS
?We note substantial inaccuracies with GFT-predicted influenza activity compared to FluNet throughout Latin America, particularly among tropical countries with irregular influenza seasonality. Our findings offer valuable lessons for future internet-based biosurveillance tools.
... The overall incidence of SARI and F-SARI in our study was estimated at 187.6 and 29.0 per 100 000 population, respectively. In a Peruvian study by Tinocco et al. (19) the annual incidence of influenza per 100 000 population in different age groups was calculated as: < 5 years, 277; 5-17 years, 225; 18-49 years, 74; 50-64 years, 65; and > 65 years, 46. We estimated the annual incidences for different age groups as: < 5 years, 492; 5-14 years, 1; 15-49 years, 23; 50-64 years, 86; and > 65 years, 47. ...
There are few estimates of influenza burden in the WHO Region for the Eastern Mediterranean. In this study we estimated the burden of severe acute respiratory infection (SARI) and influenza-associated SARI (F-SARI) in selected provinces of Islamic Republic of Iran, the trends of SARI and confirmed cases of influenza (F-SARI) over 12 months (seasonality), and the age groups most at risk. Using the electronic Iranian influenza surveillance system and data of cases in sentinel hospitals of 3 selected provinces, we estimated the monthly trend (seasonality) of incidence for SARI and F-SARI, overall incidence of SARI and F-SARI and their disaggregation by age with the aid using the Monte Carlo technique.
The age groups most at-risk were children aged under 2 years and adults older than 50 years.
