TY - JOUR
T1 - Geospatial epidemiology of hospitalized patients with a positive influenza assay
T2 - A nationwide study in Iran, 2016–2018
AU - Ebrahimi, Shahab Mohammad
AU - Kiani, Behzad
AU - Rahmatinejad, Zahra
AU - Baral, Stefan
AU - Hashtarkhani, Soheil
AU - Dehghan-Tezerjani, Mohammad
AU - Zare, Elahe
AU - Arian, Mahnaz
AU - Kiani, Fatemeh
AU - Gouya, Mohammad Mehdi
AU - Dadras, Mohammad Nasr
AU - Karamouzian, Mohammad
N1 - Publisher Copyright:
Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2022/12
Y1 - 2022/12
N2 - Introduction Seasonal influenza is a significant public health challenge worldwide. This study aimed to investigate the epidemiological characteristics and spatial patterns of severe hospitalized influenza cases confirmed by polymerase chain reaction (PCR) in Iran. Methods Data were obtained from Iran’s Ministry of Health and Medical Education and included all hospitalized lab-confirmed influenza cases from January 1, 2016, to December 30, 2018 (n = 9146). The Getis-Ord Gi* and Local Moran’s I statistics were used to explore the hotspot areas and spatial cluster/outlier patterns of influenza. We also built a multivariable logistic regression model to identify covariates associated with patients’ mortality. Results Cumulative incidence and mortality rate were estimated at 11.44 and 0.49 (per 100,000), respectively, and case fatality rate was estimated at 4.35%. The patients’ median age was 40 (interquartile range: 22–63), and 55.5% (n = 5073) were female. The hotspot and cluster analyses revealed high-risk areas in northern parts of Iran, especially in cold, humid, and densely populated areas. Moreover, influenza hotspots were more common during the colder months of the year, especially in high-elevated regions. Mortality was significantly associated with older age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 1.01–1.02), infection with virus type-A (aOR: 1.64, 95% CI: 1.27–2.15), male sex (aOR: 1.77, 95% CI: 1.44–2.18), cardiovascular disease (aOR: 1.71, 95% CI: 1.33–2.20), chronic obstructive pulmonary disease (aOR: 1.82, 95% CI: 1.40–2.34), malignancy (aOR: 4.77, 95% CI: 2.87–7.62), and grade-II obesity (aOR: 2.11, 95% CI: 1.09–3.74). Conclusions We characterized the spatial and epidemiological heterogeneities of severe hospitalized influenza cases confirmed by PCR in Iran. Detecting influenza hotspot clusters could inform prioritization and geographic specificity of influenza prevention, testing, and mitigation resource management, including vaccination planning in Iran.
AB - Introduction Seasonal influenza is a significant public health challenge worldwide. This study aimed to investigate the epidemiological characteristics and spatial patterns of severe hospitalized influenza cases confirmed by polymerase chain reaction (PCR) in Iran. Methods Data were obtained from Iran’s Ministry of Health and Medical Education and included all hospitalized lab-confirmed influenza cases from January 1, 2016, to December 30, 2018 (n = 9146). The Getis-Ord Gi* and Local Moran’s I statistics were used to explore the hotspot areas and spatial cluster/outlier patterns of influenza. We also built a multivariable logistic regression model to identify covariates associated with patients’ mortality. Results Cumulative incidence and mortality rate were estimated at 11.44 and 0.49 (per 100,000), respectively, and case fatality rate was estimated at 4.35%. The patients’ median age was 40 (interquartile range: 22–63), and 55.5% (n = 5073) were female. The hotspot and cluster analyses revealed high-risk areas in northern parts of Iran, especially in cold, humid, and densely populated areas. Moreover, influenza hotspots were more common during the colder months of the year, especially in high-elevated regions. Mortality was significantly associated with older age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 1.01–1.02), infection with virus type-A (aOR: 1.64, 95% CI: 1.27–2.15), male sex (aOR: 1.77, 95% CI: 1.44–2.18), cardiovascular disease (aOR: 1.71, 95% CI: 1.33–2.20), chronic obstructive pulmonary disease (aOR: 1.82, 95% CI: 1.40–2.34), malignancy (aOR: 4.77, 95% CI: 2.87–7.62), and grade-II obesity (aOR: 2.11, 95% CI: 1.09–3.74). Conclusions We characterized the spatial and epidemiological heterogeneities of severe hospitalized influenza cases confirmed by PCR in Iran. Detecting influenza hotspot clusters could inform prioritization and geographic specificity of influenza prevention, testing, and mitigation resource management, including vaccination planning in Iran.
UR - https://www.scopus.com/pages/publications/85144584964
UR - https://www.scopus.com/pages/publications/85144584964#tab=citedBy
U2 - 10.1371/journal.pone.0278900
DO - 10.1371/journal.pone.0278900
M3 - Article
C2 - 36512615
AN - SCOPUS:85144584964
SN - 1932-6203
VL - 17
JO - PloS one
JF - PloS one
IS - 12 December
M1 - e0278900
ER -