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      Epidemiological and virological characteristics of influenza B: results of the Global Influenza B Study

      a , b , c , d , e , f , g , h , i , j , j , k , l , m , n , o , p , q , r , s , t , u , v , w , a , x , a , on behalf of the Global Influenza B Study

      Influenza and Other Respiratory Viruses

      John Wiley & Sons, Ltd

      Burden of disease, epidemiology, Global Influenza B Study (GIBS), influenza, vaccination, vaccine mismatch

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          Literature on influenza focuses on influenza A, despite influenza B having a large public health impact. The Global Influenza B Study aims to collect information on global epidemiology and burden of disease of influenza B since 2000.


          Twenty-six countries in the Southern ( n = 5) and Northern ( n = 7) hemispheres and intertropical belt ( n = 14) provided virological and epidemiological data. We calculated the proportion of influenza cases due to type B and Victoria and Yamagata lineages in each country and season; tested the correlation between proportion of influenza B and maximum weekly influenza-like illness (ILI) rate during the same season; determined the frequency of vaccine mismatches; and described the age distribution of cases by virus type.


          The database included 935 673 influenza cases (2000–2013). Overall median proportion of influenza B was 22·6%, with no statistically significant differences across seasons. During seasons where influenza B was dominant or co-circulated (>20% of total detections), Victoria and Yamagata lineages predominated during 64% and 36% of seasons, respectively, and a vaccine mismatch was observed in ≈25% of seasons. Proportion of influenza B was inversely correlated with maximum ILI rate in the same season in the Northern and (with borderline significance) Southern hemispheres. Patients infected with influenza B were usually younger (5–17 years) than patients infected with influenza A.


          Influenza B is a common disease with some epidemiological differences from influenza A. This should be considered when optimizing control/prevention strategies in different regions and reducing the global burden of disease due to influenza.

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          Most cited references 17

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          Latitudinal Variations in Seasonal Activity of Influenza and Respiratory Syncytial Virus (RSV): A Global Comparative Review

          Background There is limited information on influenza and respiratory syncytial virus (RSV) seasonal patterns in tropical areas, although there is renewed interest in understanding the seasonal drivers of respiratory viruses. Methods We review geographic variations in seasonality of laboratory-confirmed influenza and RSV epidemics in 137 global locations based on literature review and electronic sources. We assessed peak timing and epidemic duration and explored their association with geography and study settings. We fitted time series model to weekly national data available from the WHO influenza surveillance system (FluNet) to further characterize seasonal parameters. Results Influenza and RSV activity consistently peaked during winter months in temperate locales, while there was greater diversity in the tropics. Several temperate locations experienced semi-annual influenza activity with peaks occurring in winter and summer. Semi-annual activity was relatively common in tropical areas of Southeast Asia for both viruses. Biennial cycles of RSV activity were identified in Northern Europe. Both viruses exhibited weak latitudinal gradients in the timing of epidemics by hemisphere, with peak timing occurring later in the calendar year with increasing latitude (P<0.03). Time series model applied to influenza data from 85 countries confirmed the presence of latitudinal gradients in timing, duration, seasonal amplitude, and between-year variability of epidemics. Overall, 80% of tropical locations experienced distinct RSV seasons lasting 6 months or less, while the percentage was 50% for influenza. Conclusion Our review combining literature and electronic data sources suggests that a large fraction of tropical locations experience focused seasons of respiratory virus activity in individual years. Information on seasonal patterns remains limited in large undersampled regions, included Africa and Central America. Future studies should attempt to link the observed latitudinal gradients in seasonality of viral epidemics with climatic and population factors, and explore regional differences in disease transmission dynamics and attack rates.
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            The burden of influenza B: a structured literature review.

            We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010. Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B-specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant. The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.
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              Global Patterns in Seasonal Activity of Influenza A/H3N2, A/H1N1, and B from 1997 to 2005: Viral Coexistence and Latitudinal Gradients

              Despite a mass of research on the epidemiology of seasonal influenza, overall patterns of infection have not been fully described on broad geographic scales and for specific types and subtypes of the influenza virus. Here we provide a descriptive analysis of laboratory-confirmed influenza surveillance data by type and subtype (A/H3N2, A/H1N1, and B) for 19 temperate countries in the Northern and Southern hemispheres from 1997 to 2005, compiled from a public database maintained by WHO (FluNet). Key findings include patterns of large scale co-occurrence of influenza type A and B, interhemispheric synchrony for subtype A/H3N2, and latitudinal gradients in epidemic timing for type A. These findings highlight the need for more countries to conduct year-round viral surveillance and report reliable incidence data at the type and subtype level, especially in the Tropics.

                Author and article information

                Influenza Other Respir Viruses
                Influenza Other Respir Viruses
                Influenza and Other Respiratory Viruses
                John Wiley & Sons, Ltd (Chichester, UK )
                August 2015
                10 August 2015
                : 9
                : Suppl 1
                : 3-12
                [a ]Netherlands Institute for Health Services Research (NIVEL) Utrecht, The Netherlands
                [b ]Institute of Environmental Science and Research Wellington, New Zealand
                [c ]Istanbul University Istanbul, Turkey
                [d ]Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni Santa Fe, Argentina
                [e ]Department of Health and Ageing, Influenza Surveillance Section, Surveillance Branch, Office of Health Protection Woden, ACT, Australia
                [f ]Public Health Laboratory, Department of Public Health, Ministry of Health Thimphu, Bhutan
                [g ]Ministry of Health Brasília, DF, Brazil
                [h ]Service de Virologie, Centre Pasteur du Cameroun Yaounde, Cameroon
                [i ]Sección de Virus Respiratorios y Exantemáticos, Instituto de Salud Pública de Chile Santiago de Chile, Chile
                [j ]Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention Beijing, China
                [k ]Respiratory Virus Unit, Public Health England Colindale, UK
                [l ]US Centers for Disease Control, Central American Region Guatemala City, Guatemala
                [m ]US Naval Medical Research Unit No. 2 Jakarta, Indonesia
                [n ]National Influenza Center, Istituto Superiore Sanità Rome, Italy
                [o ]Respiratory Viruses Unit, Pasteur Institute of Côte d’Ivoire Abidjan, Côte d’Ivoire
                [p ]US Centers for Disease Control and Prevention Nairobi, Kenya
                [q ]National Influenza Center, Virology Unit, Institut Pasteur of Madagascar Antananarivo, Madagascar
                [r ]Epidemiology and Disease Control Division, Ministry of Health Singapore, Singapore
                [s ]Global Disease Detection, US-CDC Pretoria, South Africa
                [t ]Zoonoses Research Unit, Department of Medical Virology, University of Pretoria Pretoria, South Africa
                [u ]L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases National Academy of Medical Science of Ukraine Kiev, Ukraine
                [v ]Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention Atlanta, GA, USA
                [w ]National Institute of Hygiene and Epidemiology Hanoi, Vietnam
                [x ]University of Pennsylvania Philadelphia, PA, USA
                Author notes
                Correspondence: John Paget, PhD, Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands., E-mail: j.paget@ 123456nivel.nl

                Global Influenza B Study members are in Appendix  1.

                Copyright © 2015 John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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