Improving Influenza Surveillance in Sub-Saharan Africa/ Amelioration De la Surveillance De la Grippe En Afrique Sub-Saharienne/ Mejorar la Vigilancia De la Gripe En El Africa Subsahariana

Introduction Acute respiratory infections are major contributors to morbidity and mortality in Africa, (1) yet the burden of influenza in African countries is still poorly understood. (2,3) In the Afriflu meeting that was held in June 2010 in Marrakesh, Morocco, influenza specialists and public health experts pledged to follow concrete measures to bridge the knowledge gap on the burden of influenza in Africa. (4) One of the key measures recommended was the reinforcement of routine influenza surveillance capacity both from an epidemiological and a virological standpoint. Surveillance data from the African continent has increased substantially in the past five years, but they are still too sparse and inconsistent to allow for a thorough understanding of influenza virus circulation patterns on the continent and their associated morbidity and mortality, or to inform influenza control strategies. Generating robust seasonal influenza surveillance data is a concern both regionally and globally. The 2009 influenza pandemic had highlighted the importance of using a standardized approach and terminology in conducting influenza surveillance activities. In March 2011, the World Health Organization (WHO) held an expert consultation in Geneva, Switzerland, to develop global standards for influenza surveillance. (5) The specific aims of the meeting were to update case definitions for influenza-like illness (ILI) and severe acute respiratory infection (SARI) and to provide guidance on creating and maintaining influenza sentinel surveillance systems. To improve regional capacity for surveillance, WHO's Regional Office for Africa developed a regional strategy whereby ILI and SARI were included as priority diseases in the technical guidelines for integrated disease surveillance and response in the African Region, (6) as well as in specific guidelines for influenza sentinel surveillance. WHO selected eight target countries in sub-Saharan Africa--Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia --to receive support in starting or strengthening influenza sentinel surveillance and in improving data sharing nationally, regionally and globally via WHO's FluNet and Fluid databases (Box 1). (7,8) This endeavour, known as the Strengthening Influenza Sentinel Surveillance in Africa (SISA) project, was implemented by the Agence de Medecine Preventive in close collaboration with WHO. Project objectives and methods The primary objective of the SISA project was to develop or strengthen influenza sentinel surveillance systems in line with WHO standards in selected sub-Saharan African countries. Countries were chosen in a way intended to synergistically enhance the surveillance capacity development activities being supported in the region by other organizations. The ultimate goal was to generate a representative network of functional surveillance systems that would provide a reasonably accurate picture of influenza activity on the African continent. Countries were given support in the development of routine influenza data collection, analysis and reporting mechanisms at the national and international level, the latter via global databases. Box 1. World Health Organization (WHO) global influenza surveillance databases FluNet and FluiD FluNet--a global tool for influenza virological surveillance FluNet is a global tool for influenza virological surveillance. The virological data entered into FluNet (e.g. number of influenza viruses detected by subtype) are important for tracking the movement of viruses globally and interpreting global epidemiological patterns. FluNet data are publically available and provided in realtime. Results are presented in various formats including tables, maps and graphs. Data are provided remotely by National Influenza Centers (NICs) of the Global Influenza Surveillance and Response System (GISRS) and other national influenza reference laboratories collaborating actively with GISRS, or are uploaded from WHO regional databases. …