Meiring S, Tempia S, Dominic EM, de Gouveia L, McA. Excess invasive meningococcal disease associated with seasonal influenza, South Africa, 2003-2018. Clin Infect Dis. 2021 Aug 14:ciab702
Methods: This ecological study used weekly data from two nationwide surveillance programmes: Viral Watch (proportion of out-patient influenza-positive cases from throat/nasal swabs) and GERMS-SA (laboratory-confirmed cases of IMD) occurring across South Africa from 2003 through 2018 in all age-bands. A bivariate time-series analysis using wavelet transform was conducted to determine co-circulation of the diseases and the time lag between the peak seasons. We modelled excess meningococcal disease cases attributable to influenza co-circulation using univariate regression spline models. Stata and R statistical packages were used for the analysis.
Results: 5256 laboratory-confirmed IMD cases were reported, with an average annual incidence of 0.23 episodes per 100 000 population and a mean seasonal peak during week 32 (+3 weeks). Forty-two percent (10 421/24 741) of swabs were positive for influenza during the study period. The mean peak for all influenza occurred at week 26 (+4 weeks). There was an average lag-time of 5 weeks between annual influenza and IMD seasons. Overall, 5% (1-9%) of meningococcal disease can be attributable to influenza co-circulation with, on average, 17 excess IMD cases per year attributable to influenza.
Conclusion: A quantifiable proportion of meningococcal disease in South Africa is associated with influenza co-circulation, therefore seasonal influenza vaccination may have an effect on preventing a small portion of meningococcal disease in addition to preventing influenza.
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