Volume 98, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



In sub-Saharan Africa, little is known about the epidemiology of pandemic-prone influenza viruses in urban settings. Using data from a prospective sentinel surveillance network, we characterized the emergence, epidemiology, and transmission dynamics of 2009 pandemic A/H1N1 influenza (H1N1pdm09) in Kampala, Uganda. After virus introduction via international air travel from England in June 2009, we estimated the basic reproductive number in Kampala to be 1.06–1.13, corresponding to attack rates of 12–22%. We subsequently identified 613 cases of influenza in Kampala from 2009 to 2015, of which 191 (31.2%) were infected with H1N1pdm09. Patients infected with H1N1pdm09 were more likely to be older adult (ages 35–64) males with illness onset during rainy season months. Urban settings in sub-Saharan Africa are vulnerable to importation and intense transmission of pandemic-prone influenza viruses. Enhanced surveillance and influenza pandemic preparedness in these settings is needed.


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  1. Girard MP, Tam JS, Assossou OM, Kieny MP, 2010. The 2009 A (H1N1) influenza virus pandemic: a review. Vaccine 28: 48954902.
    [Google Scholar]
  2. Bell DM, Weisfuse IB, Hernandez-Avila M, Del Rio C, Bustamante X, Rodier G, 2009. Pandemic influenza as 21st century urban public health crisis. Emerg Infect Dis 15: 19631969.
    [Google Scholar]
  3. World Health Organization, 2010. Limiting Spread: Limiting the Spread of Pandemic, Zoonotic, and Seasonal Epidemic Influenza. Available at: http://www.who.int/influenza/resources/research/ research_agenda_influenza_stream_2_limiting_spread.pdf. Accessed June 5, 2017.
  4. Cummings MJ et al., 2016. Epidemiologic and spatiotemporal characterization of influenza and severe acute respiratory infection in Uganda, 2010–2015. Ann Am Thorac Soc 13: 21592168.
    [Google Scholar]
  5. Uganda Bureau of Statistics, 2014. The State of Uganda Population Report 2014. Available at: library.health.go.ug/download/file/fid/580910. Accessed June 27, 2017.
  6. Alirol E, Getaz L, Stoll B, Chappuis F, Loutan L, 2011. Urbanisation and infectious diseases in a globalised world. Lancet Infect Dis 11: 131141.
    [Google Scholar]
  7. Lutwama JJ, Bakamutumaho B, Kayiwa JT, Chiiza R, Namagambo B, Katz MA, Geissler AL, 2012. Clinic- and hospital-based sentinel influenza surveillance, Uganda 2007–2010. J Infect Dis 206 (Suppl 1): S87S93.
    [Google Scholar]
  8. Keeling MJ, Rohani P, 2007. Modeling Infectious Diseases in Humans and Animals. Princeton, NJ: Princeton University Press.
  9. Carrat F, Vergu E, Ferguson NM, Lemaitre M, Cauchemez S, Leach S, Valleron AJ, 2008. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 167: 775785.
    [Google Scholar]
  10. World Health Organization, 2016. Zika Situation Report. Zika Virus Microcephaly Guillain-Barré Syndrome. Available at: http://www.who.int/emergencies/zika-virus/situation-report/1-september-2016/en/. Accessed June 27, 2017.
  11. Wong VK et al., 2015. Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella typhi identifies inter- and intracontinental transmission events. Nat Genet 47: 632639.
    [Google Scholar]
  12. Conway DJ, 2007. Molecular epidemiology of malaria. Clin Microbiol Rev 20: 188204.
    [Google Scholar]
  13. Phillips H, Killingray D, 2003. The Spanish Influenza Pandemic of 1918–19: New Perspectives. New York, NY: Routledge.
  14. Van Kerkhove MD, Hirve S, Koukounari A, Mounts AW; H1N1pdm Serology Working Group, 2013. Estimating age-specific cumulative incidence for the 2009 influenza pandemic: a meta-analysis of A(H1N1)pdm09 serological studies from 19 countries. Influenza Other Respi Viruses 7: 872886.
    [Google Scholar]
  15. Biggerstaff M, Cauchemez S, Reed C, Gambhir M, Finelli L, 2014. Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature. BMC Infect Dis 14: 480.
    [Google Scholar]
  16. Bedford T et al., 2015. Global circulation patterns of seasonal influenza viruses vary with antigenic drift. Nature 523: 217220.
    [Google Scholar]
  17. Shek LP, Lee BW, 2003. Epidemiology and seasonality of respiratory tract virus infections in the tropics. Paediatr Respir Rev 4: 105111.
    [Google Scholar]
  18. Tamerius JD, Shaman J, Alonso WJ, Bloom-Feshbach K, Uejio CK, Comrie A, Viboud C, 2013. Environmental predictors of seasonal influenza epidemics across temperate and tropical climates. PLoS Pathog 9: e1003194.
    [Google Scholar]
  19. Cohen C, Simonsen L, Sample J, Kang JW, Miller M, Madhi SA, Campsmith M, Viboud C, 2012. Influenza-related mortality among adults aged 25–54 years with AIDS in South Africa and the United States of America. Clin Infect Dis 55: 9961003.
    [Google Scholar]

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  • Received : 30 Jun 2017
  • Accepted : 05 Sep 2017
  • Published online : 30 Oct 2017
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