Emergence, Epidemiology, and Transmission Dynamics of 2009 Pandemic A/H1N1 Influenza in Kampala, Uganda, 2009–2015

Matthew J. Cummings Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York;

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Barnabas Bakamutumaho National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda;

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Wan Yang Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York;

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Joseph F. Wamala Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda;
South Sudan Country Office, World Health Organization, Juba, South Sudan;

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John Kayiwa National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda;

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Nicholas Owor National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda;

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Barbara Namagambo National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda;

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Timothy Byaruhanga National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda;

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Allison Wolf Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York;

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Julius J. Lutwama National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda;

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Jeffrey Shaman Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York;

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Max R. O’Donnell Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York;
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

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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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Author Notes

Address correspondence to Max R. O’Donnell, Columbia University Medical Center, 622 West 168th Street, PH8-E, Room 101, New York, NY 10032. E-mail: mo2130@columbia.edu

Financial support: Surveillance activities carried out by UVRI were funded through Ministry of Health, Uganda, and the World Health Organization Country Office and Regional Office for Africa and a cooperative agreement with the U.S. Centers for Disease Control and Prevention. Additional support was provided by the Irving Institute for Clinical and Translational Research at Columbia University through the National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR000040) and the David R. Nalin’65 Fund for International Research at Albany Medical College.

Authors’ addresses: Matthew J. Cummings, Allison Wolf, and Max R. O’Donnell, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, E-mails: mjc2244@columbia.edu, aw2565@columbia.edu, and mo2130@columbia.edu. Barnabas Bakamutumaho, John Kayiwa, Nicholas Owor, Barbara Namagambo, Timothy Byaruhanga, and Julius J. Lutwama, National Influenza Center, Uganda Virus Research Institute, Entebbe, Uganda, E-mails: bbarnabas2001@yahoo.com, jkayiwa@uvri.go.ug, nicowor@gmail.com, barb.namax@gmail.com, tbyaruhanga@uvri.go.ug, and jjlutwama03@yahoo.com. Wan Yang, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, E-mail: wy2202@columbia.edu. Joseph F. Wamala, South Sudan Country Office, World Health Organization, Juba, South Sudan, E-mail: wamalaj@who.int. Jeffrey Shaman, Mailman School of Public Health, Columbia University, New York, NY, E-mail: jls106@columbia.edu.

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