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Table 2 SARI data collection in nine countries in the WHO European Region, 2009-2012

From: Surveillance for severe acute respiratory infections (SARI) in hospitals in the WHO European region - an exploratory analysis of risk factors for a severe outcome in influenza-positive SARI cases

  Albania Armenia Belarus Georgia Kazakhstan Kyrgyzstan Romania Russian Federation Ukraine
Number of sentinel hospitals 15 6/7 11 6 17 4 12-26 19 9-10
Period data collection Nov 2009- Mar 2011 Dec 2010-Mar 2012 Sep 2010-Dec 2012 Jan 2009-Mar 2012 Sep 2011-Dec 2012 Nov 2010-Jun 2011 Oct 2009-May 2012 Sep 2010-Dec 2012 Sep 2009-Dec 2012
Case definition -all ages    Standarda Newcd Standardae   Newcd   
Case definition <5 WHOb Pneumb     Pneumb Pneumb Pneumb Pneumb
Case definition ≥ 5 Standarda Standarda     Standarda Standarda Standarda Standarda
No. SARI cases 102 335 1025 2138 857 369 1003 2779 4667
No. children aged 0–14 (%) 24 (23.5%) 287 (85.7%) 412 (40.1%) 1137 (53.5%) 538 (62.8%) 267 (72.4%) 491 (49.0%) 1718 (61.8%) 2339 (50.1%)
No. SARI tested influenza (%) 102 (100%) 188 (56.1%) 1025 (100%) 2138 (100%) 834 (97.3%) 43 (11.6%) 914 (91.1%) 2779 (100%) 4650 (99.6%)
Type of hospital included ID, PED, PULM, ICU GEN, ID, PED, EM, GYN GEN, ID, PED, EM GEN, ID, PED, EM, ICU ID, PED, EM GEN, ID, PED ID, PED, PULM, EM GEN, ID, PED, EM GEN, ID, PED
Number of beds per hospital 76-436 50-500 1000 63-250 100-395 180-400 92-1556 na 110-645
Catchment area and/or site selection 1 hospital in each of 12 counties + 3 hospitals in Tirana. 1 hospital in 2 regions and 5 hospitals in Yerevan. The 11 hospitals are located in large cities of the country’s 6 regions. SARI admission rates and collaboration NCDC used to identify sitese Most regions of the country were covered. The hospitals located in 7 regions of the country. Sites are located in 2 cities (Bishkek and Osh). The sites serve about 1.5 million of the population. Sites are regional clinical hospitals, well equipped for care to SARI cases, and cover 19-30% of population. Sites (1–2) are located in 9 cities in 6 Federal districts. The 9 cities cover a population of 10.5 million. Sites (10) are located in 4 cities in different geographical parts of the country.
Monitoring data quality Sentinel site visit Sentinel site visit. Monthly during season Weekly basis Monthly during seasonf All year round Two times a year at the national level Weekly at the national level by the SARI coordinator. Weekly basis Weekly at the national level by the SARI coordinator.
Vaccination recommendations (rec) g /risk groups and coverage Children < 5, Elderly >65, persons with underlying diseases, HCW WHO rec. WHO rec. Pregnant women obligatory since 2011 WHO rec. Pregnant women, persons with underlying diseasesh, > 65 yrs, children <2. Coverage in risk groups is 90% WHO rec. Coverage in risk groups is 98-100% Vaccination coverage in risk groups is about 3% (HCW, children and pilgrims) WHO rec. Persons 6 months-64 years old with chronic underlying conditions, pregnant women, HCW, staff working with institutionalised persons, residents of the social care institutions, persons ≥65 years old. Coverage is: Tot: 5.2-14.6%; 65+: 19.1%-49.4% HCW: 51%-97.8% WHO rec. >30 mln of population each year Age >60, underlying disease (chronic cardio-vascular, lung, kidney, liver, HIV, diabetes, primary immunodeficiency), pregnancy, HCW
Method influenza detection i PCR PCR, culture PCR PCR PCR, other, culture PCR, other Real-time PCR for type and subtype detection PCR PCR, other
  1. Abbreviations: ICU Intensive care unit, Na not available, PCR polymerase chain reaction, SARI severe acute respiratory infection, GEN general/multi-profile/national referral, ID infectious disease, PED paediatrics, EM emergency, PULM Pulmonology, GYN obstetrics and gynecology/maternal department, HCW Health care workers.
  2. aThe standard SARI case definition is defined as a patient with onset of the following symptoms ≤ 7 days prior to hospitalisation:
  3. Fever >38°C AND cough OR sore throat AND shortness of breath or difficulty in breathing.
  4. bThe WHO case definition is defined for pneumonia and severe pneumonia in children below the age of 5, and is as follows:
  5. Pneumonia: cough OR difficulty breathing AND breathing faster than 40 breaths/minute (12–59 month) or breathing faster than 50 breaths/minute (2–11 month);
  6. Severe pneumonia: cough OR difficulty breathing AND any of the following severe signs: unable to drink or breastfeed, OR vomits everything, OR convulsions, OR lethargic or unconscious, OR chest indrawing or stridor in a calm child.
  7. cNew WHO case definition – all ages.
  8. An acute respiratory illness with onset in the 7 days prior to hospital admission, that results in hospitalization over night and includes:
  9. History of fever or measured fever of ≥ 38°C, AND cough, AND shortness of breath or difficulty breathing.
  10. dThe new WHO case definition cdc was used in the 2011–2012 influenza season, for the seasons before 2011–2012 the WHO case definitionab was used.
  11. eSites were selected according to their SARI admission rates and collaboration with NCDC, most regions of the country were covered. In the first year 2008–2009 the surveillance was nationwide, in 2009–2010 a transition to a sentinel system was made, and was capable to provide representative data (personal communication).
  12. fThe sentinel epidemiologist monitors the data collection at a regular basis. The NCDC specialist visits the sentinel site and checks sentinel data on quarterly basis and monthly during the active influenza season (Personal communication Giorgi Chakhunashvili).
  13. gRecommended risk groups for seasonal influenza vaccination are: pregnant women (highest priority) and in no particular order of priority: children aged 6 to 59 months, the elderly, individuals with specific chronic medical conditions, and health-care workers [8].
  14. hCardiovascular disorder, respiratory disorder, kidney disorders, hepatitis, HIV, diabetes, immunocompromised persons, oncological patients.
  15. iIn case culture is used, this is performed in 1% of all tests.
  16. Note: country-specific information in this table (type of hospital included, number of beds per hospital, catchment area and/or site selection, monitoring data quality, vaccination recommendations) are kindly provided by the co-authors of this paper (personal communication).