- Flu. Epidm. BangladeshBangladesh, the seventh most populous country in the world, has the highest population density(1,000 persons per square kilometer) of any country that is not a city state. It is a high riskcountry for emergence of pandemic influenza located in a region where the epidemiology ofinfluenza is incompletely described. The objective of this proposal is to describe the clinicalpresentation, epidemiology and burden of disease from influenza in Bangladesh.
The specificaims are to 1) Describe the clinical presentation and outcome of influenza in Bangladesh,including the relationship of presentation to clinical case definitions, hospitalization rates, andrisk factors for severe adverse outcomes. 2) Describe the epidemiology of influenza inBangladesh, including the seasonality, age distribution, and transmission patterns. 3) Describethe burden of disease and health impact of influenza in Bangladesh including incidence rates,hospitalization rates and mortality rates by age group. This project will select four geographicallydispersed hospitals in Bangladesh that are already participating in influenza surveillance, andadd additional activities. First, the study team will identify the geographic area where mostpatients live who present with influenza like illness in the outpatient facility of the hospital. Thestudy team will use government census data to identify the size of the population in thesecommunities, and will conduct a population based study to assess the proportion of peopleliving in these communities who use the outpatient services of the hospital when familymembers have respiratory illness. Second, the study team will systematically identify a sampleof patients who attend the out-patient clinic at the selected hospital, who live in the primarycatchment of the hospital, and who meet a case definition of influenza like illness (fever withcough or sore throat). Surveillance physicians will collect clinical information including clinicalseverity and need for hospitalization and a nasal and pharyngeal swab. Third, the study teamwill systematicallyidentify a sample of hospitalized inpatients who meet a case definition ofsevere acute respiratory illness (1. fever >38 C, 2. cough or sore throat, and 3. shortness ofbreath or difficulty breathing). They will collect a nasal and pharyngeal swab, and follow thepatient's clinical course. Nasal and pharyngeal swabs will be evaluated by real time PCR forthe presence of influenza virus. By characterizing the patients who present with influenza froma known catchment population, the proportion who are hospitalized, and among hospitalizedpatients the proportion who have serious adverse outcomes the team will model the incidenceand burden of influenza across Bangladesh.Project Narrative - Flu. Epidm. BangladeshInfluenza causes worldwide outbreaks that in the past have killed over 40 million people in asingle year. This project collects information about how influenza affects the population ofBangladesh, a country that is at high risk for emergence of new influenza strains, and a countrythat there is little information available on human influenza infection.

National Institute of Health (NIH)
National Center for Immunication and Respiratory Diseases (NCIRD)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZIP1-TYM (09))
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International Center/Diarrhoeal Dis Research
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