TY - JOUR
T1 - Etiologies of severe acute respiratory infection (SARI) and misdiagnosis of influenza in Indonesia, 2013-2016
AU - Aman, Abu Tholib
AU - Wibawa, Tri
AU - Kosasih, Herman
AU - Asdie, Rizka Humardewayanti
AU - Safitri, Ida
AU - Intansari, Umi Solekhah
AU - Mawarti, Yuli
AU - Sudarmono, Pratiwi
AU - Arif, Mansyur
AU - Puspitasari, Dwiyanti
AU - Alisjahbana, Bachti
AU - Parwati, Ketut Tuti Merati
AU - Gasem, Muhammad Hussein
AU - Lokida, Dewi
AU - Lukman, Nurhayati
AU - Hartono, Teguh Sarry
AU - Mardian, Yan
AU - Liang, C. Jason
AU - Siddiqui, Sophia
AU - Karyana, Muhammad
AU - Lau, Chuen Yen
N1 - Funding Information:
This project has been funded in whole or in part with Federal funds from the NIAID, NIH, under contract Nos. HHSN261200800001E and HHSN261201500003I. NIAID collaborators contributed to design of the study; collection, analysis, and interpretation of data; and writing of the manuscript. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
Funding Information:
This project has been funded in whole or in part with Federal funds from the NIAID, NIH, under contract Nos. HHSN261200800001E and HHSN261201500003I. NIAID collaborators contributed to design of the study; collection, analysis, and interpretation of data; and writing of the manuscript. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. We are grateful for the support of the INA-RESPOND network, especially the research assistants. We also thank the patients at each site for their participation in the study: 1. Site 510 RSUP dr Hasan Sadikin/ Faculty of Medicine Universitas Padjajaran, Bandung; 2. Site 520 RSUP Sanglah/ Faculty of Medicine Universitas Udayana, Bali; 3. Site 530 RSUPN dr Cipto Mangunkusumo/ Faculty of Medicine Universitas Indonesia, Jakarta; 4. Site 540 RSPI Soelianti Soeroso, Jakarta; 5. Site 550 RSUP dr Wahidin Sudirohusodo/ Faculty of Medicine Universitas Hasanuddin, Makassar; 6. Site 560 RSUP dr Kariadi/ Faculty of Medicine Universitas Diponegoro, Semarang; 7. Site 570 RSUD dr Soetomo/ Faculty of Medicine Universitas Airlangga, Surabaya; and 8. Site 580 RSUP dr Sardjito/ Faculty of Medicine Universitas Gadjah Mada, Yogyakarta.
Publisher Copyright:
© 2020 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.
PY - 2021/1
Y1 - 2021/1
N2 - Background: Severe acute respiratory infection (SARI) accounts for a large burden of illness in Indonesia. However, epidemiology of SARI in tertiary hospitals in Indonesia is unknown. This study sought to assess the burden, clinical characteristics, and etiologies of SARI and concordance of clinical diagnosis with confirmed etiology. Methods: Data and samples were collected from subjects presenting with SARI as part of the acute febrile Illness requiring hospitalization study (AFIRE). In tertiary hospitals, clinical diagnosis was ascertained from chart review. Samples were analyzed to determine the “true” etiology of SARI at hospitals and Indonesia Research Partnership on Infectious Diseases (INA-RESPOND) laboratory. Distribution and characteristics of SARI by true etiology and accuracy of clinical diagnosis were assessed. Results: Four hundred and twenty of 1464 AFIRE subjects presented with SARI; etiology was identified in 242 (57.6%), including 121 (28.8%) viruses and bacteria associated with systemic infections, 70 (16.7%) respiratory bacteria and viruses other than influenza virus, and 51 (12.1%) influenza virus cases. None of these influenza patients were accurately diagnosed as having influenza during hospitalization. Conclusions: Influenza was misdiagnosed among all patients presenting with SARI to Indonesian tertiary hospitals in the AFIRE study. Diagnostic approaches and empiric management should be guided by known epidemiology. Public health strategies to address the high burden of influenza should include broad implementation of SARI screening, vaccination programs, clinician education and awareness campaigns, improved diagnostic capacity, and support for effective point-of-care tests.
AB - Background: Severe acute respiratory infection (SARI) accounts for a large burden of illness in Indonesia. However, epidemiology of SARI in tertiary hospitals in Indonesia is unknown. This study sought to assess the burden, clinical characteristics, and etiologies of SARI and concordance of clinical diagnosis with confirmed etiology. Methods: Data and samples were collected from subjects presenting with SARI as part of the acute febrile Illness requiring hospitalization study (AFIRE). In tertiary hospitals, clinical diagnosis was ascertained from chart review. Samples were analyzed to determine the “true” etiology of SARI at hospitals and Indonesia Research Partnership on Infectious Diseases (INA-RESPOND) laboratory. Distribution and characteristics of SARI by true etiology and accuracy of clinical diagnosis were assessed. Results: Four hundred and twenty of 1464 AFIRE subjects presented with SARI; etiology was identified in 242 (57.6%), including 121 (28.8%) viruses and bacteria associated with systemic infections, 70 (16.7%) respiratory bacteria and viruses other than influenza virus, and 51 (12.1%) influenza virus cases. None of these influenza patients were accurately diagnosed as having influenza during hospitalization. Conclusions: Influenza was misdiagnosed among all patients presenting with SARI to Indonesian tertiary hospitals in the AFIRE study. Diagnostic approaches and empiric management should be guided by known epidemiology. Public health strategies to address the high burden of influenza should include broad implementation of SARI screening, vaccination programs, clinician education and awareness campaigns, improved diagnostic capacity, and support for effective point-of-care tests.
KW - diagnostic accuracy
KW - etiology
KW - Indonesia
KW - influenza
KW - severe acute respiratory infection
UR - http://www.scopus.com/inward/record.url?scp=85087868865&partnerID=8YFLogxK
U2 - 10.1111/irv.12781
DO - 10.1111/irv.12781
M3 - Article
AN - SCOPUS:85087868865
VL - 15
SP - 34
EP - 44
JO - Influenza and other Respiratory Viruses
JF - Influenza and other Respiratory Viruses
SN - 1750-2640
IS - 1
ER -