Influenza Outbreak Among Students in Ghana: a Report From Three Time Points

Abstract Background: Influenza viruses are known to be responsible for a number of respiratory disease outbreaks worldwide. While there exists documented information on influenza which allows for effective strategic preparedness activities in industrialized countries, the same cannot be said of developing and underdeveloped countries. It therefore behoves on developing countries to document information on circulating strains of influenza. Such information will enable prioritization of prevention and more targeted preparedness strategies. In this paper, we report on three different outbreaks of Influenza A among Ghanaian students in December 2017, May 2019 and December 2019 in the Ashanti region of Ghana. Methods: Throat or nasal samples were collected with flocked swabs, stored in RNAlater and transported to the laboratories of Kumasi Centre for Collaborative Research (KCCR) at ambient temperature. Following viral RNA extraction, detection of viral nucleic acid of both influenza A and its subtypes including H1N1 and H3N2 was done by real-time reverse transcription Polymerase Chain Reaction (RT-PCR). Results: A total of 112 samples were taken. An overall Influenza A prevalence of 51.8% (95%CI = 42.1 – 61.3) was recorded during the three outbreak time points. Of these, 11 (9.8%) were confirmed to be H1N1 (pdm09) and 47 (42%) were H3N2 strains. All the 11 H1N1 (pdm09) were identified during the first outbreak. The H3N2 strains were identified during the second and third outbreaks in May 2019 and December 2019 respectively. Our results show that influenza A virus activity was highes during the months of November and December compared to May. Age, contact with infected subjects, temperature,fever within the last 24 hours and headaches showed significant variations (p-value <0.01) with respect to influenza A. Here, Wald’s test revealed that subjects presenting with headaches had about 5 times odds (95% CI = 1.4 - 17.7) for influenza A infection compared to subjects without headache (p = 0.014). Conclusion: Our study provides epidemiological information to better understand the incidence and burden of influenza to allow for prioritisation of prevention and control strategies. Such information would aid in controlling and preparing for future influenza epidemics.