Nonannual seasonality of influenza-like illness in a tropical urban setting

Ha Minh Lam, Amy Wesolowski, Nguyen Thanh Hung, Tran Dang Nguyen, Nguyen Thi Duy Nhat, Stacy Todd, Dao Nguyen Vinh, Nguyen Ha Thao Vy, Tran Thi Nhu Thao, Nguyen Thi Le Thanh, Phan Tri Tin, Ngo Ngoc Quang Minh, Juliet E. Bryant, Caroline O. Buckee, Tran Van Ngoc, Nguyen Van Vinh Chau, Guy E. Thwaites, Jeremy Farrar, Dong Thi Hoai Tam, Ha VinhMaciej F. Boni

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: In temperate and subtropical climates, respiratory diseases exhibit seasonal peaks in winter. In the tropics, with no winter, peak timings are irregular. Methods: To obtain a detailed picture of influenza-like illness (ILI) patterns in the tropics, we established an mHealth study in community clinics in Ho Chi Minh City (HCMC). During 2009-2015, clinics reported daily case numbers via SMS, with a subset performing molecular diagnostics for influenza virus. This real-time epidemiology network absorbs 6000 ILI reports annually, one or two orders of magnitude more than typical surveillance systems. A real-time online ILI indicator was developed to inform clinicians of the daily ILI activity in HCMC. Results: From August 2009 to December 2015, 63 clinics were enrolled and 36 920 SMS reports were received, covering approximately 1.7M outpatient visits. Approximately 10.6% of outpatients met the ILI case definition. ILI activity in HCMC exhibited strong nonannual dynamics with a dominant periodicity of 206 days. This was confirmed by time series decomposition, stepwise regression, and a forecasting exercise showing that median forecasting errors are 30%-40% lower when using a 206-day cycle. In ILI patients from whom nasopharyngeal swabs were taken, 31.2% were positive for influenza. There was no correlation between the ILI time series and the time series of influenza, influenza A, or influenza B (all P > 0.15). Conclusion: This suggests, for the first time, that a nonannual cycle may be an essential driver of respiratory disease dynamics in the tropics. An immunological interference hypothesis is discussed as a potential underlying mechanism.

Original languageEnglish (US)
Pages (from-to)742-754
Number of pages13
JournalInfluenza and other Respiratory Viruses
Issue number6
StatePublished - Nov 2018

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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