Surveillance and management of influenza on the African continent.

EVALUATION OF: Yazdanbakhsh M, Kremsner PG. Influenza in Africa. PLoS Med. 6(12), e1000182 (2009). The African continent is burdened with a very heavy load of communicable diseases over and above other severe health problems. Not surprisingly, influenza has received relatively little attention on the continent even though it is, in its own right, a major cause of morbidity and mortality--to a much greater extent than in the developed world owing to the aggravating prevalence of underlying diseases. The paucity of laboratory support can be a serious drawback in the clinical management of patients. For example, cases of febrile illnesses are frequently erroneously treated as malaria. In addition, this deficiency of laboratory capacity is a serious gap in the overall global surveillance of influenza and, indeed, of new emerging infections in general. Influenza has been one of the most rigorously studied of all human viruses, having been isolated three-quarters of a century ago and intensively investigated since then. Much is known about its molecular biology, but its epidemiological behavior and its unpredictability still remain public-health problems to this day. Furthermore, while most literature on influenza has been published from developed countries of the world, where the winter season plays a pivotal role in its epidemiology, by contrast, relatively little is known about influenza behavior in tropical countries and even less in the African continent. How important it is to have a comprehensive surveillance facility in all parts of the world has been graphically illustrated by the totally unexpected and unpredicted start of the 2009 novel influenza A (H1N1) pandemic in North America.