Influenza activity in the Eastern Mediterranean (EMR) in 2020-2021 amid the COVID-19 pandemic – World

  1. Hala Abou El Naja,

  2. Tempia,

  3. amal barakat,

  4. Amgad Elkholy,

  5. amir aman,

  6. Wasiq Khan,

  7. Abdinasir Abubakari

  8. Correspondence with Dr. Abdinasir Abubakar; [email protected]


Introduction A global decline in influenza virus activity during the COVID-19 pandemic has been observed, including in the Eastern Mediterranean (EMR). However, these changes have not been thoroughly scientifically evaluated in the EMR.

Objective We aim to present data on seasonal influenza activity during the pre-pandemic period (2016-2019) and compare it with the pandemic period (2020-2021) in emerging countries.

Methods: Influenza epidemiological and virological surveillance data were retrieved from both WHO FluNet and EMFLU networks. Four pre-pandemic analytical periods were used in the comparative analysis. We collected and calculated weekly aggregated epidemiological data on the number of patients enrolled, the number of samples tested, and the number of positive influenza samples.

Results 19 of the 22 countries of the EMR have functioning sentinel flu surveillance systems, and these countries report flu data to WHO through FluNet and EMFLU. The number of enrolled patients and tested specimens gradually increased from 51 384 and 50 672 respectively in the analysis period 2016-2017 to 194 049 enrolled patients and 124 697 tested specimens in 2019-2020. A decrease has been observed in both enrolled patients and tested samples in the 2020-2021 ‘pandemic period’ (166,576 and 44,764, respectively). By comparing the flu activity of the analysis period 2020-2021 with that of the analysis period 2016-2019, we found that flu positivity in the EMR decreased by 89%.

Conclusion The implementation of non-pharmaceutical interventions to control the COVID-19 pandemic may also have influenced the spread of flu viruses. The low circulation of influenza viruses in 2020-2021 and the associated potential immunity gap may lead to increased transmission and severity of post-pandemic influenza seasons. This requires high vigilance for continuous data and virus sharing to monitor circulating viruses in a timely manner to reduce the intensity and severity of future flu epidemics.

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