Epidemiology of seasonal influenza in the Middle East and North Africa regions, 2010‐2016: Circulating influenza A and B viruses and spatial timing of epidemics

BACKGROUND: There is a limited knowledge regarding the epidemiology of influenza in Middle East and North Africa. OBJECTIVES: We described the patterns of influenza circulation and the timing of seasonal epidemics in countries of Middle East and North Africa. METHODS: We used virological surveillance data for 2010‐2016 from the WHO FluNet database. In each country, we calculated the median proportion of cases that were caused by each virus type and subtype; determined the timing and amplitude of the primary and secondary peaks; and used linear regression models to test for spatial trends in the timing of epidemics. RESULTS: We included 70 532 influenza cases from seventeen countries. Influenza A and B accounted for a median 76.5% and 23.5% of cases in a season and were the dominant type in 86.8% and 13.2% of seasons. The proportion of influenza A cases that were subtyped was 85.9%, while only 4.4% of influenza B cases were characterized. For most countries, influenza seasonality was similar to the Northern Hemisphere, with a single large peak between January and March; exceptions were the countries in the Arabian Peninsula and Jordan, all of which showed clear secondary peaks, and some countries had an earlier primary peak (in November‐December in Bahrain and Qatar). The direction of the timing of influenza activity was east to west and south to north in 2012‐2013 and 2015‐2016, and west to east in 2014‐2015. CONCLUSIONS: The epidemiology of influenza is generally uniform in countries of Middle East and North Africa, with influenza B playing an important role in the seasonal disease burden.