Estimation of influenza‐ and respiratory syncytial virus‐attributable medically attended acute respiratory infections in Germany, 2010/11‐2017/18

BACKGROUND: The burden of influenza in primary care is difficult to assess, since most patients with symptoms of a respiratory infection are not tested. The case definition of "medically attended acute respiratory infection" (MAARI) in the German physician sentinel is sensitive; however, it requires modelling techniques to derive estimates of disease attributable to influenza and respiratory syncytial virus (RSV). OBJECTIVES: The objective of this paper was to review and extend our previously published model in order to estimate the burden of RSV and the differential burden of the two influenza B lineages (Victoria, Yamagata) as well as both influenza A subtypes on primary care visits. METHODS: Data on MAARI and virological results of respiratory samples (virological sentinel) were available from 2010/11 until 2017/18. We updated the previously published generalized additive regression model to include RSV. RESULTS: We found that the proportion of MAARI due to RSV is substantial only in the 0-1- and 2-4-year-old age groups (0-1 years old: median 7.5%, range 4.0%-14.8%; 2-4 years old: median 6.5%, range 4.0%-10.3%); in the 0-1 years old age group, RSV leads in almost all seasons to a higher burden than any influenza type or subtype, but this is reversed in the age group 2-4 years old. CONCLUSIONS: We succeeded in rearranging our previously published model on MAARI to incorporate RSV as well as the two influenza B lineages (Victoria, Yamagata) in the time period 2010 to 2018.