The 2009 pandemic influenza in Brazilian’s capitals: a multilevel analysis

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Introduction: In 2009, the World Health Organization reported a new pandemic. In Brazil, almost 90,000 cases of severe acute respiratory syndrome were confirmed. This study aims to investigate the factors associated with the 2009 pandemic influenza rate in Brazilian capitals. Methods: Ecological study, in which data were collected from the government information system. Thematic maps were built to describe the rate by sex and age group. Chi-square tests were used to evaluate the association between pandemic influenza incidence and the following factors: age group, sex, climate, Gross Domestic Product per capita, and region. The adjusted rate ratio of influenza was estimated using the multilevel Poisson model. Fixed effects were age group, sex, climate, GDP, and interaction terms. Random effects were capital (intercept) and region (slope). Results: A total of 13,171 confirmed cases of pandemic influenza were reported in 2009, in which 56% occurred in women, 39% in the 20-39 years age group, and 43% in the Southeast. The 2009 global rate of pandemic influenza in Brazilian capitals was 35.70/100,000. Women, 20-39 years of age group and subtropical climate showed the highest risk of getting ill. The highest and the lowest rates of pandemic influenza were observed in capitals of the South and Northeast regions, respectively. Conclusions: The 2009 pandemic influenza evidence high risk in adults and adolescents, female and subtropical climate. Continued social and health interventions to prevent and tackle influenza outbreaks and a robust surveillance information system are necessary to effectively control the disease.

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