Using research to prepare for outbreaks of severe acute respiratory infection

When examining interventions used, patients in East Asia (50.7%), North America (49.3%) and Europe (35.6%) had higher frequencies of invasive mechanical ventilation compared with patients in South Asia (4.4%) and Sub-Saharan Africa (14.3%). Dialysis was received in 0% in Sub-Saharan Africa and Latin America and the Caribbean, 8.3% in Europe and Central Asia, 9.3% in North America, and 6.7% in East Asia and Pacific, although with BMJ Global Health Pathogen-specific disease burden has been examined by a number of other groups. 13 14 However, our finding that the majority of critically ill patients with SARI have no diagnosed microbial aetiology reinforces the need for syndrome-based, in addition to pathogen-based, surveillance for critically ill patients. This is especially true given the lack of relevant diagnostic testing in much of the world, which impacted the proportion of patients without identified pathogens. 15 The availability of global data and collaboration is essential, given the likely international nature of future outbreaks and requirements for pre-established coordination efforts. 16 The lack of a dedicated sampling protocol clearly impacts on interpretation of those findings. Future work should focus on optimising hospital sampling strategies to better understand global SARI disease; the lack of SARI pathogen-specific diagnostics on recently released Essential Diagnostic Lists exemplifies the lack of clarity on best testing strategies. 17 Regional SARI surveillance data have been published from a variety of countries 18 19 ; while we have yet to completely avoid site selection bias through BMJ Global Health the availability of reporting hospitals, the data collection tools used help reduce the risk of bias from individual patient selection or pathogen-specific attribution.