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Title: The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st century
Authors: Caini, Saverio 
Kusznierz, Gabriela F. 
Garate, Verònica Vera 
Wangchuk, Sonam 
Thapa, Binay 
de Paula Júnior, Francisco José 
Ferreira de Almeida, Walquiria Aparecida 
Njouom, Richard 
Fasce, Rodrigo A 
Bustos, Patricia L. 
Feng, Luzhao 
Peng, Zhibin 
Araya, Jenny Lara 
Bruno, Alfredo 
de Mora, Doménica 
Barahona de Gámez, Mónica Jeannette 
Pebody, Richard 
Zambon, Maria 
Higueros, Rocio 
Rivera, Rudevelinda 
Kosasih, Herman 
Castrucci, Maria Rita 
Bella, Antonino 
Kadjo, Hervé A 
Daouda, Coulibaly 
Makusheva, Ainash 
Bessonova, Olga 
Chaves, Sandra S 
Emukule, Gideon O 
Heraud, Jean-Michel 
Razanajatovo, Norosoa H 
Barakat, Amal 
El Falaki, Fatima 
Meijer, Adam 
Donker, Gé A 
Huang, Q Sue 
Wood, Tim 
Balmaseda, Angel 
Palekar, Rakhee 
Arévalo, Brechla Moreno 
Rodrigues, Ana Paula 
Guiomar, Raquel 
Lee, Vernon Jian Ming 
Ang, Li Wei 
Cohen, Cheryl 
Treurnicht, Florette 
Mironenko, Alla 
Holubka, Olha 
Bresee, Joseph 
Brammer, Lynnette 
Le, Mai T Q 
Hoang, Phuong V M 
El Guerche-Séblain, Clotilde 
Paget, John 
Issue Date: 2019
Journal: PloS one 
We describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000-2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.
DOI: 10.1371/journal.pone.0222381
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