Since the establishment of the National Influenza Surveillance Program in 2007, Bangladesh has significantly progressed in monitoring influenza through national and international collaboration. However, this collaboration has not been translated into actionable control policies, which coupled with low vaccination coverage, impose a substantial health and economic burden in Bangladesh. Critical gaps remain in understanding the influenza burden among high-risk populations and the barriers influencing their vaccine uptake. These gaps hinder the development of evidence-based strategies for prevention and control, consequently leaving the country vulnerable to a potentially catastrophic influenza epidemic. These challenges require a multifaceted approach, including continuous local data collection on disease burden and vaccine barriers, vaccine cost-effectiveness analyses, and the design of context-specific interventions. Leveraging existing infrastructures offers opportunities to develop tailored strategies for high-risk populations. A robust national influenza policy is imperative to mitigate the burden and reduce future pandemic threats.

Background: To aid in the development of antimicrobial stewardship programs (ASPs), we analyzed the patterns and trends in antibiotic prescriptions for patients with severe acute respiratory infection (SARI), utilizing the WHO’s AWaRe classification. Methods: We analyzed data from hospital-based influenza surveillance from January 2011 to December 2020 across nine Bangladeshi tertiary-level hospitals. Surveillance physicians collected WHO-defined SARI patient data, including demographics, clinical characteristics, and antibiotic prescriptions. Descriptive statistics and parametric and non-parametric tests were used for the analysis. Results: Of 21,566 SARI patients [median age 20 years (IQR: 1.33–45), 66% male], 91% were prescribed at least one antibiotic. A total of 25,133 antibiotics were prescribed, of which 47.0% were third-generation cephalosporins, 16.5% were macrolides, and 11.1% were beta-lactam/beta-lactamase inhibitors. According to the AWaRe classification, 28.7% were in the Access group, while 71.3% were in the Watch group, and none were from the Reserve group. A downward trend in Access group (30.4% to 25.1%; p = 0.010) and an upward trend in Watch group antibiotic prescription (69.6% to 74.9%; p = 0.010) were observed. We identified that patients aged < 5 years (aOR: 1.80; 95% CI: 1.44–2.25), who were treated in government hospitals (aOR: 1.45; 95% CI: 1.35–1.57), patients with the presence of lung diseases (aOR: 1.56; 95% CI: 1.35–1.80) had an increased likelihood of being prescribed Watch group antibiotics. Conclusions: This study reveals a concerning pattern of antibiotic overuse among SARI patients in Bangladesh, with a growing trend over the past decade towards increased Watch group antibiotic prescriptions. Only one-third of the prescribed antibiotics were from the Access group, falling short of the two-thirds threshold recommended by the WHO. Effective ASPs are crucial to optimize antibiotic prescriptions and mitigate the risk of antimicrobial resistance.

There is limited global evidence on whether influenza sentinel surveillance platforms can be effectively adapted for long-term SARS-CoV-2 monitoring in low-resource contexts. We explored the utility of the hospital-based influenza sentinel surveillance (HBIS) platform for monitoring SARS-CoV-2 in Bangladesh by comparing SARS-CoV-2 detection in HBIS platform with national COVID-19 platform and assessing how its integration into influenza surveillance aligns with national trends. From March 2020 to December 2024, we analysed data from patients with severe acute respiratory infection (SARI) and influenza-like illness (ILI) enrolled in HBIS. Socio-demographic and clinical data were recorded, and nasopharyngeal and oropharyngeal swabs were tested for influenza and SARS-CoV-2 using rRT-PCR. Whole-genome sequencing was performed on a subset of SARS-CoV-2-positive samples. Data from national COVID-19 platform were obtained from the Directorate General of Health Services, Bangladesh, and were compared with HBIS platform data using epidemic curves and Pearson correlation analysis. Among 25,366 (SARI: 20,226; ILI: 5140) patients, 13.0% (3310) tested positive for influenza, 6.6% (1680) for SARS-CoV-2, and 0.2% (43) were co-infected. SARS-CoV-2 positivity in HBIS (6.8%), including 0.2% co-infections, was lower than the national average (13.1%), but showed a strong correlation with national trends (Pearson r = 0.86, P < 0.001). Sequencing of 234 SARS-CoV-2 strains detected the beta and delta variants in April and May 2021, respectively, and omicron subvariants circulating from 2022 to 2024, aligning with the national COVID-19 platform. SARS-CoV-2 positivity trends in HBIS platform closely aligned with the national COVID-19 platform, demonstrating its potential as a sustainable platform for COVID-19 monitoring. Our findings underscore the feasibility of influenza sentinel surveillance as an early warning system for future COVID-19 outbreaks or other respiratory viruses of pandemic concern in Bangladesh and similar settings. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA (U01GH002259).

Background and Aims: Severe acute respiratory infections (SARI) remain a major cause of global morbidity and mortality, with a disproportionate burden in low‐ and middle‐income countries (LMICs). Although in‐hospital mortality is frequently reported, deaths occurring after hospital discharge remain poorly documented. We aimed to synthesise the available evidence on the causes and contributing factors of in‐hospital and post‐discharge mortality among patients hospitalised with SARI in LMICs. Methods: We conducted a scoping review following the Arksey and O'Malley framework and PRISMA‐ScR guidelines. PubMed, Web of Science, Scopus, and CINAHL were searched for studies published between January 2000 and October 2025 that reported in‐hospital and/or post‐discharge mortality among patients with SARI in LMICs. Findings were synthesised narratively to describe factors associated with in‐hospital and post‐discharge mortality, as well as reported causes of death. Results: Twenty‐nine studies from 13 LMICs met the inclusion criteria. All reported in‐hospital mortality (range: 0.4%–39.3%), while four reported post‐discharge mortality (range: 0.6%–5.7%). Thirteen studies examined factors associated with mortality. In‐hospital mortality was associated with older age, male sex, comorbidities, markers of severe clinical presentation, specific respiratory pathogens, and delayed healthcare seeking. Only one study specifically evaluated factors associated with post‐discharge mortality, identifying respiratory difficulty, underlying heart disease, and longer hospital stay among children, and chronic obstructive pulmonary disease and intensive care unit admission among adults as risk factors. Pathogen‐specific causes of in‐hospital death were reported in a single study, and no study reported definitive causes of post‐discharge mortality. Conclusion: Evidence on SARI‐associated mortality in LMICs is largely confined to in‐hospital outcomes, with limited assessment of post‐discharge mortality or causes of death. Standardised post‐discharge follow‐up and systematic cause‐of‐death reporting are needed to inform clinical care, strengthen surveillance, and support targeted interventions to reduce preventable SARI‐associated mortality in LMICs.

Respiratory syncytial virus (RSV) is the leading cause of respiratory morbidity and mortality in children under five years of age, especially in low- and middle-income countries (LMICs). In 2023, two RSV immunisation options, including a maternal RSV vaccine and a monoclonal antibody (mAb), became approved in several high-income countries. The World Health Organization has recently prequalified the maternal vaccine and the Gavi has committed funding for its introduction, raising the prospect of RSV vaccine availability in LMICs in the near future. This analysis thus underscores the need for country-specific data on the burden of disease and seasonality, as well as the acceptability of new immunisation options and evaluations of their cost-effectiveness. Achieving successful implementation will require health system strengthening, targeted strategies to address unwillingness to vaccinate, securing sustainable financing for immunisation, and ensuring sustained policy commitment. As in many other LMICs, the RSV infection continues to pose a substantial public health concern in Bangladesh. However, evidence gaps persist regarding RSV epidemiology, healthcare system readiness, and public perceptions and willingness regarding new immunisation options. We use Bangladesh as a model to identify gaps, review available evidence, and outline strategies for integrating maternal vaccine and infant mAb into the country’s maternal and child health programmes. Lessons drawn from this case study may be directly applicable to other LMICs, offering a pathway to equitable adoption of these life-saving interventions and reducing the substantial global burden of RSV.

Background: To better understand the true mortality burden among SARS-CoV-2-infected patients with severe respiratory illnesses, in resource-limited settings in Bangladesh, it is crucial to consider post-discharge deaths along with in-hospital deaths. We estimated the proportion of SARS-CoV-2-associated adult SARI patients who died after discharge and identified factors associated with these deaths. Methods: From March 2020–December 2023, we analyzed WHO defined severe acute respiratory infection (SARI) patient data from nine tertiary-level hospitals participating in national hospital-based influenza surveillance in Bangladesh. We estimated the proportion of SARS-CoV-2-associated deaths that occurred within 30 days after hospital-discharge and compared demographics, clinical characteristics between SARS-CoV-2-associated decedents and SARS-CoV-2 survivors. Logistic regression analyses were performed to determine for factors associated with SARS-CoV-2-infected post-discharge deaths. Results: We identified 7,816 SARI patients with a median age of 50 years (IQR: 32–60), 62% were male, and 16.4% (1,280) were laboratory-confirmed SARS-CoV-2-infected patients. Of the SARS-CoV-2-infected patients, 9.8% (126) died during their hospital stay. Of 1,154 patients who were alive at discharge, we followed 1,108 (96%) patients, and 111 (10%) died within 30 days after discharge. Patients aged 40-60 (aOR: 8.3, 95% CI: 2.45-27.70) and those aged ≥60 (aOR: 26.3, 95% CI: 8.01-86.2) compared to 18-40 years, residents of rural areas (aOR: 1.91, 95% CI: 1.10-3.31), and individuals with difficulty breathing (aOR: 4.13, 95% CI: 1.75-9.75) or kidney diseases (aOR: 4.62, 95% CI: 1.32-16.14) were significantly associated with a higher risk of post-discharge death. Conclusion: Almost half of the deaths among SARS-CoV-2-infected SARI patients in Bangladesh occurred within 30 days post-discharge. To improve post-discharge recovery among vulnerable patients with potential risk attributes, hospitals in resource-limited settings could develop safe-discharge algorithms, strengthen post-discharge care plans, and establish outpatient monitoring of recently discharged patients. Disclosures: All Authors: No reported disclosures