It is now 10 years since the world was faced with the first severe and readily transmissible new disease of the 21st century – severe acute respiratory syndrome (SARS). Unknown and unrecognized, it emerged in late 2002 as the probable cause of an outbreak of atypical pneumonia in Guangdong Province, southern China. It then spread to Hong Kong Special Administrative Region (China) via an infected traveller who arrived at his hotel on 21 February 2003 where he infected 15 other guests. They, in turn, travelled to other countries carrying the new disease and initiating outbreaks in Viet Nam, Singapore and Canada. Three weeks later, with increasing numbers of cases among hospital staff in Hong Kong Special Administrative Region (China) and Viet Nam, the World Health Organization (WHO) issued a global alert on 12 March 2003 about this new acute respiratory syndrome of unknown etiology. However, the disease was spreading rapidly along major air routes, prompting WHO to issue an emergency travel advisory on 15 March, as well as naming the new disease “severe acute respiratory syndrome” and providing the first surveillance case definition.

Introduction: Influenza-associated severe acute respiratory infections (SARI) are a major contributor to global morbidity and mortality. In response to a cluster of SARI cases and deaths in pregnant women, with two deceased cases testing positive for influenza A(H1N1)pdm09, an investigation was initiated to determine whether there was an increase of paediatric SARI cases admitted to divisional hospital intensive care units in Fiji in may 2016 compared to May 2013–2015. Methods: Retrospective case finding was conducted at the paediatric intensive care units (PICUs) in Fiji’s three divisional hospitals. Data were collected from 1 January 2013 to 26 May 2016. Cases were identified using a list of clinical diagnoses compatible with SARI. Results: A total of 632 cases of paediatric SARI with complete details were identified. The median age of cases was 6 months (Interquartile range: 2–14 months). Children aged less than 5 years had a higher rate of paediatric SARI requiring admission to a divisional hospital PICU in May 2016 compared to May 2013–2015 (Incidence rate ratio: 1.7 [95% CI: 1.1–2.6]). This increase was not observed in children aged 5–14 years. The case-fatality ratio was not significantly different in 2016 compared to previous years. Conclusion The investigation enabled targeted public health response measures, including enhanced SARI surveillance at divisional hospitals and an emergency influenza vaccination campaign in the Northern Division.