| Title | Epidemiology of viral-associated acute lower respiratory tract infection among children <5 years of age in a high HIV prevalence setting, South Africa, 2009-2012. | ||
| Author | Cohen, Cheryl; Walaza, Sibongile; Moyes, Jocelyn; Groome, Michelle; Tempia, Stefano; Pretorius, Marthi; Hellferscee, Orienka; Dawood, Halima; Chhagan, Meera; Naby, Fathima; Haffejee, Summaya; Variava, Ebrahim; Kahn, Kathleen; Nzenze, Susan; Tshangela, Akhona; von Gottberg, Anne; Wolter, Nicole; Cohen, Adam L; Kgokong, Babatyi; Venter, Marietjie; Madhi, Shabir A | ||
| Journal | Pediatr Infect Dis J | Publication Year/Month | 2015-Jan |
| PMID | 25093972 | PMCID | PMC4276570 |
| Affiliation | 1.From the *Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service; daggerSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand; double daggerMedical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand; section signDepartment of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; paragraph signInfluenza Division, Centers for Disease Control and Prevention, Atlanta, GA; ||Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria; **Department of Medicine, Pietermaritzburg Metropolitan Hospital; daggerdaggerDepartment of Medicine, University of KwaZulu Natal; double daggerdouble daggerDepartment of Paediatrics, Pietermaritzburg Metropolitan Hospital section sign section signSchool of Pathology, University of KwaZulu Natal, Pietermaritzburg; paragraph sign paragraph signDepartment of Medicine, Klerksdorp Tshepong Hospital, Klerksdorp; || ||Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand; ***MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; daggerdaggerdaggerCentre for Global Health Research, Umea University, Umea, Sweden; double daggerdouble daggerdouble daggerINDEPTH Network, Accra, Ghana; and section sign section sign section signZoonoses Research Unit, Department of Medical Virology, University of Pretoria, Gauteng, South Africa. | ||
BACKGROUND: Data on the epidemiology of viral-associated acute lower respiratory tract infection (LRTI) from high HIV prevalence settings are limited. We aimed to describe LRTI hospitalizations among South African children aged <5 years. METHODS: We prospectively enrolled hospitalized children with physician-diagnosed LRTI from 5 sites in 4 provinces from 2009 to 2012. Using polymerase chain reaction (PCR), nasopharyngeal aspirates were tested for 10 viruses and blood for pneumococcal DNA. Incidence was estimated at 1 site with available population denominators. RESULTS: We enrolled 8723 children aged <5 years with LRTI, including 64% <12 months. The case-fatality ratio was 2% (150/8512). HIV prevalence among tested children was 12% (705/5964). The overall prevalence of respiratory viruses identified was 78% (6517/8393), including 37% rhinovirus, 26% respiratory syncytial virus (RSV), 7% influenza and 5% human metapneumovirus. Four percent (253/6612) tested positive for pneumococcus. The annual incidence of LRTI hospitalization ranged from 2530 to 3173/100,000 population and was highest in infants (8446-10532/100,000). LRTI incidence was 1.1 to 3.0-fold greater in HIV-infected than HIV-uninfected children. In multivariable analysis, compared to HIV-uninfected children, HIV-infected children were more likely to require supplemental-oxygen [odds ratio (OR): 1.3, 95% confidence interval (CI): 1.1-1.7)], be hospitalized >7 days (OR: 3.8, 95% CI: 2.8-5.0) and had a higher case-fatality ratio (OR: 4.2, 95% CI: 2.6-6.8). In multivariable analysis, HIV-infection (OR: 3.7, 95% CI: 2.2-6.1), pneumococcal coinfection (OR: 2.4, 95% CI: 1.1-5.6), mechanical ventilation (OR: 6.9, 95% CI: 2.7-17.6) and receipt of supplemental-oxygen (OR: 27.3, 95% CI: 13.2-55.9) were associated with death. CONCLUSIONS: HIV-infection was associated with an increased risk of LRTI hospitalization and death. A viral pathogen, commonly RSV, was identified in a high proportion of LRTI cases.