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

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal 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.
• Description:
  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.
  
  
• Subjects:
  AIDS Children HIV HIV Reports Lower Respiratory Tract Infection Pneumonia
• Source:
  Pediatr Infect Dis J. 2014; 34(1):66-72.
• Pubmed ID:
  25093972
• Pubmed Central ID:
  PMC4276570
• Document Type:
  Journal Article
• Funding:
  U51/IP000155-04/IP/NCIRD CDC HHS/United States
• Place as Subject:
  South Africa
• Volume:
  34
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:eb000ec6bad6fbe678f1c073cba746f29d4b7e5b047080fcf14b1645b9424224
• Download URL:
  https://stacks.cdc.gov/view/cdc/26520/cdc_26520_DS1.pdf
• File Type:
  [PDF - 930.44 KB ]