Mortality amongst Patients with Influenza-Associated Severe Acute Respiratory Illness, South Africa, 2009-2013

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Cohen, Cheryl ; Moyes, Jocelyn ; Tempia, Stefano ; Groome, Michelle ; Walaza, Sibongile ; Pretorius, Marthi ; Dawood, Halima ; Chhagan, Meera ; Haffejee, Summaya ; Variava, Ebrahim ; Kahn, Kathleen ; von Gottberg, Anne ; Wolter, Nicole ; Cohen, Adam L. ; Malope-Kgokong, Babatyi ; Venter, Marietjie ; Madhi, Shabir A.
• Description:
  Introduction
  
  Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths.
  
  Methods
  
  Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009–2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population.
  
  Results
  
  We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45–64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01–16.3) and ≥65 years (OR 6.5, 95%CI 1.2–34.3) compared to 1–4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1–7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2–7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5–11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1–31.3) and adults aged 45–64 years (10.4, 95%CI 8.4–12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0–27.8) higher in HIV-infected individuals than HIV-uninfected individuals.
  
  Conclusion
  
  Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
  
  
• Subjects:
  Acute Disease Adolescent Adult Aged Child Child, Preschool Female Hospitals Humans Incidence Infant Influenza, Human Male Middle Aged Respiratory Tract Infections Risk Factors Seasons Sentinel Surveillance Young Adult

  More +
• Source:
  PLoS One. 10(3).
• Pubmed ID:
  25786103
• Pubmed Central ID:
  PMC4365037
• Document Type:
  Journal Article
• Funding:
  U51/IP000155-04/IP/NCIRD CDC HHS/United States
• Place as Subject:
  South Africa
• Volume:
  10
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:bc0b83f4d380cd36f38b5de5582c73b7a6dfa4486689ab2f14c9a8f8b67284ef
• Download URL:
  https://stacks.cdc.gov/view/cdc/29010/cdc_29010_DS1.pdf
• File Type:
  [PDF - 441.20 KB ]