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Clin Infect Dis. 2019 Feb 15;68(5):773-780. doi: 10.1093/cid/ciy532.

The Role of Human Immunodeficiency Virus in Influenza- and Respiratory Syncytial Virus-associated Hospitalizations in South African Children, 2011-2016.

Author information

1
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
3
US Public Health Service, Rockville, Maryland.
4
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
5
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
6
Global Immunization Monitoring and Surveillance Team, Expanded Programme on Immunization, Department of Immunization, Vaccines and Biological, World Health Organization, Geneva.
7
Technical Research and Development, Novartis Pharma AG, Basel, Switzerland.
8
School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
9
Department of Paediatrics, Pietermaritzburg Metropolitan Hospitals, University of KwaZulu-Natal.
10
Department of Paediatrics, Klerksdorp Hospital, North West Province.
11
Emerging Vectorborne and Respiratory Virus Program, Center for Viral Zoonoses, Department of Medical Virology, University of Pretoria.
12
Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand.
13
Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

BACKGROUND:

Data describing influenza- or respiratory syncytial virus (RSV)-associated hospitalized illness in children aged <5 years in Africa are limited.

METHODS:

During 2011-2016, we conducted surveillance for severe respiratory illness (SRI) in children aged <5 years in 3 South African hospitals. Nasopharyngeal aspirates were tested for influenza and RSV using real-time reverse transcription polymerase chain reaction. We estimated rates of influenza- and RSV-associated hospitalized SRI by human immunodeficiency virus (HIV) status and compared children who tested positive for influenza vs RSV using multivariable penalized logistic regression.

RESULTS:

Among 3650 hospitalized children, 203 (5.6%) tested positive for influenza viruses, 874 (23.9%) for RSV, and 19 (0.5%) for both. The median age of children hospitalized with influenza was 13.9 months vs 4.4 months for RSV (P < .01). Annual influenza-associated hospitalization rates per 100000 were highest among infants aged 6-11 months (545; 95% confidence interval [CI], 409-703), while RSV-associated hospitalization rates were highest in infants aged 0-2 months (6593; 95% CI, 5947-7217). HIV exposure was associated with increased incidence of influenza- and RSV-associated hospitalization in infants aged 0-5 months, with relative risk (RR) 2.2 (95% CI, 1.4-3.4) and 1.4 (95% CI, 1.3-1.6), respectively. HIV infection was associated with increased incidence of influenza- and RSV-associated hospitalization in all age groups; RR 2.7 (95% CI, 2.0-3.5) and 3.8 (95% CI, 3.1-4.8), respectively.

CONCLUSIONS:

Influenza- and RSV-associated hospitalizations are common among South African infants. HIV infection and HIV exposure in infants increase risk of influenza- and RSV-associated hospitalization.

KEYWORDS:

South Africa; human immunodeficiency virus; incidence; influenza; respiratory syncytial virus

PMID:
29961814
DOI:
10.1093/cid/ciy532

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