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 physiciandiagnosed
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, HIVinfected
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.