BACKGROUND. There are few published data describing the mortality burden associated with influenza and respiratory
syncytial virus (RSV) infection in children in low- and middle-income countries and particularly from Africa
and settings with high prevalence of human immunodeficiency virus (HIV).
METHODS. We modeled the excess mortality attributable to influenza (seasonal and pandemic) and RSV infection
by applying Poisson regression models to monthly all-respiratory and pneumonia and influenza deaths, using
national influenza and RSV laboratory surveillance data as covariates. In addition, we estimated the seasonal influenza–
and RSV-associated deaths among HIV-infected and -uninfected children using Poisson regression models
that incorporated HIV prevalence and highly active antiretroviral therapy coverage as covariates.
RESULTS. In children less than 5 years of age, the mean annual numbers of seasonal influenza– and RSV-associated allrespiratory
deaths were 452 (8 per 100 000 person-years [PY]) and 546 (10 per 100 000 PY), respectively. Infants <1
year of age experienced higher mortality rates compared with children 1–4 years of age for both influenza (22 vs 5 per
100 000 PY) and RSV (35 vs 4 per 100 000 PY). HIV-infected compared with HIV-uninfected children <5 years of
age were at increased risk of death associated with influenza (age-adjusted relative risk [aRR], 11.5; 95% confidence
interval [CI], 9.6–12.6) and RSV (aRR, 8.1; 95% CI, 6.9–9.3) infection. In 2009, we estimated 549 (11 per 100 000 PY)
all-respiratory influenza A(H1N1)pdm09-associated deaths among children aged <5 years.
CONCLUSIONS. Our findings support increased research efforts to guide and prioritize interventions such as influenza
vaccination and HIV prevention in low- and middle-income countries with high HIV prevalence such as South