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

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Authors

Cohen, Cheryl
Walaza, Sibongile
Moyes, Jocelyn
Groome, Michelle
Tempia, Stefano
Pretorius, Marthi Andréa
Hellferscee, Orienka
Dawood, Halima
Chhagan, Meera
Naby, Fathima

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Lippincott Williams and Wilkins

Abstract

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.

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Keywords

Pneumonia, Children, Human immunodeficiency virus (HIV), Acquired immune deficiency syndrome (AIDS), South Africa (SA), Lower respiratory tract infection (LRTI), Polymerase chain reaction (PCR), Respiratory syncytial virus (RSV)

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Citation

Cohen, C, Walaza, S, Moyes, J, Groome, M, Tempia, S, Pretorius, M, Hellferscee, O, Dawood, H, Chhagan, M, Naby, F, Haffejee, S, Variava, E, Kahn, K, Nenze, S, Tshangela, A, Von Gottberg, A, Wolter, N, Cohen, AL, Kgokong, B, Venter, M & Madhi, SA 2015, 'Respiratory Tract Infection Among Children < 5 Years of Age in a High HIV Prevalence Setting, South Africa, 2009-2012', Pediatric Infectious Disease Journal, vol. 34, no. 1, pp. 66-72.