Mortality amongst patients with influenza - associated severe acute respiratory illness, South Africa, 2009-2013

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Authors

Cohen, Cheryl
Moyes, Jocelyn
Tempia, Stefano
Groome, Michelle
Walaza, Sibongile
Pretorius, Marthinus W.
Dawood, Halima
Chhagan, Meera
Haffejee, Summaya
Variava, Ebrahim

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Public Library of Science

Abstract

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.

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Keywords

Influenza-associated, Africa, Risk-factors, Severe acute respiratory illness (SARI)

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Citation

Cohen C, Moyes J, Tempia S, Groome M, Walaza S, Pretorius M, Dawood, H, Chhagan, M, Haffwjee, S, Variava, E, Kahn, K, Von Gottberg, A, Wolter, N, Cohen, AL. & Venter, M (2015) Mortality amongst Patients with Influenza-Associated Severe Acute Respiratory Illness, South Africa, 2009-2013. PLoS ONE 10(3): e0118884. DOI: 10.1371/journal. pone.0118884