Cohen, CherylWalaza, SibongileMoyes, JocelynGroome, MichelleTempia, StefanoPretorius, Marthi AndréaHellferscee, OrienkaDawood, HalimaChhagan, MeeraNaby, FathimaHaffejee, SummayaVariava, EbrahimKahn, KathleenNzenze, SusanTshangela, AkhonaVon Gottberg, AnneWolter, NicoleCohen, Adam L.Kgokong, BabatyiVenter, MarietjieMadhi, Shabir A.2015-10-052015-10-052015-01Cohen, 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. 66-72.0891-3668 (print)1532-0987 (online)10.1097/INF.0000000000000478http://hdl.handle.net/2263/50150BACKGROUND : 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.en© 2014 Lippincott Williams & Wilkins. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial- No Derivatives 3.0 License,PneumoniaChildrenHuman immunodeficiency virus (HIV)Acquired immune deficiency syndrome (AIDS)South Africa (SA)Lower respiratory tract infection (LRTI)Polymerase chain reaction (PCR)Respiratory syncytial virus (RSV)Article