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

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 wi...

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Detalles Bibliográficos
Autores principales: Cohen, Cheryl, Walaza, Sibongile, Moyes, Jocelyn, Groome, Michelle, Tempia, Stefano, Pretorius, Marthi, Hellferscee, Orienka, Dawood, Halima, Chhagan, Meera, Naby, Fathima, Haffejee, Summaya, Variava, Ebrahim, Kahn, Kathleen, Nzenze, Susan, Tshangela, Akhona, von Gottberg, Anne, Wolter, Nicole, Cohen, Adam L., Kgokong, Babatyi, Venter, Marietjie, Madhi, Shabir A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Williams & Wilkins 2015
Materias:
HIV Reports
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276570/
https://www.ncbi.nlm.nih.gov/pubmed/25093972
http://dx.doi.org/10.1097/INF.0000000000000478
Descripción
Sumario: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 physician-diagnosed 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, HIV-infected 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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