Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–2009<sup>1</sup>

Tempia, Stefano; Walaza, Sibongile; Viboud, Cécile; Cohen, Adam L.; Madhi, Shabir А.; Venter, Marietjie; Mollendorf, Claire von; Moyes, Jocelyn; McAnerney, Johanna M.; Cohen, Cheryl

doi:10.3201/eid2104.141033

Cited by 44 publications

(72 citation statements)

References 34 publications

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“…Our estimates of influenza‐associated SARI hospitalization in individuals aged ≥5 years are on the lower end, but overall similar to other estimates from Africa (22 per 100 000 population in South Africa 21 and 30 per 100 000 population in Kenya 20). Underlying medical conditions including HIV infection is known risk factors for influenza‐associated severe illness 21, 22, 23, 24. Differences in the prevalence of such conditions in different settings may explain some of the observed differences in the influenza‐associated SARI hospitalization rates in this age‐group.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically in a study conducted in South Africa, influenza virus was detected in 5.8% of patients hospitalized with respiratory illnesses that did not meet the SARI case definition 25. Last, ecological studies have suggested that influenza virus is responsible for hospitalizations and deaths also among patients presenting with circulatory illnesses or even syndromes different than respiratory and circulatory 23, 26. In addition, individuals that may have developed influenza‐associated severe respiratory illness, but did not seek care, would have been missed in our study; hence, our estimates should be considered minimum estimates.…”

Section: Discussionmentioning

confidence: 99%

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The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

Theo

Tempia

Cohen

et al. 2017

Influenza Resp Viruses

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BackgroundEstimates of influenza‐associated hospitalization are limited in low‐ and middle‐income countries, especially in Africa.ObjectiveTo estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Zambia.MethodsWe conducted active prospective hospital‐based surveillance for SARI at the University Teaching Hospital (UTH) situated in Lusaka Province during 2011‐2014. Upper respiratory tract samples were tested for influenza virus using a reverse transcriptase polymerase chain reaction assay. We estimated age‐specific rates of influenza‐associated SARI hospitalizations for the UTH using census and secondary data on respiratory hospitalizations following estimation approaches recommended by the World Health Organization. We used the UTH hospitalization rates as a proxy for Lusaka Province. These rates were adjusted for each of the remaining 9 provinces based on their prevalence of risk factors for pneumonia and healthcare‐seeking behavior. Rates were expressed per 100,000 population.Results SARI cases accounted for 77.1% (13 389/17 354) of respiratory admissions at the UTH; 82.7% (11 859/14 344) and 50.8% (1530/3010) among individuals aged <5 and ≥5 years, respectively. Among SARI cases tested, the influenza virus detection rate was 5.5% (152/2734), 4.8% (48/998), and 6.0% (104/1736) among individuals aged <5 and ≥5 years, respectively. The mean annual national number of influenza‐associated SARI hospitalizations was 6181 (95% CI: 4321‐8041—rate: 43.9; 95% CI: 30.7‐57.1); 4669 (95% CI: 3287‐6051—rate: 187.7; 95% CI: 132.1‐243.3) among children aged <5 years; and 1512 (95% CI: 1037‐1987—rate: 13.1; 95% CI: 9.0‐17.2) among individuals aged ≥5 years.ConclusionsThe burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

Theo

Tempia

Cohen

et al. 2017

Influenza Resp Viruses

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“…Lower estimates in this age group may be due to different prevalence of chronic underlying medical conditions (known risk factors for influenza‐associated severe illness21) in different populations. Specifically, HIV infection is a well‐documented risk factor for influenza‐associated severe illness,4, 5, 6, 21 and this may have played a role in the observed “higher” rates especially in South Africa where the HIV prevalence in the adult population is elevated 4…”

Section: Discussionmentioning

confidence: 99%

“…Specifically in a study conducted in South Africa, influenza virus was detected in 5.8% of patients hospitalized with respiratory illnesses that did not meet the SARI case definition 24. In addition, ecological studies have suggested that influenza virus is responsible for hospitalizations and deaths also among patients presenting with circulatory illnesses or even non‐respiratory and non‐circulatory syndromes 5, 6, 19. Third, we did not collect data on the total number of medical hospitalizations, hindering our ability to estimate the proportional contribution of SARI‐associated admissions among any medical admission.…”

Section: Discussionmentioning

confidence: 99%

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Rwanda, 2012‐2014

Nyamusore

Rukelibuga

Mutagoma

et al. 2017

Influenza Resp Viruses

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BackgroundEstimates of influenza‐associated hospitalization are severely limited in low‐ and middle‐income countries, especially in Africa.ObjectivesTo estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Rwanda.MethodsWe multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012‐2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100 000 population. A sensitivity analysis using a different estimation approach was also conducted.Results SARI cases accounted for 70.6% (9759/13 813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and ≥5 years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and ≥5 years, respectively. The estimated mean annual national number of influenza‐associated SARI hospitalizations was 3663 (95% CI: 2930‐4395—rate: 34.7; 95% CI: 25.4‐47.7): 2637 (95% CI: 2110‐3164—rate: 168.7; 95% CI: 135.0‐202.4) among children aged <5 years and 1026 (95% CI: 821‐1231—rate: 11.3; 95% CI: 9.0‐13.6) among individuals aged ≥5 years. The estimates obtained from both approaches were not statistically different (overlapping CIs).ConclusionsThe burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.

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“…Since influenza virus infections are rarely laboratory-confirmed and influenza-related deaths may be attributed to other comorbid conditions or secondary complications, we applied modelling approaches as previously described [6, 7] to estimate the influenza-associated mortality among individuals who died with pulmonary tuberculosis (PTB) in South Africa from 1999 through 2009.…”

Section: Introductionmentioning

confidence: 99%

Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999–2009

et al. 2015

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BackgroundPublished data on the interaction between influenza and pulmonary tuberculosis (PTB) are limited. We aimed to estimate the influenza-associated mortality among individuals with PTB in South Africa from 1999–2009.MethodsWe modelled the excess influenza-associated mortality by applying Poisson regression models to monthly PTB and non-tuberculosis respiratory deaths, using laboratory-confirmed influenza as a covariate.ResultsPTB deaths increased each winter, coinciding with influenza virus circulation. Among individuals of any age, mean annual influenza-associated PTB mortality rate was 164/100,000 person-years (n = 439). The rate of non-tuberculosis respiratory deaths was 27/100,000 (n = 1125) for HIV-infected and 5/100,000 (n = 2367) for HIV-uninfected individuals of all ages. Among individuals aged <65 years, influenza-associated PTB mortality risk was elevated compared to influenza-associated non-tuberculosis respiratory deaths in HIV-infected (relative risk (RR): 5.2; 95% CI: 4.6–5.9) and HIV-uninfected individuals (RR: 61.0; CI: 41.4–91.0). Among individuals aged ≥65 years, influenza-associated PTB mortality risk was elevated compared to influenza-associated non-tuberculosis respiratory deaths in HIV-uninfected individuals (RR: 13.0; 95% CI: 12.0–14.0).ConclusionWe observed an increased risk of influenza-associated mortality in persons with PTB compared to non-tuberculosis respiratory deaths. If confirmed in other settings, our findings may support recommendations for active inclusion of patients with TB for influenza vaccination and empiric influenza anti-viral treatment of patients with TB during influenza epidemics.

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Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–2009¹

Abstract: Mortality rates were higher among HIV-positive persons and older persons who had influenza. Deaths Associated with Respiratory Viruses in HIV-Prevalent Area

Cited by 44 publications

References 34 publications

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Rwanda, 2012‐2014

Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999–2009

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Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091

Abstract: Mortality rates were higher among HIV-positive persons and older persons who had influenza. Deaths Associated with Respiratory Viruses in HIV-Prevalent Area

Cited by 44 publications

References 34 publications

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Rwanda, 2012‐2014

Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999–2009

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Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–2009¹