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PLoS One. 2019 Sep 19;14(9):e0222294. doi: 10.1371/journal.pone.0222294. eCollection 2019.
The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011-2015.
Ngobeni H1,2, Tempia S3,4,5,6, Cohen AL4,7, Walaza S3, Kuonza L1,2,8, Musekiwa A2, von Gottberg A3,9, Hellferscee O3, Wolter N3,9, Treurnicht FK3, Moyes J3,8, Naby F3, Mekgoe O3, Cohen C3,8.
Author information
1 South African Field Epidemiology Training Programme, Johannesburg, South Africa. 2 School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa. 3 Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. 4 Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. 5 Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa. 6 MassGenics, Duluth, Georgia, United States of America. 7 Global Immunization Monitoring and Surveillance Team, Vaccines and Biologicals, World Health Organisation, Geneva, Switzerland. 8 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 9 School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38?C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5-3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89-98%) in HIV-uninfected and of 100% (95% CI 79-100%) in HIV-infected children but low specificity: 7% (95% CI 6-8%) and 6% (95% CI 3-9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI-an acute respiratory infection with history of fever or measured fever of ≥ 38?C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56-76%) and specificity of 46% (95% CI 44-48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35-84%) and a specificity of 42% (95% CI 36-48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.
PMID: 31536552 DOI: 10.1371/journal.pone.0222294
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The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011-2015.
Ngobeni H1,2, Tempia S3,4,5,6, Cohen AL4,7, Walaza S3, Kuonza L1,2,8, Musekiwa A2, von Gottberg A3,9, Hellferscee O3, Wolter N3,9, Treurnicht FK3, Moyes J3,8, Naby F3, Mekgoe O3, Cohen C3,8.
Author information
1 South African Field Epidemiology Training Programme, Johannesburg, South Africa. 2 School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa. 3 Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. 4 Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. 5 Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa. 6 MassGenics, Duluth, Georgia, United States of America. 7 Global Immunization Monitoring and Surveillance Team, Vaccines and Biologicals, World Health Organisation, Geneva, Switzerland. 8 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 9 School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38?C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5-3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89-98%) in HIV-uninfected and of 100% (95% CI 79-100%) in HIV-infected children but low specificity: 7% (95% CI 6-8%) and 6% (95% CI 3-9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI-an acute respiratory infection with history of fever or measured fever of ≥ 38?C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56-76%) and specificity of 46% (95% CI 44-48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35-84%) and a specificity of 42% (95% CI 36-48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.
PMID: 31536552 DOI: 10.1371/journal.pone.0222294
Free full text