tetano
Editor, Senior Moderator
Pediatr Infect Dis J. 2014 Aug 4. [Epub ahead of print]
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.
Cohen C1, Walaza S, Moyes J, Groome M, Tempia S, Pretorius M, Hellferscee O, Dawood H, Chhagan M, Naby F, Haffejee S, Variava E, Kahn K, Nzenze S, Tshangela A, von Gottberg A, Wolter N, Cohen AL, Kgokong B, Venter M, Madhi SA.
Author information
Abstract
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 hospitalisations amongst South African children aged <5 years.
METHODS::
We prospectively enrolled hospitalized children with physician-diagnosed LRTI from 5 sites in 4 provinces from 2009-2012. Using polymerase chain reaction, nasopharyngeal aspirates were tested for ten viruses and blood for pneumococcal DNA. Incidence was estimated at one 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 hospitalisation ranged from 2530-3173/100000 population and was highest in infants (8446-10532/100000). LRTI incidence was 1.1-3.0-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 (OR 1.3, 95%CI:1.1-1.7), be hospitalised >7 days (OR 3.8, 95%CI:2.8-5.0) and had a higher case-fatality ratio (4.2, 95%CI:2.6-6.8). In multivariable analysis HIV-infection (OR 3.7, 95%CI:2.2-6.1), pneumococcal co-infection (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 hospitalisation and death. A viral pathogen, commonly RSV, was identified in a high proportion of LRTI cases.
PMID:
25093972
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25093972
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.
Cohen C1, Walaza S, Moyes J, Groome M, Tempia S, Pretorius M, Hellferscee O, Dawood H, Chhagan M, Naby F, Haffejee S, Variava E, Kahn K, Nzenze S, Tshangela A, von Gottberg A, Wolter N, Cohen AL, Kgokong B, Venter M, Madhi SA.
Author information
Abstract
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 hospitalisations amongst South African children aged <5 years.
METHODS::
We prospectively enrolled hospitalized children with physician-diagnosed LRTI from 5 sites in 4 provinces from 2009-2012. Using polymerase chain reaction, nasopharyngeal aspirates were tested for ten viruses and blood for pneumococcal DNA. Incidence was estimated at one 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 hospitalisation ranged from 2530-3173/100000 population and was highest in infants (8446-10532/100000). LRTI incidence was 1.1-3.0-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 (OR 1.3, 95%CI:1.1-1.7), be hospitalised >7 days (OR 3.8, 95%CI:2.8-5.0) and had a higher case-fatality ratio (4.2, 95%CI:2.6-6.8). In multivariable analysis HIV-infection (OR 3.7, 95%CI:2.2-6.1), pneumococcal co-infection (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 hospitalisation and death. A viral pathogen, commonly RSV, was identified in a high proportion of LRTI cases.
PMID:
25093972
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25093972