tetano
Editor, Senior Moderator
PLoS One. 2015 Mar 18;10(3):e0118884. doi: 10.1371/journal.pone.0118884. eCollection 2015.
[h=1]Mortality amongst Patients with Influenza-Associated Severe Acute Respiratory Illness, South Africa, 2009-2013.[/h] Cohen C[SUP]1[/SUP], Moyes J[SUP]1[/SUP], Tempia S[SUP]2[/SUP], Groome M[SUP]3[/SUP], Walaza S[SUP]4[/SUP], Pretorius M[SUP]5[/SUP], Dawood H[SUP]6[/SUP], Chhagan M[SUP]7[/SUP], Haffejee S[SUP]8[/SUP], Variava E[SUP]9[/SUP], Kahn K[SUP]10[/SUP], von Gottberg A[SUP]11[/SUP], Wolter N[SUP]11[/SUP], Cohen AL[SUP]2[/SUP], Malope-Kgokong B[SUP]4[/SUP], Venter M[SUP]12[/SUP], Madhi SA[SUP]13[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]INTRODUCTION:[/h] Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths.
[h=4]METHODS:[/h] Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009-2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population.
[h=4]RESULTS:[/h] We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45-64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01-16.3) and ≥65 years (OR 6.5, 95%CI 1.2-34.3) compared to 1-4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1-7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2-7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5-11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1-31.3) and adults aged 45-64 years (10.4, 95%CI 8.4-12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0-27.8) higher in HIV-infected individuals than HIV-uninfected individuals.
[h=4]CONCLUSION:[/h] Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
PMID: 25786103 [PubMed - in process] Free full text
[h=1]Mortality amongst Patients with Influenza-Associated Severe Acute Respiratory Illness, South Africa, 2009-2013.[/h] Cohen C[SUP]1[/SUP], Moyes J[SUP]1[/SUP], Tempia S[SUP]2[/SUP], Groome M[SUP]3[/SUP], Walaza S[SUP]4[/SUP], Pretorius M[SUP]5[/SUP], Dawood H[SUP]6[/SUP], Chhagan M[SUP]7[/SUP], Haffejee S[SUP]8[/SUP], Variava E[SUP]9[/SUP], Kahn K[SUP]10[/SUP], von Gottberg A[SUP]11[/SUP], Wolter N[SUP]11[/SUP], Cohen AL[SUP]2[/SUP], Malope-Kgokong B[SUP]4[/SUP], Venter M[SUP]12[/SUP], Madhi SA[SUP]13[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]INTRODUCTION:[/h] Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths.
[h=4]METHODS:[/h] Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009-2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population.
[h=4]RESULTS:[/h] We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45-64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01-16.3) and ≥65 years (OR 6.5, 95%CI 1.2-34.3) compared to 1-4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1-7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2-7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5-11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1-31.3) and adults aged 45-64 years (10.4, 95%CI 8.4-12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0-27.8) higher in HIV-infected individuals than HIV-uninfected individuals.
[h=4]CONCLUSION:[/h] Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
PMID: 25786103 [PubMed - in process] Free full text