tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 Nov 2;9(12)
fac578.
doi: 10.1093/ofid/ofac578. eCollection 2022 Dec.
Risk Factors for Severe Coronavirus Disease 2019 Among Human Immunodeficiency Virus-Infected and -Uninfected Individuals in South Africa, April 2020-March 2022: Data From Sentinel Surveillance
Sibongile Walaza[SUP] 1 2 [/SUP], Stefano Tempia[SUP] 1 2 3 4 [/SUP], Anne von Gottberg[SUP] 1 5 [/SUP], Nicole Wolter[SUP] 1 5 [/SUP], Jinal N Bhiman[SUP] 1 5 [/SUP], Amelia Buys[SUP] 1 [/SUP], Daniel Amoako[SUP] 1 [/SUP], Fahima Moosa[SUP] 1 5 [/SUP], Mignon du Plessis[SUP] 1 5 [/SUP], Jocelyn Moyes[SUP] 1 2 [/SUP], Meredith L McMorrow[SUP] 6 4 [/SUP], Halima Dawood[SUP] 7 8 [/SUP], Ebrahim Variava[SUP] 9 10 [/SUP], Gary Reubenson[SUP] 11 [/SUP], Jeremy Nel[SUP] 10 [/SUP], Heather J Zar[SUP] 12 [/SUP], Mvuyo Makhasi[SUP] 1 [/SUP], Susan Meiring[SUP] 2 13 [/SUP], Vanessa Quan[SUP] 13 [/SUP], Cheryl Cohen[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: Data on risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization and mortality in high human immunodeficiency virus (HIV) prevalence settings are limited.
Methods: Using existing syndromic surveillance programs for influenza-like-illness and severe respiratory illness at sentinel sites in South Africa, we identified factors associated with COVID-19 hospitalization and mortality.
Results: From April 2020 through March 2022, severe acute respiratory syndrome coronavirus 2 was detected in 24.0% (660 of 2746) of outpatient and 32.5% (2282 of 7025) of inpatient cases. Factors associated with COVID-19-associated hospitalization included the following: older age (25-44 [adjusted odds ratio {aOR}= 1.8, 95% confidence interval (CI) = 1.1-2.9], 45-64 [aOR = 6.8, 95% CI = 4.2-11.0] and ≥65 years [aOR = 26.6, 95% CI = 14.4-49.1] vs 15-24 years); black race (aOR, 3.3; 95% CI, 2.2-5.0); obesity (aOR, 2.3; 95% CI, 1.4-3.9); asthma (aOR, 3.5; 95% CI, 1.4-8.9); diabetes mellitus (aOR, 5.3; 95% CI, 3.1-9.3); HIV with CD4 ≥200/mm[SUP]3[/SUP] (aOR, 1.5; 95% CI, 1.1-2.2) and CD4 <200/mm[SUP]3[/SUP] (aOR, 10.5; 95% CI, 5.1-21.6) or tuberculosis (aOR, 12.8; 95% CI, 2.8-58.5). Infection with Beta (aOR, 0.5; 95% CI, .3-.7) vs Delta variant and being fully vaccinated (aOR, 0.1; 95% CI, .1-.3) were less associated with COVID-19 hospitalization. In-hospital mortality was increased in older age (45-64 years [aOR, 2.2; 95% CI, 1.6-3.2] and ≥65 years [aOR, 4.0; 95% CI, 2.8-5.8] vs 25-44 years) and male sex (aOR, 1.3; 95% CI, 1.0-1.6) and was lower in Omicron-infected (aOR, 0.3; 95% CI, .2-.6) vs Delta-infected individuals.
Conclusions: Active syndromic surveillance encompassing clinical, laboratory, and genomic data identified setting-specific risk factors associated with COVID-19 severity that will inform prioritization of COVID-19 vaccine distribution. Elderly people with tuberculosis or people with HIV, especially severely immunosuppressed, should be prioritized for vaccination.
Keywords: COVID-19; HIV; South Africa; severity.
. 2022 Nov 2;9(12)
fac578.doi: 10.1093/ofid/ofac578. eCollection 2022 Dec.
Risk Factors for Severe Coronavirus Disease 2019 Among Human Immunodeficiency Virus-Infected and -Uninfected Individuals in South Africa, April 2020-March 2022: Data From Sentinel Surveillance
Sibongile Walaza[SUP] 1 2 [/SUP], Stefano Tempia[SUP] 1 2 3 4 [/SUP], Anne von Gottberg[SUP] 1 5 [/SUP], Nicole Wolter[SUP] 1 5 [/SUP], Jinal N Bhiman[SUP] 1 5 [/SUP], Amelia Buys[SUP] 1 [/SUP], Daniel Amoako[SUP] 1 [/SUP], Fahima Moosa[SUP] 1 5 [/SUP], Mignon du Plessis[SUP] 1 5 [/SUP], Jocelyn Moyes[SUP] 1 2 [/SUP], Meredith L McMorrow[SUP] 6 4 [/SUP], Halima Dawood[SUP] 7 8 [/SUP], Ebrahim Variava[SUP] 9 10 [/SUP], Gary Reubenson[SUP] 11 [/SUP], Jeremy Nel[SUP] 10 [/SUP], Heather J Zar[SUP] 12 [/SUP], Mvuyo Makhasi[SUP] 1 [/SUP], Susan Meiring[SUP] 2 13 [/SUP], Vanessa Quan[SUP] 13 [/SUP], Cheryl Cohen[SUP] 1 2 [/SUP]
Affiliations
- PMID: 36570970
- PMCID: PMC9772867
- DOI: 10.1093/ofid/ofac578
Abstract
Background: Data on risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization and mortality in high human immunodeficiency virus (HIV) prevalence settings are limited.
Methods: Using existing syndromic surveillance programs for influenza-like-illness and severe respiratory illness at sentinel sites in South Africa, we identified factors associated with COVID-19 hospitalization and mortality.
Results: From April 2020 through March 2022, severe acute respiratory syndrome coronavirus 2 was detected in 24.0% (660 of 2746) of outpatient and 32.5% (2282 of 7025) of inpatient cases. Factors associated with COVID-19-associated hospitalization included the following: older age (25-44 [adjusted odds ratio {aOR}= 1.8, 95% confidence interval (CI) = 1.1-2.9], 45-64 [aOR = 6.8, 95% CI = 4.2-11.0] and ≥65 years [aOR = 26.6, 95% CI = 14.4-49.1] vs 15-24 years); black race (aOR, 3.3; 95% CI, 2.2-5.0); obesity (aOR, 2.3; 95% CI, 1.4-3.9); asthma (aOR, 3.5; 95% CI, 1.4-8.9); diabetes mellitus (aOR, 5.3; 95% CI, 3.1-9.3); HIV with CD4 ≥200/mm[SUP]3[/SUP] (aOR, 1.5; 95% CI, 1.1-2.2) and CD4 <200/mm[SUP]3[/SUP] (aOR, 10.5; 95% CI, 5.1-21.6) or tuberculosis (aOR, 12.8; 95% CI, 2.8-58.5). Infection with Beta (aOR, 0.5; 95% CI, .3-.7) vs Delta variant and being fully vaccinated (aOR, 0.1; 95% CI, .1-.3) were less associated with COVID-19 hospitalization. In-hospital mortality was increased in older age (45-64 years [aOR, 2.2; 95% CI, 1.6-3.2] and ≥65 years [aOR, 4.0; 95% CI, 2.8-5.8] vs 25-44 years) and male sex (aOR, 1.3; 95% CI, 1.0-1.6) and was lower in Omicron-infected (aOR, 0.3; 95% CI, .2-.6) vs Delta-infected individuals.
Conclusions: Active syndromic surveillance encompassing clinical, laboratory, and genomic data identified setting-specific risk factors associated with COVID-19 severity that will inform prioritization of COVID-19 vaccine distribution. Elderly people with tuberculosis or people with HIV, especially severely immunosuppressed, should be prioritized for vaccination.
Keywords: COVID-19; HIV; South Africa; severity.