Epidemiology of severe acute respiratory illness (SARI) among adults and children aged ≥5 years in a high HIV-prevalence setting, 2009-2012

• Published in: PloS one Vol. 10; no. 2; p. e0117716
• Main Authors: Cohen, Cheryl, Walaza, Sibongile, Moyes, Jocelyn, Groome, Michelle, Tempia, Stefano, Pretorius, Marthi, Hellferscee, Orienka, Dawood, Halima, Haffejee, Summaya, Variava, Ebrahim, Kahn, Kathleen, Tshangela, Akhona, von Gottberg, Anne, Wolter, Nicole, Cohen, Adam L, Kgokong, Babatyi, Venter, Marietjie, Madhi, Shabir A
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.02.2015; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Acute Disease; Adolescent; Adult; Adults; Age; Aged; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Child; Child, Preschool; Children; Comorbidity; Councils; Deoxyribonucleic acid; Disease control; Disease prevention; DNA; Epidemiology; Etiology; Female; Health risks; Health sciences; Health surveillance; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Hospitals; Hospitals, Rural - statistics & numerical data; Hospitals, Urban - statistics & numerical data; Human immunodeficiency virus; Humans; Illnesses; Incidence; Infections; Influenza; Influenza, Human - epidemiology; Influenza, Human - virology; Laboratories; Male; Mechanical ventilation; Medical research; Medicine; Meningitis; Middle Aged; Mortality; Oxygen; Pathogens; Pneumonia; Polymerase chain reaction; Population Surveillance - methods; Prevalence; Prospective Studies; Public health; Respiratory diseases; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - virology; Reverse Transcriptase Polymerase Chain Reaction; Risk analysis; Severity of Illness Index; South Africa - epidemiology; Streptococcus infections; Therapy; Tuberculosis; Urban areas; Ventilation; Viruses; Viruses - genetics; Young Adult; South Africa; Atlanta Georgia; Georgia; Kenya; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0117716

There are few published studies describing severe acute respiratory illness (SARI) epidemiology amongst older children and adults from high HIV-prevalence settings. We aimed to describe SARI epidemiology amongst individuals aged ≥5 years in South Africa. We conducted prospective surveillance for individuals with SARI from 2009-2012. Using polymerase chain reaction, respiratory samples were tested for ten viruses, and blood for pneumococcal DNA. Cumulative annual SARI incidence was estimated at one site with population denominators. We enrolled 7193 individuals, 9% (621/7067) tested positive for influenza and 9% (600/6519) for pneumococcus. HIV-prevalence was 74% (4663/6334). Among HIV-infected individuals with available data, 41% of 2629 were receiving antiretroviral therapy (ART). The annual SARI hospitalisation incidence ranged from 325-617/100,000 population. HIV-infected individuals experienced a 13-19 times greater SARI incidence than HIV-uninfected individuals (p<0.001). On multivariable analysis, compared to HIV-uninfected individuals, HIV-infected individuals were more likely to be receiving tuberculosis treatment (odds ratio (OR):1.7; 95%CI:1.1-2.7), have pneumococcal infection (OR 2.4; 95%CI:1.7-3.3) be hospitalised for >7 days rather than <2 days (OR1.7; 95%CI:1.2-2.2) and had a higher case-fatality ratio (8% vs 5%;OR1.7; 95%CI:1.2-2.3), but were less likely to be infected with influenza (OR 0.6; 95%CI:0.5-0.8). On multivariable analysis, independent risk indicators associated with death included HIV infection (OR 1.8;95%CI:1.3-2.4), increasing age-group, receiving mechanical ventilation (OR 6.5; 95%CI:1.3-32.0) and supplemental-oxygen therapy (OR 2.6; 95%CI:2.1-3.2). The burden of hospitalized SARI amongst individuals aged ≥5 years is high in South Africa. HIV-infected individuals are the most important risk group for SARI hospitalization and mortality in this setting.