Epidemiology of severe acute respiratory infections from hospital-based surveillance in Madagascar, November 2010 to July 2013

• Published in: PloS one Vol. 13; no. 11; p. e0205124
• Main Authors: Razanajatovo, Norosoa Harline, Guillebaud, Julia, Harimanana, Aina, Rajatonirina, Soatiana, Ratsima, Elisoa Hariniaina, Andrianirina, Zo Zafitsara, Rakotoariniaina, Hervé, Andriatahina, Todisoa, Orelle, Arnaud, Ratovoson, Rila, Irinantenaina, Judickaelle, Rakotonanahary, Dina Arinalina, Ramparany, Lovasoa, Randrianirina, Frédérique, Richard, Vincent, Heraud, Jean-Michel
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.11.2018; Public Library of Science (PLoS)
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Antibiotics; Bacteria; Biology and Life Sciences; Child; Child, Preschool; Children; Epidemiological Monitoring; Epidemiology; Etiology; Fatalities; Female; Health risks; Hospitalization; Hospitals; Humans; Infant; Infant, Newborn; Infections; Influenza; Klebsiella; Life Sciences; Logistic Models; Madagascar - epidemiology; Male; Medicine and Health Sciences; Morbidity; Patients; People and Places; Prevalence; Respiratory syncytial virus; Respiratory tract infection; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Respiratory Tract Infections - virology; Rhinovirus; Santé publique et épidémiologie; Sputum; Streptococcus; Streptococcus infections; Streptococcus pneumoniae; Surveillance; Systematic review; Vaccines; Viruses; Young Adult; Madagascar; United States > US; New Caledonia; Africa
• DOI: 10.1371/journal.pone.0205124
• ISSN: 1932-6203

Few comprehensive data exist regarding the epidemiology of severe acute respiratory infections (SARI) in low income countries. This study aimed at identifying etiologies and describing clinical features of SARI-associated hospitalization in Madagascar. It is a prospective surveillance of SARI in 2 hospitals for 3 years. Nasopharyngeal swabs, sputum, and blood were collected from SARI patients enrolled and tested for viruses and bacteria. Epidemiological and clinical information were obtained from case report forms. Overall, 876 patients were enrolled in the study, of which 83.1% (728/876) were tested positive for at least one pathogen. Viral and bacterial infections occurred in 76.1% (667/876) and 35.8% (314/876) of tested samples, respectively. Among all detected viruses, respiratory syncytial virus (RSV) was the most common (37.7%; 348/924) followed by influenza virus A (FLUA, 18.4%; 170/924), rhinovirus (RV, 13.5%; 125/924), and adenovirus (ADV, 8.3%; 77/924). Among bacteria, Streptococcus pneumoniae (S. pneumoniae, 50.3%, 189/370) was the most detected followed by Haemophilus influenzae type b (Hib, 21.4%; 79/370), and Klebsiella (4.6%; 17/370). Other Streptococcus species were found in 8.1% (30/370) of samples. Compared to patients aged less than 5 years, older age groups were significantly less infected with RSV. On the other hand, patients aged more than 64 years (OR = 3.66) were at higher risk to be infected with FLUA, while those aged 15-29 years (OR = 3.22) and 30-64 years (OR = 2.39) were more likely to be infected with FLUB (influenza virus B). The frequency of influenza viruses detected among SARI patients aged 65 years and more highlights the need for health authorities to develop strategies to reduce morbidity amongst at-risk population through vaccine recommendation. Amongst young children, the demonstrated burden of RSV should guide clinicians for a better case management of children. These findings reveal the need to develop point-of-care tests to avoid overuse of antibiotics and to promote vaccine that could reduce drastically the RSV hospitalizations.