Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009-2011

• Published in: Emerging infectious diseases Vol. 19; no. 11; pp. 1766 - 1774
• Main Authors: Cohen, Cheryl, Moyes, Jocelyn, Tempia, Stefano, Groom, Michelle, Walaza, Sibongile, Pretorius, Marthi, Dawood, Halima, Chhagan, Meera, 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 U.S. National Center for Infectious Diseases 01.11.2013; Centers for Disease Control and Prevention
• Subjects: Adolescent; Adult; adults; Aged; Aged, 80 and over; AIDS; Analysis; Child; Child, Preschool; children; Coinfection; Female; Health aspects; HIV; HIV (Viruses); HIV infection; HIV Infections - epidemiology; HIV testing; Hospitalization; Humans; Incidence; Infant; Infant, Newborn; Influenza; Influenza, Human - epidemiology; Lung diseases; Male; Middle Aged; pneumonia; Prevalence; Prevalence studies (Epidemiology); Prospective Studies; Public Health Surveillance; Respiratory Tract Infections - epidemiology; South Africa - epidemiology; Young Adult; South Africa; influenza; viruses; bacteria; co-infection; adults; AIDS; pneumoccocus; pneumococcal; respiratory infections; HIV; pneumonia; children; lower respiratory tract infection; South Africa; vaccination
• ISSN: 1080-6040; 1080-6059; 1080-6059
• DOI: 10.3201/eid1911.130546

Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009-2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4-8 times greater for HIV-infected (186-228/100,000) than for HIV-uninfected persons (26-54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2-7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.