Cheryl Cohen , MD , *† , Sibongile Walaza , MD *† , Jocelyn Moyes , MD *† , Michelle Groome , MD ‡§ , Stefano Tempia , PhD ¶‖ , Marthi Pretorius , MSc * , Orienka Hellferscee , MSc * , Halima Dawood , MD **†† , Meera Chhagan , MD ‡‡ , Fathima Naby , MD ‡‡ , Summaya Haffejee , MD §§ , Ebrahim Variava , MD ¶¶‖‖ , Kathleen Kahn , MD ***†††‡‡‡ , Susan Nzenze , MD ‡§ , Akhona Tshangela , BSc * , Anne von Gottberg , MD *‡ , Nicole Wolter , PhD *‡ , Adam L. Cohen , MD ¶‖ , Babatyi Kgokong , PhD * , Marietjie Venter , PhD *§§§ , Shabir A. Madhi , PhD *‡§
11 December 2014
Supplemental Digital Content is available in the text.
Data on the epidemiology of viral-associated acute lower respiratory tract infection (LRTI) from high HIV prevalence settings are limited. We aimed to describe LRTI hospitalizations among South African children aged <5 years.
We prospectively enrolled hospitalized children with physician-diagnosed LRTI from 5 sites in 4 provinces from 2009 to 2012. Using polymerase chain reaction (PCR), nasopharyngeal aspirates were tested for 10 viruses and blood for pneumococcal DNA. Incidence was estimated at 1 site with available population denominators.
We enrolled 8723 children aged <5 years with LRTI, including 64% <12 months. The case-fatality ratio was 2% (150/8512). HIV prevalence among tested children was 12% (705/5964). The overall prevalence of respiratory viruses identified was 78% (6517/8393), including 37% rhinovirus, 26% respiratory syncytial virus (RSV), 7% influenza and 5% human metapneumovirus. Four percent (253/6612) tested positive for pneumococcus. The annual incidence of LRTI hospitalization ranged from 2530 to 3173/100,000 population and was highest in infants (8446–10532/100,000). LRTI incidence was 1.1 to 3.0-fold greater in HIV-infected than HIV-uninfected children. In multivariable analysis, compared to HIV-uninfected children, HIV-infected children were more likely to require supplemental-oxygen [odds ratio (OR): 1.3, 95% confidence interval (CI): 1.1–1.7)], be hospitalized >7 days (OR: 3.8, 95% CI: 2.8–5.0) and had a higher case-fatality ratio (OR: 4.2, 95% CI: 2.6–6.8). In multivariable analysis, HIV-infection (OR: 3.7, 95% CI: 2.2–6.1), pneumococcal coinfection (OR: 2.4, 95% CI: 1.1–5.6), mechanical ventilation (OR: 6.9, 95% CI: 2.7–17.6) and receipt of supplemental-oxygen (OR: 27.3, 95% CI: 13.2–55.9) were associated with death.