1921
Volume 99, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Data on the epidemiology of severe acute respiratory illness (SARI) in adults from low-income, high human immunodeficiency virus (HIV) prevalence African settings are scarce. We conducted adult SARI surveillance in Blantyre, Malawi. From January 2011 to December 2013, individuals aged ≥ 15 years with SARI (both inpatients and outpatients) were enrolled at a large teaching hospital in Blantyre, Malawi. Nasopharyngeal aspirates were tested for influenza and other respiratory viruses by polymerase chain reaction. We estimated hospital-attended influenza-positive SARI incidence rates and assessed factors associated with influenza positivity and clinical severity (Modified Early Warning Score > 4). We enrolled 1,126 SARI cases; 163 (14.5%) were positive for influenza. Human immunodeficiency virus prevalence was 50.3%. Annual incidence of hospital-attended influenza-associated SARI was 9.7–16.8 cases per 100,000 population. Human immunodeficiency virus was associated with a 5-fold greater incidence (incidence rate ratio 4.91, 95% confidence interval [CI]: 3.83–6.32). On multivariable analysis, female gender, as well as recruitment in hot, rainy season (December to March; adjusted odds ratios (aOR): 2.82, 95% CI: 1.57–5.06) and cool, dry season (April to August; aOR: 2.47, 95% CI: 1.35–4.15), was associated with influenza positivity, whereas influenza-positive patients were less likely to be HIV-infected (aOR: 0.59, 95% CI: 0.43–0.80) or have viral coinfection (aOR: 0.51, 95% CI: 0.36–0.73). Human immunodeficiency virus infection (aOR: 1.86; 95% CI: 1.35–2.56) and recruitment in hot, rainy season (aOR: 4.98, 95% CI: 3.17–7.81) were independently associated with clinical severity. In this high HIV prevalence population, influenza was associated with nearly 15% of hospital-attended SARI. Human immunodeficiency virus infection is an important risk factor for clinical severity in all-cause and influenza-associated SARI. Expanded access to HIV testing and antiretroviral treatment, as well as targeted influenza vaccination, may reduce the burden of SARI in Malawi and other high HIV prevalence settings.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. GBD 2015 LRI Collaborators, 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 11331161. [Google Scholar]
  2. Gessner BD, Shindo N, Briand S, , 2011. Seasonal influenza epidemiology in sub-Saharan Africa: a systematic review. Lancet Infect Dis 11: 223235. [Google Scholar]
  3. WHO, 2012. Vaccines against influenza WHO position paper–November 2012. Weekly epidemiological record/Releve epidemiologique hebdomadaire. Wkly Epidemiol Rec 87: 461476. [Google Scholar]
  4. Duque J, McMorrow ML, Cohen AL, , 2014. Influenza vaccines and influenza antiviral drugs in Africa: are they available and do guidelines for their use exist? BMC Public Health 14: 41. [Google Scholar]
  5. Steffen C, 2012. Improving influenza surveillance in sub-Saharan Africa. Bull World Health Organ 90: 301305. [Google Scholar]
  6. World Health Organization Global Influenza Surveillance and Response System (GISRS), . Available at: www.who.int/influenza/gisrs_laboratory/en/. Accessed October 7, 2016.
  7. Radin JM, 2012. Influenza surveillance in 15 countries in Africa, 2006–2010. J Infect Dis 206 (Suppl 1): S14S21. [Google Scholar]
  8. Cohen C, Simonsen L, Sample J, Kang JW, Miller M, Madhi SA, Campsmith M, Viboud C, , 2012. Influenza-related mortality among adults aged 25–54 years with AIDS in South Africa and the United States of America. Clin Infect Dis 55: 9961003. [Google Scholar]
  9. Feikin DR, 2012. Etiology and Incidence of viral and bacterial acute respiratory illness among older children and adults in rural western Kenya, 2007–2010. PLoS One 7: e43656. [Google Scholar]
  10. Cohen C, 2015. Epidemiology of severe acute respiratory illness (SARI) among adults and children aged ≥ 5 years in a high HIV-prevalence setting, 2009–2012. PLoS One 10: e0117716. [Google Scholar]
  11. United Nations Development Programme, 2016. Human Development Report 2016. 1 UN Plaza, New York.
  12. Ministry of Health, Malawi, 2016. Malawi Population-based HIV Impact Assessment (MPHIA) 2015–16: First Report. Lilongwe, Malawi: Ministry of Health. November 2017.
  13. SanJoaquin MA, 2013. Surveillance programme of IN-patients and epidemiology (SPINE): implementation of an electronic data collection tool within a large hospital in Malawi. PLoS Med 10: e1001400. [Google Scholar]
  14. Segula D, Frosch AP, SanJoaquin M, Taulo D, Skarbinski J, Mathanga DP, Allain TJ, Molyneux M, Laufer MK, Heyderman RS, , 2014. Prevalence and spectrum of illness among hospitalized adults with malaria in Blantyre, Malawi. Malar J 13: 391. [Google Scholar]
  15. Mihigo R, Torrealba CV, Coninx K, Nshimirimana D, Kieny MP, Carrasco P, Hedman L, Widdowson MA, , 2012. 2009 Pandemic influenza A virus subtype H1N1 vaccination in Africa—successes and challenges. J Infect Dis 206 (Suppl 1): S22S28. [Google Scholar]
  16. Peterson I, 2016. Respiratory virus-associated severe acute respiratory illness (SARI) and viral clustering in Malawian children in a setting with a high prevalence of HIV, malaria and malnutrition. J Infect Dis 214: 17001711. [Google Scholar]
  17. World Health Organization, 2004. Rapid HIV Tests: Guidelines for Use in HIV Testing and Counselling Services in Resource-constrained Settings. Geneva, Switzerland: WHO.
  18. National Statistics Office (NSO), 2008. Malawi 2008 Population and Housing Census Results. Zomba, Malawi: NSO.
  19. Subbe CP, Kruger M, Rutherford P, Gemmel L, , 2001. Validation of a modified early warning score in medical admissions. QJM 94: 521526. [Google Scholar]
  20. Subbe CP, Slater A, Menon D, Gemmell L, , 2006. Validation of physiological scoring systems in the accident and emergency department. Emerg Med J 23: 841845. [Google Scholar]
  21. Burch VC, Tarr G, Morroni C, , 2008. Modified early warning score predicts the need for hospital admission and inhospital mortality. Emerg Med J 25: 674678. [Google Scholar]
  22. Kruisselbrink R, 2016. Modified early warning score (MEWS) identifies critical illness among ward patients in a resource restricted setting in Kampala, Uganda: a prospective observational study. PLoS One 11: e0151408. [Google Scholar]
  23. Emukule GO, Khagayi S, McMorrow ML, Ochola R, Otieno N, Widdowson MA, Ochieng M, Feikin DR, Katz MA, Mott JA, , 2014. The burden of influenza and RSV among inpatients and outpatients in rural western Kenya, 2009–2012. PLoS One 9: e105543. [Google Scholar]
  24. Cohen C, 2013. Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009–2011. Emerg Infect Dis 19: 17661774. [Google Scholar]
  25. Desmond NA, Nyirenda D, Dube Q, Mallewa M, Molyneux E, Lalloo DG, Heyderman RS, , 2013. Recognising and treatment seeking for acute bacterial meningitis in adults and children in resource-poor settings: a qualitative study. PLoS One 8: e68163. [Google Scholar]
  26. Scott JA, 2000. Aetiology, outcome, and risk factors for mortality among adults with acute pneumonia in Kenya. Lancet 355: 12251230. [Google Scholar]
  27. Hartung TK, Chimbayo D, van Oosterhout JJ, Chikaonda T, van Doornum GJ, Claas EC, Melchers WJ, Molyneux ME, Zijlstra EE, , 2011. Etiology of suspected pneumonia in adults admitted to a high-dependency unit in Blantyre, Malawi. Am J Trop Med Hyg 85: 105112. [Google Scholar]
  28. Albrich WC, 2012. Use of a rapid test of pneumococcal colonization density to diagnose pneumococcal pneumonia. Nephrol Dial Transplant 54: 601609. [Google Scholar]
  29. Zar HJ, Madhi SA, Aston SJ, Gordon SB, , 2013. Pneumonia in low and middle income countries: progress and challenges. Thorax 68: 10521056. [Google Scholar]
  30. Madhi SA, Schoub B, Simmank K, Blackburn N, Klugman KP, , 2000. Increased burden of respiratory viral associated severe lower respiratory tract infections in children infected with human immunodeficiency virus type-1. J Pediatr 137: 7884. [Google Scholar]
  31. Ho A, 2017. Impact of human immunodeficiency virus on the burden and severity of influenza illness in Malawian adults: a prospective cohort and parallel case-control study. Clin Infect Dis 66: 865876. [Google Scholar]
  32. Ope MO, Katz MA, Aura B, Gikunju S, Njenga MK, Ng’ang’a Z, Vulule J, Breiman RF, Feikin DR, , 2011. Risk factors for hospitalized seasonal influenza in rural western Kenya. PLoS One 6: e20111. [Google Scholar]
  33. Remschmidt C, Wichmann O, Harder T, , 2014. Influenza vaccination in HIV-infected individuals: systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness and safety. Vaccine 32: 55855592. [Google Scholar]
  34. Palache A, Oriol-Mathieu V, Abelin A, Music T, , 2014. Seasonal influenza vaccine dose distribution in 157 countries (2004–2011). Vaccine 32: 63696376. [Google Scholar]
  35. World Food Program, 2016. Situation Report and What the World Food Programme is Doing in Malawi. Available at: www.wfp.org/countries/malawi. Accessed December 15, 2016.
  36. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR, , 2011. Viral pneumonia. Lancet 377: 12641275. [Google Scholar]
  37. Jain S, 2015. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 373: 415427. [Google Scholar]
  38. Pretorius MA, 2016. The role of influenza, RSV and other common respiratory viruses in severe acute respiratory infections and influenza-like illness in a population with a high HIV sero-prevalence, South Africa 2012–2015. J Clin Virol 75: 2126. [Google Scholar]
  39. Self WH, 2015. Respiratory viral detection in children and adults: comparing asymptomatic controls and patients with community-acquired pneumonia. J Infect Dis 213: 584591. [Google Scholar]
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  • Received : 20 Nov 2017
  • Accepted : 26 Apr 2018
  • Published online : 23 Jul 2018

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