Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka

L. Gayani Tillekeratne Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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Champica K. Bodinayake Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Ryan Simmons Duke Global Health Institute, Durham, North Carolina;

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Ajith Nagahawatte Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Vasantha Devasiri Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Wasantha Kodikara Arachchi Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Teaching Hospital Karapitiya, Galle, Sri Lanka;

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Bradly P. Nicholson Duke University, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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Lawrence P. Park Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;

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Sky Vanderburg Duke University, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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Ruvini Kurukulasooriya Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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Aruna Dharshan De Silva Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
General Sir Kotelawala Defence University, Ratmalana, Sri Lanka

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Truls Østybe Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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Megan E. Reller Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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Christopher W. Woods Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;

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The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ≥ 1 year of age admitted to a tertiary care hospital in southern Sri Lanka, June 2012–October 2014. We collected epidemiologic/clinical data and a nasal or nasopharyngeal sample that was tested using polymerase chain reaction (Luminex NxTAG, Austin, TX). We determined associations between weather data and respiratory viral activity using the Spearman correlation and assessed respiratory virus seasonality using a Program for Appropriate Technology definition. Bivariable and multivariable regression analyses were conducted to identify features associated with respiratory virus detection. Among 964 patients, median age was 26.2 years (interquartile range 14.6–39.9) and 646 (67.0%) were male. One-fifth (203, 21.1%) had respiratory virus detected: 13.9% influenza, 1.4% human enterovirus/rhinovirus, 1.4% parainfluenza virus, 1.1% respiratory syncytial virus, and 1.1% human metapneumovirus. Patients with respiratory virus identified were younger (median 9.8 versus 27.7 years, P < 0.001) and more likely to have respiratory signs and symptoms. Influenza A and respiratory viral activity peaked in February–June each year. Maximum daily temperature was associated with influenza and respiratory viral activity (P = 0.03 each). Patients with respiratory virus were as likely as others to be prescribed antibiotics (55.2% versus 52.6%, P = 0.51), and none reported prior influenza vaccination. Respiratory viral infection was a common cause of AFI. Improved access to vaccines and respiratory diagnostics may help reduce disease burden and inappropriate antibiotic use.

Author Notes

Address correspondence to L. Gayani Tillekeratne, Duke Global Health Institute, 310 Trent Dr., Durham, NC 27705. E-mail: gayani.tillekeratne@dm.duke.edu

Please note that Megan E. Reller and Christopher W. Woods are co-senior authors.

Conflicts of Interest: Dr. Woods reports other relationships with Predigen; personal fees from IDbyDNA, Becton Dickinson, and Giner; grants and personal fees from bioMerieux; and grants from Pfizer, Biofire, Openbiome, Janus, BioMeme, MRI Global, and RTI, outside the submitted work.

Financial support: This work was supported by a grant from the National Institutes of Allergy and Infectious Diseases (K23AI125677 to LGT); Fogarty International Center and the National Institute of Mental Health (#R25 TW009337), the U.S. Department of Defense (BA150703 to CWW); the Office of Naval Research to the Emerging Infectious Diseases Programme, Duke-NUS Graduate Medical School, Singapore; a Johns Hopkins Center for Global Health Junior Faculty Grant (MER); and the Hubert-Yeargan Center for Global Health.

Authors’ addresses: L. Gayani Tillekeratne, Truls Østybe, Megan E. Reller, and Christopher W. Woods, Duke University, Durham, NC, Duke Global Health Institute, Durham, NC, and Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, E-mails: gayani.tillekeratne@dm.duke.edu, truls.ostbye@duke.edu, megan.reller@duke.edu, and chris.woods@duke.edu. Champica K. Bodinayake, Ajith Nagahawatte, and Vasantha Devasiri, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, and Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: bodinayake@gmail.com, ajithnagahawatte@yahoo.co.uk, and vdevasiri@gmail.com. Ryan Simmons, Duke Global Health Institute, Durham, NC, E-mail: ryan.simmons@duke.edu. Wasantha Kodikara Arachchi, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, and Teaching Hospital Karapitiya, Galle, Sri Lanka, E-mail: kody@sltnet.lk. Bradly P. Nicholson and Sky Vanderburg, Duke University, Durham, NC, and Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, E-mails: brad.nicholson@duke.edu and sky.vanderburg@duke.edu. Larry P. Park, Duke University, Durham, NC, and Duke Global Health Institute, Durham, NC, E-mail: larry.park@duke.edu. Ruvini Kurukulasooriya, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, E-mail: ruhunasearch@gmail.com. Aruna Dharshan De Silva, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, and General Sir Kotelawala Defence University, Ratmalana, Sri Lanka, E-mail: dslv90@yahoo.com.

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