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Nosocomial Respiratory Infections in a Rural Zambian Hospital

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  • 1 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland;
  • | 2 Johns Hopkins School of Medicine, Baltimore, Maryland;
  • | 3 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • | 4 Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland;
  • | 5 Macha Research Trust, Choma, Zambia;
  • | 6 Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
  • | 7 Virology Laboratory, University Teaching Hospital, Lusaka, Zambia;
  • | 8 Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

ABSTRACT.

The burden of nosocomial respiratory infections in rural southern Africa is poorly understood. We established a surveillance program at a rural Zambian hospital to detect influenza-like illness (ILI) and respiratory infections among hospitalized patients and a cohort of healthcare workers (HCWs). Nasopharyngeal specimens from symptomatic patients and HCWs underwent broadly multiplexed molecular testing to detect viruses and atypical bacteria. During 1 year of surveillance, 15 patients (1.7% of admissions) developed ILI more than 48 hours after admission. Among 44 HCWs, 19 (43%) experienced at least one ILI episode, with a total of 31 ILI episodes detected. Respiratory viruses were detected in 45% of patient and 55% of HCW specimens. The cumulative incidence of influenza infection among HCWs over 1 year was 9%. Overall, respiratory viruses were commonly found among patients and HCWs in a rural Zambian hospital with limited infection control infrastructure.

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Author Notes

Address correspondence to Catherine Sutcliffe, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6535, Baltimore, MD 21205. E-mail: csutcli1@jhu.edu

Financial support: The work was supported by the National Institute of Allergy and Infectious Diseases contract HHSN272201400007C awarded to the Johns Hopkins Center of Excellence in Influenza Research and Surveillance (JHCEIRS) at the Johns Hopkins University. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not represent the policy or position of NIAID or NIH. The funding agency had no role in the analysis of the data, writing of the manuscript, or the decision to submit the manuscript for publication.

Authors’ addresses: Gideon Loevinsohn and Catherine G. Sutcliffe, Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, MD, E-mails: gloevin1@jhmi.edu and csutcli1@jhu.edu. Justin Hardick and Charlotte A. Gaydos, Johns Hopkins School of Medicine, Medicine, Infectious Diseases, Baltimore, MD, E-mails: jhardic1@jhmi.edu and cgaydos@jhmi.edu. Thomas Mehoke, Johns Hopkins, Applied Physics Laboratory, Baltimore, MD, E-mail: thomas.mehoke@jhuapl.edu. Pamela Sinywimaanzi, Macha Research Trust, Influenza Study, Choma, Zambia, E-mail: pamela.sinywimaanzi@macharesearch.org. Mutinta Hamahuwa, Macha Research Trust, Clinical Research Laboratory, Choma, Southern Province, Zambia, E-mail: mutintahamahuwa@gmail.com. Katherine Z. J. Fenstermacher, Richard E. Rothman, and Lauren M. Sauer, Johns Hopkins School of Medicine, Emergency Medicine, Baltimore, MD, E-mails: kfenste1@jhu.edu, rrothma1@jhmi.edu, and lsauer2@jhmi.edu. Kathryn Shaw-Saliba, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD, E-mail: kshawsaliba@gmail.com. Peter Thielen, Jared Evans, Kenneth Bowden, and Kristina Zudock, Johns Hopkins University, Applied Physics Laboratory, Laurel, MD, E-mails: peter.thielen@jhuapl.edu, jared.evans@jhuapl.edu, kbowden2@jhmi.edu, and kzudock2@jhu.edu. Mwaka Monze, National Influenza Centre, Virology Laboratory, Lusaka, Lusaka, Zambia, E-mail: mwakamonze@hotmail.com. Andrew Pekosz, Johns Hopkins University Bloomberg School of Public Health, Molecular Microbiology and Immunology, Baltimore, MD, E-mail: apekosz1@jhu.edu. Philip E. Thuma, Macha Research Trust, Clinical Research Department, Choma, Zambia, E-mail: phil.thuma@macharesearch.org.

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