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Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka

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  • 1 Department of Pediatrics, Duke University, Durham, North Carolina
  • | 2 Department of Medicine, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka
  • | 3 Department of Microbiology, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka
  • | 4 Department of Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka
  • | 5 Collaborative Research Center, Ruhuna University, Galle, Sri Lanka
  • | 6 Durham Veterans Affairs Medical Center, Durham, North Carolina
  • | 7 Genetech Research Institute, Colombo, Sri Lanka
  • | 8 Duke Global Health Institute, Durham, North Carolina
  • | 9 Department of Community and Family Medicine, Duke University, Durham, North Carolina
  • | 10 Department of Medicine, Duke University, Durham, North Carolina

In tropical and subtropical settings, the epidemiology of viral acute respiratory tract infections varies widely between countries. We determined the etiology, seasonality, and clinical presentation of viral acute respiratory tract infections among outpatients in southern Sri Lanka. From March 2013 to January 2015, we enrolled outpatients presenting with influenza-like illness (ILI). Nasal/nasopharyngeal samples were tested in duplicate using antigen-based rapid influenza testing and multiplex polymerase chain reaction (PCR) for respiratory viruses. Monthly proportion positive was calculated for each virus. Bivariable and multivariable logistic regression were used to identify associations between sociodemographic/clinical information and viral detection. Of 571 subjects, most (470, 82.3%) were ≥ 5 years of age and 53.1% were male. A respiratory virus was detected by PCR in 63.6% (N = 363). Common viral etiologies included influenza (223, 39%), human enterovirus/rhinovirus (HEV/HRV, 14.5%), respiratory syncytial virus (RSV, 4.2%), and human metapneumovirus (hMPV, 3.9%). Both ILI and influenza showed clear seasonal variation, with peaks from March to June each year. RSV and hMPV activity peaked from May to July, whereas HEV/HRV was seen year-round. Patients with respiratory viruses detected were more likely to report pain with breathing (odds ratio [OR] = 2.60, P = 0.003), anorexia (OR = 2.29, P < 0.001), and fatigue (OR = 2.00, P = 0.002) compared with patients with no respiratory viruses detected. ILI showed clear seasonal variation in southern Sri Lanka, with most activity during March to June; peak activity was largely due to influenza. Targeted infection prevention activities such as influenza vaccination in January–February may have a large public health impact in this region.

Author Notes

Address correspondence to David Shapiro, Division of Pediatric Infectious Disease, Duke University Medical Center, 2301 Erwin Road, CHC T-Level Suite 0915, Durham, NC, E-mail: david.j.shapiro@duke.edu or L. Gayani Tillekeratne, Division of Infectious Diseases, Duke University Medical Center, Durham, NC, E-mail: gayani.tillekeratne@dm.duke.edu.

Financial support: This work was supported by the NIH Research Training Grant no. R25 TW009337 funded by the Fogarty International Center and the National Institute of Mental Health.

Disclosure: Christopher W. Woods has served in an advisory capacity to Becton, Dickinson, and Company.

Authors’ addresses: David Shapiro, Department of Pediatrics, Duke University, Durham, NC, E-mail: david.shapiro@duke.edu. Champica K. Bodinayake, Department of Medicine, Ruhuna University, Galle, Sri Lanka, E-mail: bodinayake@yahoo.co.uk. Ajith Nagahawatte, Department of Microbiology, Ruhuna University, Galle, Sri Lanka, E-mail: ajithnagahawatte@yahoo.co.uk. Vasantha Devasiri, Department of Pediatrics, Ruhuna University, Galle, Sri Lanka, E-mail: vdevasiri@gmail.com. Ruvini Kurukulasooriya, Duke-Ruhuna Collaborative Research Center, Ruhuna University, Galle, Sri Lanka, E-mail: ruhunasearch@gmail.com. Jeremy Hsiang and Bradley Nicholson, Durham Veterans Affairs Medical Center, Durham, NC, E-mails: jeremyhsiang8@gmail.com and brad.nicholson@duke.edu. Aruna Dharshan De Silva, Genetech, Research Institute, Colombo, Sri Lanka, E-mail: dslv90@yahoo.com. Truls Østbye, Department of Community and Family Medicine, Duke University, Durham, NC, and Global Health Institute, Duke University, Durham, NC, E-mail: truls.ostbye@dm.duke.edu. Megan E. Reller, Department of Medicine, Duke University, Durham, NC, E-mail: megan.reller@duke.edu. Christopher W. Woods and L. Gayani Tillekeratne, Department of Medicine, Duke University, Durham, NC, and Global Health Institute, Duke University, Durham, NC, E-mails: chris.woods@duke.edu and gayani.tillekeratne@dm.duke.edu.

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