| Autor: |
Ho A; Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Mallewa J; Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Peterson I; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., SanJoaquin M; World Bank, Phnom Penh, Cambodia., Garg S; Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia., Bar-Zeev N; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Menyere M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Alaerts M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Mapurisa G; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Chilombe M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Nyirenda M; Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi., Lalloo DG; Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Rothe C; Division of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany., Widdowson MA; Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.; Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya., McMorrow M; Influenza Division, Centers for Disease Control and Prevention, Pretoria, South Africa.; Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia., French N; Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Everett D; University of Edinburgh, Edinburgh, United Kingdom.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi., Heyderman RS; Division of Infection and Immunity, University College London, London, United Kingdom. |
| Abstrakt: |
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. |
