Mortality Associated with Seasonal and Pandemic Influenza and Respiratory Syncytial Virus among Children less than 5 Years of Age in a High HIV-Prevalence Setting - South Africa, 1998-2009.

Clinical Infectious Diseases

PubMedID: 24567249

Tempia S, Walaza S, Viboud C, Cohen AL, Madhi SA, Venter M, McAnerney JM, Cohen C. Mortality Associated with Seasonal and Pandemic Influenza and Respiratory Syncytial Virus among Children less than 5 Years of Age in a High HIV-Prevalence Setting - South Africa, 1998-2009. Clin Infect Dis. 2014;58(9):1241-9.
Background. There are few published data describing the mortality burden associated with influenza and RSV infection in children in low- and middle-income countries and particularly from Africa and high HIV-prevalence settings. Methods. We modeled the excess mortality attributable to influenza (seasonal and pandemic) and RSV infection by applying Poisson regression models to monthly all-respiratory and pneumonia and influenza deaths, using national influenza and RSV laboratory surveillance data as covariates. In addition, we estimated the seasonal influenza- and RSV-associated deaths among HIV-infected and -uninfected children using Poisson regression models that incorporated HIV prevalence and HAART coverage as covariates. Results. In children <5 years of age, the mean annual number of seasonal influenza- and RSV-associated all-respiratory deaths were 452 (8 per 100,000 person-years) and 546 (10 per 100,000 person-years), respectively. Infants <1 year of age experienced higher mortality rates as compared to the 1-4 years age group for both influenza (22 vs. 5 per 100,000 person-years) and RSV (35 vs. 4 per 100,000 person years). HIV-infected as compared to HIV-uninfected children <5 years of age were at increased risk of death associated with influenza (age-adjusted relative risk (aRR): 11.5; 95% confidence interval (CI): 9.6-12.6) and RSV (aRR: 8.1; 95% CI: 6.9-9.3) infection. In 2009, we estimated 549 (11 per 100,000 person-year) all-respiratory influenza A(H1N1)pdm09-associated deaths among children aged <5 years. Conclusions. Our findings support increased research efforts to guide and prioritize interventions such as influenza vaccination and HIV prevention in low- and middle-income countries with high HIV-prevalence such as South Africa.