Cohen Cheryl, Moyes Jocelyn, Tempia Stefano, Groome Michelle, Walaza Sibongile, Pretorius Marthi, Dawood Halima, Chhagan Meera, Haffejee Summaya, Variava Ebrahim, Kahn Kathleen, von Gottberg Anne, Wolter Nicole, Cohen Adam L, Malope-Kgokong Babatyi, Venter Marietjie, Madhi Shabir A
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa.
PLoS One. 2015 Mar 18;10(3):e0118884. doi: 10.1371/journal.pone.0118884. eCollection 2015.
Data on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths.
Hospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009-2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population.
We enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45-64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01-16.3) and ≥65 years (OR 6.5, 95%CI 1.2-34.3) compared to 1-4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1-7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2-7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5-11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1-31.3) and adults aged 45-64 years (10.4, 95%CI 8.4-12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0-27.8) higher in HIV-infected individuals than HIV-uninfected individuals.
Influenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
来自非洲的流感相关死亡率的负担和风险群体数据有限。我们旨在估计住院的流感相关严重急性呼吸疾病（SARI）死亡的发病率和风险因素。
2009年至2013年期间，在南非四个省份对住院的SARI患者进行前瞻性登记。使用聚合酶链反应对呼吸道样本检测十种呼吸道病毒，对血液检测肺炎球菌DNA。在一家有明确集水区人口的城市医院估计流感相关SARI死亡的发病率。
我们登记了1376例流感相关SARI患者，3%（1358例有可用结局数据中的41例）死亡。在有可用HIV状态的患者中，HIV感染患者的病死率（CFP）高于未感染HIV的个体（5%，22/419对比2%，13/620；p = 0.006）。CFP因年龄组而异，在5岁以上个体中通常随年龄增长而增加（p<0.001）。多变量分析显示，与死亡相关的因素包括45 - 64岁年龄组（比值比（OR）4.0，95%置信区间（CI）1.01 - 16.3）和≥65岁年龄组（OR 6.5，95%CI 1.2 - 34.3），对比CFP最低的1 - 4岁年龄组，HIV感染（OR 2.9，95%CI 1.1 - 7.8），除HIV外的基础疾病（OR 2.9，95%CI 1.2 - 7.3）和肺炎球菌合并感染（OR 4.1，95%CI 1.5 - 11.2）。每10万人口中流感相关SARI死亡的估计发病率在<1岁儿童中最高（20.1，95%CI 12.1 - 31.3），在45 - 64岁成年人中为（10.4，95%CI 8.4 - 12.9）。调整年龄后，HIV感染个体的死亡率比未感染HIV的个体高20倍（95%CI 15.0 - 27.8）。
流感在南非城市导致大量死亡，特别是在<1岁婴儿和HIV感染个体中。更广泛地获得抗逆转录病毒治疗和流感疫苗接种可能减轻这一负担。
