Tempia Stefano, Walaza Sibongile, Moyes Jocelyn, Cohen Adam L, von Mollendorf Claire, Treurnicht Florette K, Venter Marietjie, Pretorius Marthi, Hellferscee Orienka, Mtshali Senzo, Seleka Mpho, Tshangela Akhona, Nguweneza Athermon, McAnerney Johanna M, Wolter Nicole, von Gottberg Anne, Dawood Halima, Variava Ebrahim, Madhi Shabir A, Cohen Cheryl
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
Open Forum Infect Dis. 2017 Feb 10;4(1):ofw262. doi: 10.1093/ofid/ofw262. eCollection 2017 Winter.
Data on risk factors for influenza-associated hospitalizations in low- and middle-income countries are limited.
We conducted active syndromic surveillance for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) in 2 provinces of South Africa during 2012-2015. We compared the characteristics of influenza-positive patients with SARI to those with ILI to identify factors associated with severe disease requiring hospitalization, using unconditional logistic regression.
During the study period, influenza virus was detected in 5.9% (110 of 1861) and 15.8% (577 of 3652) of SARI and ILI cases, respectively. On multivariable analysis factors significantly associated with increased risk of influenza-associated SARI hospitalization were as follows: younger and older age (<6 months [adjusted odds ratio {aOR}, 37.6], 6-11 months [aOR, 31.9], 12-23 months [aOR, 22.1], 24-59 months [aOR, 7.1], and ≥65 years [aOR, 40.7] compared with 5-24 years of age), underlying medical conditions (aOR, 4.5), human immunodeficiency virus infection (aOR, 4.3), and colonization density ≥1000 deoxyribonucleic acid copies/mL (aOR, 4.8). Underlying medical conditions in children aged <5 years included asthma (aOR, 22.7), malnutrition (aOR, 2.4), and prematurity (aOR, 4.8); in persons aged ≥5 years, conditions included asthma (aOR, 3.6), diabetes (aOR, 7.1), chronic lung diseases (aOR, 10.7), chronic heart diseases (aOR, 9.6), and obesity (aOR, 21.3). Mine workers (aOR, 13.8) and pregnant women (aOR, 12.5) were also at increased risk for influenza-associated hospitalization.
The risk groups identified in this study may benefit most from annual influenza immunization, and children <6 months of age may be protected through vaccination of their mothers during pregnancy.
低收入和中等收入国家中与流感相关住院的危险因素数据有限。
2012年至2015年期间，我们在南非的两个省份对住院的严重急性呼吸道疾病（SARI）和门诊流感样疾病（ILI）开展了主动症状监测。我们将流感阳性的SARI患者与ILI患者的特征进行比较，采用无条件逻辑回归分析来确定与需要住院治疗的严重疾病相关的因素。
在研究期间，分别在5.9%（1861例中的110例）的SARI病例和15.8%（3652例中的577例）的ILI病例中检测到流感病毒。多变量分析显示，与流感相关的SARI住院风险增加显著相关的因素如下：年龄较小和较大（与5至24岁相比，<6个月[调整优势比{aOR}，37.6]、6至11个月[aOR，31.9]、12至23个月[aOR，22.1]、24至59个月[aOR，7.1]以及≥65岁[aOR，40.7]）、基础疾病（aOR，4.5）、人类免疫缺陷病毒感染（aOR，4.3）以及定植密度≥1000个脱氧核糖核酸拷贝/毫升（aOR，4.8）。<5岁儿童的基础疾病包括哮喘（aOR，22.7）、营养不良（aOR，2.4）和早产（aOR，4.8）；≥5岁人群的基础疾病包括哮喘（aOR，3.6）、糖尿病（aOR，7.1）、慢性肺病（aOR，10.7）、慢性心脏病（aOR，9.6）和肥胖（aOR，21.3）。矿工（aOR，13.8）和孕妇（aOR，12.5）患流感相关住院的风险也增加。
本研究确定的风险人群可能从年度流感疫苗接种中获益最大，6个月以下的儿童可通过其母亲在孕期接种疫苗而得到保护。
