Epidemiology of viral-associated acute lower respiratory tract infection among children <5 years of age in a high HIV prevalence setting, South Africa, 2009-2012.
Epidemiology of viral-associated acute lower respiratory tract infection among children <5 years of age in a high HIV prevalence setting, South Africa, 2009-2012.
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DOI：
10.1097/inf.0000000000000478
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发表时间：
2015-01
期刊：
影响因子：
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通讯作者：
Madhi SA
中科院分区：
文献类型：
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作者：
Cohen C;Walaza S;Moyes J;Groome M;Tempia S;Pretorius M;Hellferscee O;Dawood H;Chhagan M;Naby F;Haffejee S;Variava E;Kahn K;Nzenze S;Tshangela A;von Gottberg A;Wolter N;Cohen AL;Kgokong B;Venter M;Madhi SA
补充数字内容可在文本中找到。艾滋病毒高流行率环境中病毒相关急性下呼吸道感染（LRTI）的流行病学数据有限。我们的目的是描述南非5岁以下儿童的LRTI住院情况。我们前瞻性纳入了2009年至2012年4个省5个研究中心的经医生诊断为下呼吸道感染的住院儿童。使用聚合酶链反应（PCR），鼻咽吸出物进行了测试的10种病毒和血液的肺炎球菌DNA。在1个研究中心估计了发生率，并提供了可用的人群回归系数。我们招募了8723名5岁以下的LRTI儿童，其中64% <12个月。病死率为2%（150/8512）。接受检测的儿童中艾滋病毒感染率为12%（705/5964）。确定的呼吸道病毒的总体患病率为78%（6517/8393），包括37%鼻病毒、26%呼吸道合胞病毒（RSV）、7%流感病毒和5%人偏肺病毒。4%（253/6612）的人肺炎球菌检测呈阳性。下呼吸道感染住院的年发病率范围为2530 - 3173/100，000，婴儿最高（8446-10532/100，000）。艾滋病毒感染儿童的下呼吸道感染发病率是未感染艾滋病毒儿童的1.1至3.0倍。多因素分析显示，与未感染HIV的儿童相比，感染HIV的儿童更可能需要吸氧[比值比（OR）：1.3，95%可信区间（CI）：1.1-1.7]，住院时间>7天（OR：3.8，95% CI：2.8-5.0），病死率（OR：4.2，95% CI：2.6-6.8）较高。在多变量分析中，HIV感染（OR：3.7，95%CI：2.2-6.1）、肺炎球菌合并感染（OR：2.4，95%CI：1.1-5.6）、机械通气（OR：6.9，95%CI：2.7-17.6）和接受呼吸机吸氧（OR：27.3，95%CI：13.2-55.9）与死亡相关。HIV感染与LRTI住院和死亡风险增加相关。在高比例的下呼吸道感染病例中发现了一种病毒病原体，通常为RSV。
Supplemental Digital Content is available in the text. Data on the epidemiology of viral-associated acute lower respiratory tract infection (LRTI) from high HIV prevalence settings are limited. We aimed to describe LRTI hospitalizations among South African children aged <5 years. We prospectively enrolled hospitalized children with physician-diagnosed LRTI from 5 sites in 4 provinces from 2009 to 2012. Using polymerase chain reaction (PCR), nasopharyngeal aspirates were tested for 10 viruses and blood for pneumococcal DNA. Incidence was estimated at 1 site with available population denominators. We enrolled 8723 children aged <5 years with LRTI, including 64% <12 months. The case-fatality ratio was 2% (150/8512). HIV prevalence among tested children was 12% (705/5964). The overall prevalence of respiratory viruses identified was 78% (6517/8393), including 37% rhinovirus, 26% respiratory syncytial virus (RSV), 7% influenza and 5% human metapneumovirus. Four percent (253/6612) tested positive for pneumococcus. The annual incidence of LRTI hospitalization ranged from 2530 to 3173/100,000 population and was highest in infants (8446–10532/100,000). LRTI incidence was 1.1 to 3.0-fold greater in HIV-infected than HIV-uninfected children. In multivariable analysis, compared to HIV-uninfected children, HIV-infected children were more likely to require supplemental-oxygen [odds ratio (OR): 1.3, 95% confidence interval (CI): 1.1–1.7)], be hospitalized >7 days (OR: 3.8, 95% CI: 2.8–5.0) and had a higher case-fatality ratio (OR: 4.2, 95% CI: 2.6–6.8). In multivariable analysis, HIV-infection (OR: 3.7, 95% CI: 2.2–6.1), pneumococcal coinfection (OR: 2.4, 95% CI: 1.1–5.6), mechanical ventilation (OR: 6.9, 95% CI: 2.7–17.6) and receipt of supplemental-oxygen (OR: 27.3, 95% CI: 13.2–55.9) were associated with death. HIV-infection was associated with an increased risk of LRTI hospitalization and death. A viral pathogen, commonly RSV, was identified in a high proportion of LRTI cases.