Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011-2013
Epidemiology of Severe Acute Respiratory Illness and Risk Factors for Influenza Infection and Clinical Severity among Adults in Malawi, 2011-2013
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DOI：
10.4269/ajtmh.17-0905
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发表时间：
2018-01-01
影响因子：
3.3
通讯作者：
Heyderman, Robert S.
中科院分区：
文献类型：
--
作者：
Ho, Antonia;Mallewa, Jane;Heyderman, Robert S.
关于低收入、人类免疫缺陷病毒（HIV）高流行非洲地区成人严重急性呼吸道疾病（SARI）流行病学的数据很少。我们在马拉维布兰太尔进行了成人 SARI 监测。 2011年1月至2013年12月，马拉维布兰太尔一家大型教学医院招募了年龄(3)15岁的SARI患者（住院患者和门诊患者）。通过聚合酶链反应检测鼻咽吸出物中是否存在流感和其他呼吸道病毒。我们估计了医院就诊的流感阳性 SARI 发病率，并评估了与流感阳性和临床严重程度相关的因素（修正早期预警评分 > 4）。我们登记了 1,126 例 SARI 病例； 163 人（14.5%）流感呈阳性。人类免疫缺陷病毒患病率为50.3%。医院就诊的流感相关 SARI 的年发病率为每 10 万人 9.7-16.8 例。人类免疫缺陷病毒的发病率高出 5 倍（发病率比 4.91，95% 置信区间 [CI]：3.83-6.32）。多变量分析显示，女性性别以及炎热雨季（12 月至 3 月；调整优势比 (aOR)：2.82，95% CI：1.57-5.06）和凉爽干燥季节（4 月至 8 月；aOR：2.47，95% CI：1.35-4.15）的招募与流感阳性相关，而流感阳性患者则不太可能出现流感阳性。 HIV感染（aOR：0.59，95% CI：0.43-0.80）或病毒合并感染（aOR：0.51，95% CI：0.36-0.73）。人类免疫缺陷病毒感染（aOR：1.86；95% CI：1.35-2.56）和炎热雨季的招募（aOR：4.98，95% CI：3.17-7.81）与临床严重程度独立相关。在这一艾滋病毒高流行人群中，近 15% 的住院 SARI 与流感有关。人类免疫缺陷病毒感染是全因和流感相关 SARI 临床严重程度的重要危险因素。扩大艾滋病毒检测和抗逆转录病毒治疗以及有针对性的流感疫苗接种的机会，可能会减轻马拉维和其他艾滋病毒高流行地区的严重急性呼吸道感染的负担。
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 (3) 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). Onmultivariable 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.