Respiratory Virus–Associated Severe Acute Respiratory Illness and Viral Clustering in Malawian Children in a Setting With a High Prevalence of HIV Infection, Malaria, and Malnutrition
Open Access
- 13 September 2016
- journal article
- research article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 214 (11), 1700-1711
- https://doi.org/10.1093/infdis/jiw426
Abstract
We used data from 4 years of pediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi, to identify factors associated with clinical severity and coviral clustering. From January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to the hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza virus and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with viral codetection. Hospital-attended influenza virus–positive SARI incidence was 2.0 cases per 10 000 children annually; it was highest among children aged <1 year (6.3 cases per 10 000), and human immunodeficiency virus (HIV)–infected children aged 5–9 years (6.0 cases per 10 000). A total of 605 SARI cases (26.8%) had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR], 2.4; 95% confidence interval [CI], 1.4–3.9), respiratory syncytial virus infection (aRR, 1.9; 95% CI, 1.3–3.0) and rainy season (aRR, 2.4; 95% CI, 1.6–3.8). We identified 6 coviral clusters; 1 cluster was associated with SARI with warning signs. Influenza vaccination may benefit young children and HIV-infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance.Keywords
Funding Information
- CDC (5U01CK000146-04)
This publication has 30 references indexed in Scilit:
- Viral and bacterial etiology of severe acute respiratory illness among children < 5 years of age without influenza in NigerBMC Infectious Diseases, 2015
- Influenza Sentinel Surveillance among Patients with Influenza-Like-Illness and Severe Acute Respiratory Illness within the Framework of the National Reference Laboratory, Niger, 2009-2013PLOS ONE, 2015
- Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired PneumoniaThe Journal of Infectious Diseases, 2015
- Severe acute respiratory infection in children in a densely populated urban slum in Kenya, 2007–2011BMC Infectious Diseases, 2015
- Identification of viral and bacterial pathogens from hospitalized children with severe acute respiratory illness in Lusaka, Zambia, 2011–2012: a cross-sectional studyBMC Infectious Diseases, 2015
- Global burden of childhood pneumonia and diarrhoeaThe Lancet, 2013
- Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysisThe Lancet, 2013
- Viral and Bacterial Causes of Severe Acute Respiratory Illness Among Children Aged Less Than 5 Years in a High Malaria Prevalence Area of Western Kenya, 2007–2010The Pediatric Infectious Disease Journal, 2013
- Incidence of Respiratory Virus-Associated Pneumonia in Urban Poor Young Children of Dhaka, Bangladesh, 2009–2011PLOS ONE, 2012
- Viral Etiology of Severe Pneumonia Among Kenyan Infants and ChildrenJAMA, 2010