Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009-2011

Abstract

Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009-2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4-8 times greater for HIV-infected (186-228/100,000) than for HIV-uninfected persons (26-54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2-7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.

Keywords: AIDS; HIV; South Africa; adults; bacteria; children; co-infection; influenza; lower respiratory tract infection; pneumoccocus; pneumococcal; pneumonia; respiratory infections; vaccination; viruses.

Figure 1

Number of patients testing influenza positive by subtype and influenza detection rate by epidemiologic week and year among patients with hospitalized pneumonia at 4 sentinel surveillance sites, South Africa, 2009–2011.

Figure 2

Incidence of laboratory-confirmed influenza-associated lower respiratory tract infection hospitalization, per 100,000 population, by year and age group, at Chris Hani-Baragwanath Hospital, South Africa, 2009–2011. Error bars indicate 95% CIs.