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. 2015 Oct 1;61(7):1063-70.
doi: 10.1093/cid/civ448. Epub 2015 Jun 9.

Mortality Associated With Seasonal and Pandemic Influenza Among Pregnant and Nonpregnant Women of Childbearing Age in a High-HIV-Prevalence Setting-South Africa, 1999-2009

Stefano Tempia  1 , Sibongile Walaza  2 , Adam L Cohen  3 , Claire von Mollendorf  2 , Jocelyn Moyes  2 , Johanna M McAnerney  4 , Cheryl Cohen  2
Affiliations

Mortality Associated With Seasonal and Pandemic Influenza Among Pregnant and Nonpregnant Women of Childbearing Age in a High-HIV-Prevalence Setting-South Africa, 1999-2009

Stefano Tempia et al. Clin Infect Dis. .

Abstract

Background: Information on the mortality burden associated with seasonal and pandemic influenza virus infection among pregnant women is scarce in most settings, particularly in sub-Saharan Africa where pregnancy and maternal mortality rates as well as human immunodeficiency virus (HIV) prevalence are elevated.

Methods: We used an ecological study design to estimate the seasonal and A(H1N1)pdm09 influenza-associated mortality among pregnant and nonpregnant women of childbearing age (15-49 years) by HIV serostatus during 1999-2009 in South Africa. Mortality rates were expressed per 100 000 person-years.

Results: During 1999-2009, the estimated mean annual seasonal influenza-associated mortality rates were 12.6 (123 deaths) and 7.3 (914 deaths) among pregnant and nonpregnant women, respectively. Among pregnant women, the estimated mean annual seasonal influenza-associated mortality rates were 74.9 (109 deaths) among HIV-infected and 1.5 (14 deaths) among HIV-uninfected individuals. Among nonpregnant women, the estimated mean annual seasonal influenza-associated mortality rate was 41.2 (824 deaths) among HIV-infected and 0.9 (90 deaths) among HIV-uninfected individuals. Pregnant women experienced an increased risk of seasonal influenza-associated mortality compared with nonpregnant women (relative risk [RR], 2.8; 95% confidence interval [CI], 1.7-3.9). In 2009, the estimated influenza A(H1N1)pdm09-associated mortality rates were 19.3 (181 deaths) and 9.4 (1189 deaths) among pregnant and nonpregnant women, respectively (RR, 3.2; 95% CI, 2.3-4.1).

Conclusions: Among women of childbearing age, the majority of estimated seasonal influenza-associated deaths occurred in HIV-infected individuals. Pregnant women experienced an increased risk of death associated with seasonal and A(H1N1)pdm09 influenza infection compared with nonpregnant women.

Keywords: HIV; South Africa; influenza; mortality; pregnancy.

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Conflict of interest statement

Potential conflicts of interest. All authors: No potential conflicts of interest.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1
Figure 1
Monthly mortality and influenza virus detection rates in South Africa, 1999–2009. A, Observed all-respiratory deaths, predicted deaths, and predicted baseline (Model 1) among pregnant women of childbearing age (15–49 years of age). B, Observed all-respiratory deaths, predicted deaths, and predicted baseline (Model 1) among nonpregnant women of childbearing age (15–49 years of age). C, Influenza detection rate (ie, monthly number of positive specimens divided by total specimens). Observed deaths are adjusted for maternal death underreporting.
See this image and copyright information in PMC

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