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. 2015 Jun 15;10(6):e0129173.
doi: 10.1371/journal.pone.0129173. eCollection 2015.

Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999-2009

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

Excess Mortality Associated with Influenza among Tuberculosis Deaths in South Africa, 1999-2009

Sibongile Walaza et al. PLoS One. .

Abstract

Background: Published data on the interaction between influenza and pulmonary tuberculosis (PTB) are limited. We aimed to estimate the influenza-associated mortality among individuals with PTB in South Africa from 1999-2009.

Methods: We modelled the excess influenza-associated mortality by applying Poisson regression models to monthly PTB and non-tuberculosis respiratory deaths, using laboratory-confirmed influenza as a covariate.

Results: PTB deaths increased each winter, coinciding with influenza virus circulation. Among individuals of any age, mean annual influenza-associated PTB mortality rate was 164/100,000 person-years (n = 439). The rate of non-tuberculosis respiratory deaths was 27/100,000 (n = 1125) for HIV-infected and 5/100,000 (n = 2367) for HIV-uninfected individuals of all ages. Among individuals aged <65 years, influenza-associated PTB mortality risk was elevated compared to influenza-associated non-tuberculosis respiratory deaths in HIV-infected (relative risk (RR): 5.2; 95% CI: 4.6-5.9) and HIV-uninfected individuals (RR: 61.0; CI: 41.4-91.0). Among individuals aged ≥65 years, influenza-associated PTB mortality risk was elevated compared to influenza-associated non-tuberculosis respiratory deaths in HIV-uninfected individuals (RR: 13.0; 95% CI: 12.0-14.0).

Conclusion: We observed an increased risk of influenza-associated mortality in persons with PTB compared to non-tuberculosis respiratory deaths. If confirmed in other settings, our findings may support recommendations for active inclusion of patients with TB for influenza vaccination and empiric influenza anti-viral treatment of patients with TB during influenza epidemics.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Monthly observed deaths, predicted deaths and predicted baseline (Poisson model), South Africa, 1999–2009.
A: Pulmonary tuberculosis deaths in individuals <65 years of age. B: Pulmonary tuberculosis deaths in individuals ≥65 years of age; C Non-tuberculosis respiratory deaths in individuals <65 years of age. D Non-tuberculosis respiratory deaths in individuals ≥65 years of age.
Fig 2
Fig 2. Monthly detection rate (i.e., monthly number of positive specimens divided by total specimens) of influenza (all ages) in South Africa, 1999–2009.
See this image and copyright information in PMC

References

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    1. Cohen C, Moyes J, Tempia S, Groom M, Walaza S, Pretorius M, et al. Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009–2011. Emerg.Infect.Dis. 2013,19:1766–1774. 10.3201/eid1911.130546 - DOI - PMC - PubMed