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. 2017 Feb 10;4(1):ofw262.
doi: 10.1093/ofid/ofw262. eCollection 2017 Winter.

Risk Factors for Influenza-Associated Severe Acute Respiratory Illness Hospitalization in South Africa, 2012-2015

Stefano Tempia  1   2   3 , Sibongile Walaza  3   4 , Jocelyn Moyes  3   4 , Adam L Cohen  1   5 , Claire von Mollendorf  3   4 , Florette K Treurnicht  3 , Marietjie Venter  6   7 , Marthi Pretorius  3   7   8 , Orienka Hellferscee  3   9 , Senzo Mtshali  3 , Mpho Seleka  3 , Akhona Tshangela  3 , Athermon Nguweneza  3 , Johanna M McAnerney  3 , Nicole Wolter  3   9 , Anne von Gottberg  3   9 , Halima Dawood  10   11 , Ebrahim Variava  12   13   14 , Shabir A Madhi  3   15   16 , Cheryl Cohen  3   4
Affiliations

Risk Factors for Influenza-Associated Severe Acute Respiratory Illness Hospitalization in South Africa, 2012-2015

Stefano Tempia et al. Open Forum Infect Dis. .

Abstract

Background: Data on risk factors for influenza-associated hospitalizations in low- and middle-income countries are limited.

Methods: We conducted active syndromic surveillance for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) in 2 provinces of South Africa during 2012-2015. We compared the characteristics of influenza-positive patients with SARI to those with ILI to identify factors associated with severe disease requiring hospitalization, using unconditional logistic regression.

Results: During the study period, influenza virus was detected in 5.9% (110 of 1861) and 15.8% (577 of 3652) of SARI and ILI cases, respectively. On multivariable analysis factors significantly associated with increased risk of influenza-associated SARI hospitalization were as follows: younger and older age (<6 months [adjusted odds ratio {aOR}, 37.6], 6-11 months [aOR, 31.9], 12-23 months [aOR, 22.1], 24-59 months [aOR, 7.1], and ≥65 years [aOR, 40.7] compared with 5-24 years of age), underlying medical conditions (aOR, 4.5), human immunodeficiency virus infection (aOR, 4.3), and Streptococcus pneumoniae colonization density ≥1000 deoxyribonucleic acid copies/mL (aOR, 4.8). Underlying medical conditions in children aged <5 years included asthma (aOR, 22.7), malnutrition (aOR, 2.4), and prematurity (aOR, 4.8); in persons aged ≥5 years, conditions included asthma (aOR, 3.6), diabetes (aOR, 7.1), chronic lung diseases (aOR, 10.7), chronic heart diseases (aOR, 9.6), and obesity (aOR, 21.3). Mine workers (aOR, 13.8) and pregnant women (aOR, 12.5) were also at increased risk for influenza-associated hospitalization.

Conclusions: The risk groups identified in this study may benefit most from annual influenza immunization, and children <6 months of age may be protected through vaccination of their mothers during pregnancy.

Keywords: HIV; South Africa; hospitalization; influenza; risk factors; severe acute respiratory illness.

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Figures

Figure 1.
Figure 1.
Number of influenza-positive severe acute respiratory illness and influenza-like illness cases by week, Klerksdorp and Pietermaritzburg, South Africa, May 2012–April 2015.
See this image and copyright information in PMC

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