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. 2021 Jan:102:291-298.
doi: 10.1016/j.ijid.2020.10.054. Epub 2020 Oct 27.

Respiratory pathogen diversity and co-infections in rural Zambia

Gideon Loevinsohn  1 , Justin Hardick  2 , Pamela Sinywimaanzi  3 , Katherine Z J Fenstermacher  4 , Kathryn Shaw-Saliba  4 , Mwaka Monze  5 , Charlotte A Gaydos  2 , Richard E Rothman  4 , Andrew Pekosz  6 , Philip E Thuma  7 , Catherine G Sutcliffe  8
Affiliations

Respiratory pathogen diversity and co-infections in rural Zambia

Gideon Loevinsohn et al. Int J Infect Dis. 2021 Jan.

Abstract

Objectives: The role of respiratory co-infections in modulating disease severity remains understudied in southern Africa, particularly in rural areas. This study was performed to characterize the spectrum of respiratory pathogens in rural southern Zambia and the prognostic impact of co-infections.

Methods: Respiratory specimens collected from inpatient and outpatient participants in a viral surveillance program in 2018-2019 were tested for selected viruses and atypical bacteria using the Xpert Xpress Flu/RSV assay and FilmArray Respiratory Panel EZ. Participants were followed for 3-5 weeks to assess their clinical course. Multivariable regression was used to examine the role of co-infections in influencing disease severity.

Results: A respiratory pathogen was detected in 63.2% of samples from 671 participants who presented with influenza-like illness. Common pathogens identified included influenza virus (18.2% of samples), respiratory syncytial virus (RSV) (11.8%), rhinovirus (26.4%), and coronavirus (6.0%). Overall, 6.4% of participants were co-infected with multiple respiratory pathogens. Compared to mono-infections, co-infections were found not to be associated with severe clinical illness either overall (relative risk (RR) 0.72, 95% confidence interval (CI) 0.39-1.32) or specifically with influenza virus (RR 0.80, 95% CI 0.14-4.46) or RSV infections (RR 0.44, 95% CI 0.17-1.11).

Conclusions: Respiratory infections in rural southern Zambia were associated with a wide range of viruses. Respiratory co-infections in this population were not associated with clinical severity.

Keywords: Co-infections; Respiratory viruses; Rural; Severity; Sub-Saharan.

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Conflict of interest statement

Conflicts of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Seasonal trends by respiratory pathogen; Macha, Zambia—December 2018 to December 2019. Estimated pathogen prevalence among outpatients with influenza-like illness (ILI) over the study period for (A) influenza A virus, (B) influenza B virus, (C) respiratory syncytial virus (RSV), (D) rhinovirus, (E) parainfluenza virus, (F) metapneumovirus, (G) coronavirus, (H) adenovirus, and (I) Bordetella pertussis. Percentages represent estimated pathogen prevalence overall among all outpatients with ILI. Lines represent estimated monthly prevalence and gray bands represent associated 95% confidence intervals.
See this image and copyright information in PMC

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