The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011–2015
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Hetani Ngobeni aff001; Stefano Tempia aff003; Adam L. Cohen aff004; Sibongile Walaza aff003; Lazarus Kuonza aff001; Alfred Musekiwa aff002; Anne von Gottberg aff003; Orienka Hellferscee aff003; Nicole Wolter aff003; Florette K. Treurnicht aff003; Jocelyn Moyes aff003; Fathima Naby aff003; Omphile Mekgoe aff003; Cheryl Cohen aff003
Působiště autorů:
South African Field Epidemiology Training Programme, Johannesburg, South Africa
aff001; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
aff002; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
aff003; Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
aff004; Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
aff005; MassGenics, Duluth, Georgia, United States of America
aff006; Global Immunization Monitoring and Surveillance Team, Vaccines and Biologicals, World Health Organisation, Geneva, Switzerland
aff007; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
aff008; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
aff009
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222294
Souhrn
In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38°C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5–3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89–98%) in HIV-uninfected and of 100% (95% CI 79–100%) in HIV-infected children but low specificity: 7% (95% CI 6–8%) and 6% (95% CI 3–9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI—an acute respiratory infection with history of fever or measured fever of ≥ 38°C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56–76%) and specificity of 46% (95% CI 44–48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35–84%) and a specificity of 42% (95% CI 36–48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.
Klíčová slova:
Medicine and health sciences – Infectious diseases – Viral diseases – Influenza – Infectious disease control – Infectious disease surveillance – Diagnostic medicine – Signs and symptoms – Fevers – Pathology and laboratory medicine – Pathogens – Epidemiology – Disease surveillance – Pulmonology – Respiratory infections – Biology and life sciences – Physiology – Physiological processes – Coughing – Organisms – Viruses – RNA viruses – Orthomyxoviruses – Influenza viruses – Microbiology – Medical microbiology – Microbial pathogens – Viral pathogens – Immunodeficiency viruses – HIV – Retroviruses – Lentivirus – People and places – Population groupings – Age groups – Children – Families
Zdroje
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