The attributable fraction of respiratory syncytial virus among patients of different ages with influenza-like illness and severe acute respiratory illness in a high HIV prevalence setting, South Africa, 2012-2016

Jocelyn Moyes; Stefano Tempia; Sibongile Walaza; Meredith L McMorrow; Adam L Cohen; Florette Treurnicht; Orienka Hellferscee; Nicole Wolter; Anne Von Gottberg; Halima Dawood; Ebrahim Variava; Kathleen Kahn; Shabir A Madhi; Cheryl Cohen

doi:10.1016/j.ijid.2023.05.009

The attributable fraction of respiratory syncytial virus among patients of different ages with influenza-like illness and severe acute respiratory illness in a high HIV prevalence setting, South Africa, 2012-2016

Int J Infect Dis. 2023 Sep:134:71-77. doi: 10.1016/j.ijid.2023.05.009. Epub 2023 May 20.

Authors

Affiliations

¹ Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: jossmoyes@gmail.com.
² Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; MassGenics, Atlanta, Georgia, United States of America and Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
³ Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America and Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
⁵ Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America and Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa; Global Immunization Monitoring and Surveillance, Expanded Programme on Immunization Department of Immunization, Vaccines and Biologicals World Health Organization, Geneva, Switzerland.
⁶ Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.
⁷ Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁸ Department of Medicine, Greys Hospital, Pietermaritzburg, South Africa; Caprisa, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
⁹ Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa; Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Medical Research Council of South Africa/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg Epidemiology and Global Health Unit, Johannesburg, South Africa.
¹¹ South African Medical Research Council Vaccines and Infectious Diseases Analytical Research Unit, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, University of the Witwatersrand, Johannesburg, South Africa.
¹² Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: cherylc@nicd.ac.za.

PMID: 37211271
PMCID: PMC10675839 (available on 2024-07-01)
DOI: 10.1016/j.ijid.2023.05.009

Abstract

Objectives: The detection of respiratory syncytial virus (RSV) in upper airway samples does not necessarily infer causality of illness. We aimed to calculate the attributable fraction (AF) of RSV in clinical syndromes across age groups.

Methods: Using unconditional logistic regression models, we estimated the AF of RSV-associated influenza-like illness (ILI) and severe acute respiratory illness (SARI) cases by comparing RSV detection prevalence among ILI and SARI cases to those of healthy controls in South Africa, 2012-2016. The analysis, stratified by HIV serostatus, was conducted in the age categories <1, 1-4, 5-24, 25-44, 45-64, and ≥65 years.

Results: We included 12,048 individuals: 2687 controls, 5449 ILI cases, and 5449 SARI cases. RSV-AFs for ILI were significant in <1, 1-4, 5-and 24, 25-44-year age groups: 84.9% (95% confidence interval [CI] 69.3-92.6%), 74.6% (95% CI 53.6-86.0%), 60.8% (95% CI 21.4-80.5%) and 64.1% (95% CI 14.9-84.9%), respectively. Similarly, significant RSV-AFs for SARI were 95.3% (95% CI 91.1-97.5) and 83.4% (95% CI 70.9-90.5) in the <1 and 1-4-year age groups respectively. In HIV-infected persons, RSV was significantly associated with ILI cases vs controls in individuals aged 5-44 years.

Conclusion: High RSV-AFs in young children confirm RSV detection is associated with severe respiratory illness in South African children, specifically infants. These estimates will assist with refining burden estimates and cost-effectiveness models.

Keywords: Attributable fraction; Burden of disease; Respiratory syncytial virus.

MeSH terms

Aged, 80 and over
Child
Child, Preschool
HIV Infections* / complications
HIV Infections* / epidemiology
Humans
Infant
Influenza, Human*
Prevalence
Respiratory Syncytial Virus Infections* / epidemiology
Respiratory Syncytial Virus, Human*
Respiratory Tract Infections* / epidemiology
South Africa / epidemiology
Virus Diseases* / complications

Abstract

MeSH terms

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