Risk factors for severe respiratory syncytial virus-associated respiratory tract infection in a high HIV prevalence setting, South Africa, 2012 - 2018

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

doi:10.1186/s12879-024-10024-9

Risk factors for severe respiratory syncytial virus-associated respiratory tract infection in a high HIV prevalence setting, South Africa, 2012 - 2018

BMC Infect Dis. 2024 Oct 9;24(1):1128. doi: 10.1186/s12879-024-10024-9.

Authors

Jocelyn Moyes^{1

2}, Stefano Tempia^{3

4}, Sibongile Walaza^{5

6}, Adam L Cohen^{7

8}, Florette Treurnicht⁹, Orienka Hellferscee⁵, Nicole Wolter^{5

10}, Anne von Gottberg^{5

10}, Halima Dawood^{11

12}, Ebrahim Variava^{13

14}, Kathleen Kahn¹⁵, Shabir A Madhi¹⁶, Cheryl Cohen^{17

18}

Affiliations

¹ Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa. [email protected].
² School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. [email protected].
³ MassGenics, Duluth, GA, United States of America.
⁴ Centers for Disease Control and Prevention, Influenza Program, Pretoria, South Africa.
⁵ Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa.
⁶ School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁸ Expanded Programme On Immunization Department of Immunization, Vaccines and Biologicals World Health Organization, Geneva, Switzerland.
⁹ Division of Virology, Faculty of Health Sciences, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
¹⁰ School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ Department of Medicine, Greys Hospital, Pietermaritzburg, South Africa.
¹² Caprisa, University of KwaZulu Natal, Pietermaritzburg, South Africa.
¹³ Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa.
¹⁴ Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁵ School of Public Health, Faculty of Health Sciences, SAMRC/Wits Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
¹⁶ South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
¹⁷ Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, PVT Bag X4, Sandringham, Johannesburg, Gauteng, 2131, South Africa. [email protected].
¹⁸ School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. [email protected].

Abstract

Background: Identifying risk factors for respiratory syncytial virus (RSV)-associated severe acute respiratory illness (SARI) will assist with targeting vaccine interventions.

Methods: Using surveillance data from South Africa (2012-2018), we compared the characteristics of individuals with RSV-associated influenza-like illness (ILI) (reference group) to those with RSV-associated SARI to describe factors associated with SARI using a multivariable analysis.

Results: RSV was detected in 6% (483/7792) of ILI cases and 15% (844/5672) of SARI cases. Factors associated with SARI in children included age < 2 months, compared to age 2-4 years (adjusted odds ratio (aOR) 54.4; 95% confidence interval (CI) 23.5-125.8), malnutrition (aOR 1.9; 95% CI 1.2-3.2), prematurity (aOR 2.4; 95% CI 1.3-4.6) and living with HIV (LWH) (aOR 22.5; 95% CI 2.9-174.3). In individuals ≥ 5 years, factors associated with SARI included age ≥ 65 years compared to age 5-24 years (aOR 10.7; 95% CI 1.1-107.5), symptom duration ≥ 5 days (aOR 2.7; 95% CI 1.1-6.3), underlying illness (aOR 2.7; 95% CI 1.5-26.1) and LWH (aOR 16.8, 95% CI: 4.8-58.2).

Conclusion: Individuals at the extremes of age and those with identified risk factors might benefit most from RSV prevention interventions.

Clinical trial number: Not applicable, this is not a clinical trial.

Keywords: HIV infection; Lower respiraptry tract infection; RSV; Respiratory syncytial virus; Risk factors.

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
Female
HIV Infections* / complications
HIV Infections* / epidemiology
Humans
Infant
Infant, Newborn
Male
Middle Aged
Prevalence
Respiratory Syncytial Virus Infections* / epidemiology
Respiratory Syncytial Virus, Human*
Respiratory Tract Infections* / epidemiology
Respiratory Tract Infections* / virology
Risk Factors
South Africa / epidemiology
Young Adult