Aetiological Fraction of Influenza, Respiratory Syncytial Virus and Other Respiratory Pathogens in Infants Aged < 1 Year Hospitalised With Respiratory and Non-Respiratory Medical Illness in South Africa, 2016–2018

IF 4.2 4区医学 Q1 INFECTIOUS DISEASES

Influenza and Other Respiratory Viruses Pub Date : 2025-07-01 DOI:10.1111/irv.70135

Nicole Wolter, Cheryl Cohen, Anne von Gottberg, Stefano Tempia, Jocelyn Moyes, Claire von Mollendorf, Florette K. Treurnicht, Orienka Hellferscee, Kathleen Subramoney, Malefu Moleleki, Cayla Reddy, Lorens Maake, Mvuyo Makhasi, Neydis Baute, Sibongile Walaza

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Abstract

Background

Understanding the contribution of pathogens to respiratory illness in infants is important to guide interventions. We assessed the aetiology of respiratory pathogens among infants hospitalised with respiratory and non-respiratory illness.

Methods

We conducted an unmatched case–control study among infants aged < 1 year. Cases were admitted with acute respiratory and non-respiratory illness in November 2016–October 2018. Controls were infants presenting for immunisation with no reported illness. Nasopharyngeal aspirates and blood were tested using multi-pathogen real-time PCR. Aetiological fraction (AF) was calculated using logistic regression, adjusting for HIV, age, season and pathogens with higher prevalence in cases than controls. Factors associated with respiratory illness hospitalisation were assessed using logistic regression.

Results

Overall, 1214 cases (846 respiratory, 368 non-respiratory) and 684 controls were included. Respiratory syncytial virus (RSV) (AF 94.0%), influenza (AF 72.6%) and human metapneumovirus (HMPV) (AF 74.9%) were significantly attributable to respiratory illness hospitalisation. Klebsiella pneumoniae had significant AF in both respiratory (AF 48.0%) and non-respiratory (AF 60.7%) hospitalisation. HIV exposure (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.1–2.0) and living with HIV (aOR 6.6, 95%CI 2.1–20.5), underlying illness (aOR 4.8, 95%CI 1.3–17.6), malnutrition (aOR 6.0, 95%CI 4.0–8.9), infection with RSV (aOR 19.7, 95%CI 11.4–34.1), influenza (aOR 5.7, 95%CI 2.3–14.1) or HMPV (aOR 4.1, 95%CI 2.0–8.6) were associated with respiratory illness hospitalisation.

Conclusions

Maternal immunisation to prevent severe RSV and influenza illness in infants should be prioritised. In addition, improved infant nutrition and the prevention of HIV-infection and HIV-exposure could reduce the high burden of severe respiratory illness.

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2016-2018年南非因呼吸道和非呼吸道疾病住院的1岁以下婴儿中流感、呼吸道合胞病毒和其他呼吸道病原体的病原学分析

背景了解病原体对婴儿呼吸道疾病的影响对指导干预措施具有重要意义。我们评估了呼吸道和非呼吸道疾病住院婴儿呼吸道病原体的病因学。方法我们在1岁的婴儿中进行了一项无与伦比的病例对照研究。病例于2016年11月至2018年10月因急性呼吸道和非呼吸道疾病入院。对照组为接受免疫接种且未报告疾病的婴儿。采用多病原体实时荧光定量PCR检测鼻咽吸出液和血液。使用逻辑回归计算病原学分数（AF），调整HIV、年龄、季节和病例中患病率高于对照组的病原体。使用logistic回归评估与呼吸系统疾病住院相关的因素。结果共纳入1214例（呼吸系统846例，非呼吸系统368例），对照组684例。呼吸道合胞病毒（RSV）（AF 94.0%）、流感（AF 72.6%）和人偏肺病毒（HMPV）（AF 74.9%）显著归因于呼吸道疾病住院。肺炎克雷伯菌在呼吸道住院（房颤48.0%）和非呼吸道住院（房颤60.7%）均有显著房颤。HIV暴露（校正优势比[aOR] 1.5, 95%可信区间[CI] 1.1-2.0）、HIV携带者（aOR 6.6, 95%CI 2.1-20.5）、基础疾病（aOR 4.8, 95%CI 1.3-17.6）、营养不良（aOR 6.0, 95%CI 4.0-8.9）、RSV感染（aOR 19.7, 95%CI 11.4-34.1）、流感（aOR 5.7, 95%CI 2.3-14.1）或HMPV （aOR 4.1, 95%CI 2.0-8.6）与呼吸道疾病住院相关。结论预防婴幼儿严重呼吸道合胞病毒和流感疾病应优先考虑孕产妇免疫接种。此外，改善婴儿营养和预防艾滋病毒感染和接触艾滋病毒可以减轻严重呼吸道疾病的沉重负担。

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来源期刊

Influenza and Other Respiratory Viruses 医学-病毒学

CiteScore

7.20

自引率

4.50%

发文量

120

审稿时长

6-12 weeks

期刊介绍： Influenza and Other Respiratory Viruses is the official journal of the International Society of Influenza and Other Respiratory Virus Diseases - an independent scientific professional society - dedicated to promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases. Influenza and Other Respiratory Viruses is an Open Access journal. Copyright on any research article published by Influenza and Other Respiratory Viruses is retained by the author(s). Authors grant Wiley a license to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.