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Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091 - Volume 21, Number 4—April 2015 - Emerging Infectious Disease journal - CDC


Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091 - Volume 21, Number 4—April 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 4—April 2015


Deaths Associated with Respiratory Syncytial and Influenza Viruses among Persons ≥5 Years of Age in HIV-Prevalent Area, South Africa, 1998–20091

Stefano TempiaComments to Author , Sibongile Walaza, Cecile Viboud, Adam L. Cohen, Shabir A. Madhi, Marietjie Venter, Claire von Mollendorf, Jocelyn Moyes, Johanna M. McAnerney, and Cheryl Cohen
Author affiliations: National Health Laboratory Service, Johannesburg, South Africa (S. Tempia, S. Walaza, S.A. Madhi, C. von Mollendorf, J. Moyes, J.M. McAnerney, C. Cohen)Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Tempia, A.L. Cohen)Centers for Disease Control and Prevention, Pretoria, South Africa (S. Tempia, A.L. Cohen, M. Venter)National Institutes of Health, Bethesda, Maryland, USA (C. Viboud);University of the Witwatersrand, Johannesburg (S.A. Madhi, J. Moyes, C. Cohen)


We estimated deaths attributable to influenza and respiratory syncytial virus (RSV) among persons >5 years of age in South Africa during 1998–2009 by applying regression models to monthly deaths and laboratory surveillance data. Rates were expressed per 100,000 person-years. The mean annual number of seasonal influenza–associated deaths was 9,093 (rate 21.6). Persons >65 years of age and HIV-positive persons accounted for 50% (n = 4,552) and 28% (n = 2,564) of overall seasonal influenza-associated deaths, respectively. In 2009, we estimated 4,113 (rate 9.2) influenza A(H1N1)pdm09–associated deaths. The mean of annual RSV-associated deaths during the study period was 511 (rate 1.2); no RSV-associated deaths were estimated in persons >45 years of age. Our findings support the recommendation for influenza vaccination of older persons and HIV-positive persons. Surveillance for RSV should be strengthened to clarify the public health implications and severity of illness associated with RSV infection in South Africa.
Influenza virus and respiratory syncytial virus (RSV) infections cause substantial numbers of illness and deaths globally each year; the highest rates are in young children and persons >65 years of age (14). However, national estimates of deaths caused by these infections remain scarce in Africa.
Available data suggest that the severity of influenza and RSV illness is higher among HIV-positive persons (5–11). During 2009 in South Africa, ≈5.1 million HIV-positive persons >5 years of age were reported (12). The highest prevalence was in the 20–44-year age group, among whom HIV prevalence increased from 10% in 1998 to 24% in 2009. Coverage with highly active antiretroviral therapy (HAART) among HIV-positive persons slowly increased from 2004 to reach a plateau of ≈14% in 2009 (12). The lowest reported occurrence of HIV infection in the country was in persons >75 years of age; data showed a 0.6% prevalence and 26% HAART coverage for this group in 2009 (12). Pneumonia ranked within the top 5 leading causes of death among persons >15 years of age in South Africa in 2009 (13).
Clarification of the annual number of deaths associated with influenza and RSV in South Africa could assist with the prioritization of interventions. Because influenza virus and RSV infections are rarely confirmed by laboratory diagnosis and related deaths may be attributed to co-morbid conditions or secondary infections, we applied modeling approaches (14) to estimate seasonal and pandemic influenza- and RSV-associated deaths among persons >5 years of age during 1998–2009.

Dr. Stefano Tempia is a veterinary epidemiologist working for the Influenza Division, US Centers for Disease Control and Prevention, and based at the National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa. His research interests are focused on infectious diseases.



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Technical Appendix

Suggested citation for this article: Tempia S, Walaza S, Viboud C, Cohen AL, Madhi SA, Venter M, et al. Deaths associated with respiratory syncytial and influenza viruses among persons >5 years of age in HIV-prevalent area, South Africa, 1998–2009. Emerg Infect Dis. 2015 Apr [date cited].http://dx.doi.org/10.3201/eid2103.141033
DOI: 10.3201/eid2104.141033
1Data from this study were presented in part at the Options for the Control of Influenza Conference VIII; 2013 Sep 5–10; Cape Town, South Africa.

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