Severe influenza-associated respiratory infection in high HIV prevalence setting, South Africa, 2009-2011

Emerg Infect Dis. 2013 Nov;19(11):1766-74. doi: 10.3201/eid1911.130546.


Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009-2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4-8 times greater for HIV-infected (186-228/100,000) than for HIV-uninfected persons (26-54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2-7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.

Keywords: AIDS; HIV; South Africa; adults; bacteria; children; co-infection; influenza; lower respiratory tract infection; pneumoccocus; pneumococcal; pneumonia; respiratory infections; vaccination; viruses.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Coinfection*
  • Female
  • HIV Infections / epidemiology*
  • Hospitalization
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Influenza, Human / epidemiology*
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Public Health Surveillance
  • Respiratory Tract Infections / epidemiology*
  • South Africa / epidemiology
  • Young Adult