The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011-2015
In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza...
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| Veröffentlicht in: | PloS one 2019-09, Vol.14 (9), p.e0222294 |
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| creator | Ngobeni, Hetani Tempia, Stefano Cohen, Adam L Walaza, Sibongile Kuonza, Lazarus Musekiwa, Alfred von Gottberg, Anne Hellferscee, Orienka Wolter, Nicole Treurnicht, Florette K Moyes, Jocelyn Naby, Fathima Mekgoe, Omphile Cohen, Cheryl |
| description | In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged |
| doi_str_mv | 10.1371/journal.pone.0222294 |
| format | Article |
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Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38°C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5-3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89-98%) in HIV-uninfected and of 100% (95% CI 79-100%) in HIV-infected children but low specificity: 7% (95% CI 6-8%) and 6% (95% CI 3-9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI-an acute respiratory infection with history of fever or measured fever of ≥ 38°C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56-76%) and specificity of 46% (95% CI 44-48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35-84%) and a specificity of 42% (95% CI 36-48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0222294</identifier><identifier>PMID: 31536552</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Biology and Life Sciences ; Care and treatment ; Case-Control Studies ; Child, Preschool ; Children ; Coinfection - diagnosis ; Coinfection - epidemiology ; Coinfection - virology ; Confidence intervals ; Cough ; Cough - etiology ; Diagnosis ; Disease control ; Disease prevention ; Epidemiology ; Female ; Fever ; Fever - etiology ; Health aspects ; Health sciences ; HIV ; HIV infections ; HIV Infections - complications ; HIV Infections - epidemiology ; HIV patients ; Hospitalization ; Human immunodeficiency virus ; Humans ; Illnesses ; Infant ; Infection ; Infections ; Influenza ; Influenza, Human - diagnosis ; Influenza, Human - epidemiology ; Influenza, Human - etiology ; Laboratories ; Lung diseases ; Male ; Medicine and Health Sciences ; Meningitis ; Mortality ; Older people ; People and Places ; Performance assessment ; Physicians ; Polymerase chain reaction ; Population Surveillance - methods ; Prevalence studies (Epidemiology) ; Prospective Studies ; Public health ; Respiratory diseases ; Respiratory tract ; Respiratory tract diseases ; Reverse transcription ; Sensitivity ; Signs and symptoms ; South Africa - epidemiology ; Statistical analysis ; Surveillance ; Viruses</subject><ispartof>PloS one, 2019-09, Vol.14 (9), p.e0222294</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Ngobeni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Ngobeni et al 2019 Ngobeni et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c653t-cc5d2a7730b3048bb640431168a4ef767e4cb5eda5ba1e9c3aae772f9152f07c3</citedby><cites>FETCH-LOGICAL-c653t-cc5d2a7730b3048bb640431168a4ef767e4cb5eda5ba1e9c3aae772f9152f07c3</cites><orcidid>0000-0003-2610-5807 ; 0000-0003-4395-347X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752836/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752836/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31536552$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ngobeni, Hetani</creatorcontrib><creatorcontrib>Tempia, Stefano</creatorcontrib><creatorcontrib>Cohen, Adam L</creatorcontrib><creatorcontrib>Walaza, Sibongile</creatorcontrib><creatorcontrib>Kuonza, Lazarus</creatorcontrib><creatorcontrib>Musekiwa, Alfred</creatorcontrib><creatorcontrib>von Gottberg, Anne</creatorcontrib><creatorcontrib>Hellferscee, Orienka</creatorcontrib><creatorcontrib>Wolter, Nicole</creatorcontrib><creatorcontrib>Treurnicht, Florette K</creatorcontrib><creatorcontrib>Moyes, Jocelyn</creatorcontrib><creatorcontrib>Naby, Fathima</creatorcontrib><creatorcontrib>Mekgoe, Omphile</creatorcontrib><creatorcontrib>Cohen, Cheryl</creatorcontrib><title>The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011-2015</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38°C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5-3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89-98%) in HIV-uninfected and of 100% (95% CI 79-100%) in HIV-infected children but low specificity: 7% (95% CI 6-8%) and 6% (95% CI 3-9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI-an acute respiratory infection with history of fever or measured fever of ≥ 38°C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56-76%) and specificity of 46% (95% CI 44-48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35-84%) and a specificity of 42% (95% CI 36-48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.</description><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Case-Control Studies</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Coinfection - diagnosis</subject><subject>Coinfection - epidemiology</subject><subject>Coinfection - virology</subject><subject>Confidence intervals</subject><subject>Cough</subject><subject>Cough - etiology</subject><subject>Diagnosis</subject><subject>Disease control</subject><subject>Disease prevention</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fever</subject><subject>Fever - etiology</subject><subject>Health aspects</subject><subject>Health sciences</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>HIV patients</subject><subject>Hospitalization</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Infant</subject><subject>Infection</subject><subject>Infections</subject><subject>Influenza</subject><subject>Influenza, Human - diagnosis</subject><subject>Influenza, Human - epidemiology</subject><subject>Influenza, Human - etiology</subject><subject>Laboratories</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Meningitis</subject><subject>Mortality</subject><subject>Older people</subject><subject>People and Places</subject><subject>Performance assessment</subject><subject>Physicians</subject><subject>Polymerase chain reaction</subject><subject>Population Surveillance - methods</subject><subject>Prevalence studies (Epidemiology)</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Respiratory diseases</subject><subject>Respiratory tract</subject><subject>Respiratory tract diseases</subject><subject>Reverse transcription</subject><subject>Sensitivity</subject><subject>Signs and symptoms</subject><subject>South Africa - epidemiology</subject><subject>Statistical 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C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ngobeni, Hetani</au><au>Tempia, Stefano</au><au>Cohen, Adam L</au><au>Walaza, Sibongile</au><au>Kuonza, Lazarus</au><au>Musekiwa, Alfred</au><au>von Gottberg, Anne</au><au>Hellferscee, Orienka</au><au>Wolter, Nicole</au><au>Treurnicht, Florette K</au><au>Moyes, Jocelyn</au><au>Naby, Fathima</au><au>Mekgoe, Omphile</au><au>Cohen, Cheryl</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011-2015</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-09-19</date><risdate>2019</risdate><volume>14</volume><issue>9</issue><spage>e0222294</spage><pages>e0222294-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In 2014, the World Health Organization (WHO) proposed a new severe influenza surveillance case definition, which has not been evaluated in a high human immunodeficiency virus (HIV) prevalence setting. Our study aimed to assess the performance of this proposed case definition in identifying influenza among HIV-uninfected and HIV-infected children aged <5 years in South Africa. We prospectively enrolled children aged <5 years hospitalised with physician-diagnosed lower respiratory tract infection (LRTI) at two surveillance sites from January 2011 to December 2015. Epidemiologic and clinical data were collected. We tested nasopharyngeal aspirates for influenza using reverse transcription polymerase chain reaction. We used logistic regression to assess factors associated with influenza positivity among HIV-infected and HIV-uninfected children. We calculated sensitivity and specificity for different signs and symptoms and combinations of these for laboratory-confirmed influenza. We enrolled 2,582 children <5 years of age with LRTI of whom 87% (2,257) had influenza and HIV results, of these 14% (318) were HIV-infected. The influenza detection rate was 5% (104/1,939) in HIV-uninfected and 5% (16/318) in HIV-infected children. Children with measured fever (≥38°C) were two times more likely to test positive for influenza than those without measured fever among the HIV-uninfected (OR 2.2, 95% Confidence Interval (CI) 1.5-3.4; p<0.001). No significant association was observed between fever and influenza infection among HIV-infected children. Cough alone had sensitivity of 95% (95% CI 89-98%) in HIV-uninfected and of 100% (95% CI 79-100%) in HIV-infected children but low specificity: 7% (95% CI 6-8%) and 6% (95% CI 3-9%) in HIV-uninfected and HIV-infected children, respectively. The WHO post-2014 case definition for severe acute respiratory illness (SARI-an acute respiratory infection with history of fever or measured fever of ≥ 38°C and cough; with onset within the last ten days and requires hospitalization), had a sensitivity of 66% (95% CI 56-76%) and specificity of 46% (95% CI 44-48%) among HIV-uninfected and a sensitivity of 63% (95% CI 35-84%) and a specificity of 42% (95% CI 36-48%) among HIV-infected children. The sensitivity and specificity of the WHO post-2014 case definition for SARI were similar among HIV-uninfected and HIV-infected children. Our findings support the adoption of the 2014 WHO case definition for children aged <5 years irrespective of HIV infection status.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31536552</pmid><doi>10.1371/journal.pone.0222294</doi><tpages>e0222294</tpages><orcidid>https://orcid.org/0000-0003-2610-5807</orcidid><orcidid>https://orcid.org/0000-0003-4395-347X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-09, Vol.14 (9), p.e0222294 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2294170271 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Biology and Life Sciences Care and treatment Case-Control Studies Child, Preschool Children Coinfection - diagnosis Coinfection - epidemiology Coinfection - virology Confidence intervals Cough Cough - etiology Diagnosis Disease control Disease prevention Epidemiology Female Fever Fever - etiology Health aspects Health sciences HIV HIV infections HIV Infections - complications HIV Infections - epidemiology HIV patients Hospitalization Human immunodeficiency virus Humans Illnesses Infant Infection Infections Influenza Influenza, Human - diagnosis Influenza, Human - epidemiology Influenza, Human - etiology Laboratories Lung diseases Male Medicine and Health Sciences Meningitis Mortality Older people People and Places Performance assessment Physicians Polymerase chain reaction Population Surveillance - methods Prevalence studies (Epidemiology) Prospective Studies Public health Respiratory diseases Respiratory tract Respiratory tract diseases Reverse transcription Sensitivity Signs and symptoms South Africa - epidemiology Statistical analysis Surveillance Viruses |
| title | The performance of different case definitions for severe influenza surveillance among HIV-infected and HIV-uninfected children aged <5 years in South Africa, 2011-2015 |
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