TY - JOUR
T1 - Respiratory pathogen diversity and co-infections in rural Zambia
AU - Loevinsohn, Gideon
AU - Hardick, Justin
AU - Sinywimaanzi, Pamela
AU - Fenstermacher, Katherine Z.J.
AU - Shaw Saliba, Katy
AU - Monze, Mwaka
AU - Gaydos, Charlotte A.
AU - Rothman, Richard E.
AU - Pekosz, Andrew
AU - Thuma, Philip E
AU - Sutcliffe, Catherine G.
N1 - Funding Information:
This study was nested within an ongoing surveillance program supported by the National Institutes of Health (Centers for Influenza Surveillance and Research) at Macha Hospital in Southern Province, Zambia. Macha Hospital is a 208-bed district-level hospital, located in a rural area, that serves a catchment population of approximately 150 000. Southern Province historically experiences three seasons: a rainy season from November to April, a cool dry season from May to August, and a warm dry season from September to November ( Sutcliffe et al., 2012 ). Routine vaccination against Streptococcus pneumoniae and Haemophilus influenzae type b has been introduced nationwide, and 91% of children 12–23 months of age in Southern Province were estimated to have received three doses of these vaccines in 2018 ( Zambia Statistics Agency et al., 2019 ). In Southern Province, influenza vaccines are not routinely administered, and prior to the initiation of this surveillance program, there had been no ongoing viral surveillance.
Funding Information:
The work was supported by the National Institute of Allergy and Infectious Diseases contract HHSN272201400007C awarded to the Johns Hopkins Center of Excellence in Influenza Research and Surveillance (JHCEIRS) at the Johns Hopkins University. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not represent the policy or position of NIAID or NIH. The funding agency had no role in the analysis of the data, writing of the manuscript, or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2020 The Authors
PY - 2021/1
Y1 - 2021/1
N2 - Objectives: The role of respiratory co-infections in modulating disease severity remains understudied in southern Africa, particularly in rural areas. This study was performed to characterize the spectrum of respiratory pathogens in rural southern Zambia and the prognostic impact of co-infections. Methods: Respiratory specimens collected from inpatient and outpatient participants in a viral surveillance program in 2018–2019 were tested for selected viruses and atypical bacteria using the Xpert Xpress Flu/RSV assay and FilmArray Respiratory Panel EZ. Participants were followed for 3–5 weeks to assess their clinical course. Multivariable regression was used to examine the role of co-infections in influencing disease severity. Results: A respiratory pathogen was detected in 63.2% of samples from 671 participants who presented with influenza-like illness. Common pathogens identified included influenza virus (18.2% of samples), respiratory syncytial virus (RSV) (11.8%), rhinovirus (26.4%), and coronavirus (6.0%). Overall, 6.4% of participants were co-infected with multiple respiratory pathogens. Compared to mono-infections, co-infections were found not to be associated with severe clinical illness either overall (relative risk (RR) 0.72, 95% confidence interval (CI) 0.39–1.32) or specifically with influenza virus (RR 0.80, 95% CI 0.14–4.46) or RSV infections (RR 0.44, 95% CI 0.17–1.11). Conclusions: Respiratory infections in rural southern Zambia were associated with a wide range of viruses. Respiratory co-infections in this population were not associated with clinical severity.
AB - Objectives: The role of respiratory co-infections in modulating disease severity remains understudied in southern Africa, particularly in rural areas. This study was performed to characterize the spectrum of respiratory pathogens in rural southern Zambia and the prognostic impact of co-infections. Methods: Respiratory specimens collected from inpatient and outpatient participants in a viral surveillance program in 2018–2019 were tested for selected viruses and atypical bacteria using the Xpert Xpress Flu/RSV assay and FilmArray Respiratory Panel EZ. Participants were followed for 3–5 weeks to assess their clinical course. Multivariable regression was used to examine the role of co-infections in influencing disease severity. Results: A respiratory pathogen was detected in 63.2% of samples from 671 participants who presented with influenza-like illness. Common pathogens identified included influenza virus (18.2% of samples), respiratory syncytial virus (RSV) (11.8%), rhinovirus (26.4%), and coronavirus (6.0%). Overall, 6.4% of participants were co-infected with multiple respiratory pathogens. Compared to mono-infections, co-infections were found not to be associated with severe clinical illness either overall (relative risk (RR) 0.72, 95% confidence interval (CI) 0.39–1.32) or specifically with influenza virus (RR 0.80, 95% CI 0.14–4.46) or RSV infections (RR 0.44, 95% CI 0.17–1.11). Conclusions: Respiratory infections in rural southern Zambia were associated with a wide range of viruses. Respiratory co-infections in this population were not associated with clinical severity.
KW - Co-infections
KW - Respiratory viruses
KW - Rural
KW - Severity
KW - Sub-Saharan
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U2 - 10.1016/j.ijid.2020.10.054
DO - 10.1016/j.ijid.2020.10.054
M3 - Article
C2 - 33127501
AN - SCOPUS:85096870538
SN - 1201-9712
VL - 102
SP - 291
EP - 298
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -