title: Etiology and epidemiology of viral pneumonia among hospitalized children in rural Mozambique: a malaria endemic area with high prevalence of human immunodeficiency virus.
abstract: BACKGROUND
  The role of viruses in pediatric pneumonia remains poorly studied in sub-Saharan Africa, where pneumonia-associated mortality is high.
  
  
  METHODS
  During a 1-year hospital-based surveillance, a nasopharyngeal aspirate (NPA) was collected from children aged <5 years admitted to hospital in rural Mozambique with clinically severe pneumonia. Identification of 12 respiratory viruses was performed by polymerase chain reactions (PCR). Study children were also tested for invasive bacterial infection (IBI), Plasmodium falciparum parasitemia, and HIV.
  
  
  RESULTS
  Almost half (394/807) of the children hospitalized with clinically severe pneumonia had at least one respiratory virus detected. A total of 475 viruses were detected among these 394 children, the most prevalent ones were rhinovirus (41%), adenovirus (21%), and respiratory syncytial virus (11%). Eleven percent of viral infected children had concomitant IBI, 15% had malaria parasites, and 25% had HIV coinfection. Viral infection was 5.5 to 16 times more prevalent among HIV-infected children and incidence rate ratios varied according to virus. Inhospital mortality of viral cases was 9%, being highest among cases with IBI coinfection (odds ratio = 7) or HIV infection (odds ratio = 7).
  
  
  CONCLUSIONS
  Study results highlight the high prevalence of respiratory viruses among hospitalized pneumonia cases in Mozambique. HIV infection is an important contributor to the high burden of disease and associated mortality of viral pneumonia. IBI also contributes to a worse prognosis of viral cases. Strategies to prevent mother-to-child transmission of HIV as well as introduction of Hib and pneumococcal vaccines could have a substantial impact on reduction of viral pneumonia and associated mortality among children in rural Africa.
authors.affiliation: Barcelona Center for International Health Research (CRESIB), Hospital Clínic, Institut d'Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: O'Callaghan-Gordo
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.forename: Luis
authors.initials: L
authors.lastname: Morais
authors.forename: Núria
authors.initials: N
authors.lastname: Díez-Padrisa
authors.forename: Sónia
authors.initials: S
authors.lastname: Machevo
authors.forename: Tacilta
authors.initials: T
authors.lastname: Nhampossa
authors.forename: Delino
authors.initials: D
authors.lastname: Nhalungo
authors.forename: Sergi
authors.initials: S
authors.lastname: Sanz
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.forename: Anna
authors.initials: A
authors.lastname: Roca
mesh_terms: D000256:Adenoviridae / Q000302:isolation & purification; D000704:Analysis of Variance; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000469:parasitology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology / Q000821:virology; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D009305:Nasopharynx / Q000821:virology; D011024:Pneumonia, Viral / Q000453:epidemiology* / Q000469:parasitology / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012229:Rhinovirus / Q000302:isolation & purification; D012307:Risk Factors