Etiology and epidemiology of viral pneumonia among hospitalized children in rural Mozambique: a malaria endemic area with high prevalence of human immunodeficiency virus.
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.
O'Callaghan-Gordo
Cristina
C
Barcelona Center for International Health Research (CRESIB), Hospital Clínic, Institut d'Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Bassat
Quique
Q
Morais
Luis
L
Díez-Padrisa
Núria
N
Machevo
Sónia
S
Nhampossa
Tacilta
T
Nhalungo
Delino
D
Sanz
Sergi
S
Quintó
Llorenç
L
Alonso
Pedro L
PL
Roca
Anna
A
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