title: Mortality associated with seasonal and pandemic influenza and respiratory syncytial virus among children <5 years of age in a high HIV prevalence setting--South Africa, 1998-2009.
abstract: BACKGROUND
  There are few published data describing the mortality burden associated with influenza and respiratory syncytial virus (RSV) infection in children in low- and middle-income countries and particularly from Africa and settings with high prevalence of human immunodeficiency virus (HIV).
  
  
  METHODS
  We modeled the excess mortality attributable to influenza (seasonal and pandemic) and RSV infection by applying Poisson regression models to monthly all-respiratory and pneumonia and influenza deaths, using national influenza and RSV laboratory surveillance data as covariates. In addition, we estimated the seasonal influenza- and RSV-associated deaths among HIV-infected and -uninfected children using Poisson regression models that incorporated HIV prevalence and highly active antiretroviral therapy coverage as covariates.
  
  
  RESULTS
  In children <5 years of age, the mean annual numbers of seasonal influenza- and RSV-associated all-respiratory deaths were 452 (8 per 100 000 person-years [PY]) and 546 (10 per 100 000 PY), respectively. Infants <1 year of age experienced higher mortality rates compared with children 1-4 years of age for both influenza (22 vs 5 per 100 000 PY) and RSV (35 vs 4 per 100 000 PY). HIV-infected compared with HIV-uninfected children <5 years of age were at increased risk of death associated with influenza (age-adjusted relative risk [aRR], 11.5; 95% confidence interval [CI], 9.6-12.6) and RSV (aRR, 8.1; 95% CI, 6.9-9.3) infection. In 2009, we estimated 549 (11 per 100 000 PY) all-respiratory influenza A(H1N1)pdm09-associated deaths among children aged <5 years.
  
  
  CONCLUSIONS
  Our findings support increased research efforts to guide and prioritize interventions such as influenza vaccination and HIV prevention in low- and middle-income countries with high HIV prevalence such as South Africa.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tempia
authors.forename: Sibongile
authors.initials: S
authors.lastname: Walaza
authors.forename: Cecile
authors.initials: C
authors.lastname: Viboud
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Marietjie
authors.initials: M
authors.lastname: Venter
authors.forename: Johanna M
authors.initials: JM
authors.lastname: McAnerney
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D058873:Pandemics; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology / Q000401:mortality*; D012136:Respiratory Syncytial Viruses; D018570:Risk Assessment; D012621:Seasons; D013019:South Africa / Q000453:epidemiology
keywords: HIV; South Africa; influenza; mortality; respiratory syncytial virus