title: Parainfluenza Virus Infection Among Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Children and Adults Hospitalized for Severe Acute Respiratory Illness in South Africa, 2009-2014.
abstract: Background.  Parainfluenza virus (PIV) is a common cause of acute respiratory tract infections, but little is known about PIV infection in children and adults in Africa, especially in settings where human immunodeficiency virus (HIV) prevalence is high. Methods.  We conducted active, prospective sentinel surveillance for children and adults hospitalized with severe acute respiratory illness (SARI) from 2009 to 2014 in South Africa. We enrolled controls (outpatients without febrile or respiratory illness) to calculate the attributable fraction for PIV infection. Respiratory specimens were tested by multiplex real-time reverse-transcription polymerase chain reaction assay for parainfluenza types 1, 2, and 3. Results.  Of 18 282 SARI cases enrolled, 1188 (6.5%) tested positive for any PIV type: 230 (19.4%) were type 1; 168 (14.1%) were type 2; 762 (64.1%) were type 3; and 28 (2.4%) had coinfection with 2 PIV types. After adjusting for age, HIV serostatus, and respiratory viral coinfection, the attributable fraction for PIV was 65.6% (95% CI [confidence interval], 47.1-77.7); PIV contributed to SARI among HIV-infected and -uninfected children <5 years of age and among individuals infected with PIV types 1 and 3. The observed overall incidence of PIV-associated SARI was 38 (95% CI, 36-39) cases per 100 000 population and was highest in children <1 year of age (925 [95% CI, 864-989] cases per 100 000 population). Compared with persons without HIV, persons with HIV had an increased relative risk of PIV hospitalization (9.4; 95% CI, 8.5-10.3). Conclusions.  Parainfluenza virus causes substantial severe respiratory disease in South Africa among children <5 years of age, especially those that are infected with HIV.
authors.affiliation: Centers for Disease Control and Prevention , Pretoria , South Africa ; Centers for Disease Control and Prevention , Atlanta, Georgia ; US Public Health Service, Rockville, Maryland.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.affiliation: South African Field Epidemiology Training Program, Johannesburg ; School of Health Systems and Public Health, Faculty of Health Sciences , University of Pretoria.
authors.forename: Philip K
authors.initials: PK
authors.lastname: Sahr
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg.
authors.forename: Florette
authors.initials: F
authors.lastname: Treurnicht
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Public Health.
authors.forename: Sibongile
authors.initials: S
authors.lastname: Walaza
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences ; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Groome
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health ; Centre for Global Health Research , Umeå University , Sweden ; INDEPTH Network, Accra , Ghana.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: Pietermaritzburg Metropolitan Hospital Complex ; University of KwaZulu-Natal , Durban.
authors.forename: Halima
authors.initials: H
authors.lastname: Dawood
authors.affiliation: Department of Internal Medicine ; Department of Internal Medicine , Klerksdorp-Tshepong Hospital Complex.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Variava
authors.affiliation: Centers for Disease Control and Prevention , Pretoria , South Africa ; Centers for Disease Control and Prevention , Atlanta, Georgia ; Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tempia
authors.affiliation: Department of Medical Virology, Zoonoses Research Unit , University of Pretoria ; National Health Laboratory Service, Tshwane Academic Division.
authors.forename: Marthi
authors.initials: M
authors.lastname: Pretorius
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Public Health.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Moyes
authors.affiliation: Medical Research Council , Pretoria , South Africa.
authors.forename: Steven A S
authors.initials: SA
authors.lastname: Olorunju
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg.
authors.forename: Babatyi
authors.initials: B
authors.lastname: Malope-Kgokong
authors.affiliation: South African Field Epidemiology Training Program, Johannesburg.
authors.forename: Lazarus
authors.initials: L
authors.lastname: Kuonza
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Pathology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Nicole
authors.initials: N
authors.lastname: Wolter
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Pathology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Anne
authors.initials: A
authors.lastname: von Gottberg
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences ; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.affiliation: Centers for Disease Control and Prevention , Pretoria , South Africa ; Department of Medical Virology, Zoonoses Research Unit , University of Pretoria.
authors.forename: Marietjie
authors.initials: M
authors.lastname: Venter
authors.affiliation: Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Public Health.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cohen
keywords: HIV; South Africa; parainfluenza virus; severe acute respiratory illness