Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study

Ho, Antonia; Aston, Stephen; Jary, Hannah; Mitchell, Tamara; Alaerts, Maaike; Menyere, Mavis; Mallewa, Jane; Nyirenda, Mulinda; Everett, Dean; Heyderman, Robert S.; French, Neil

doi:10.1093/cid/cix903

Cited by 29 publications

(35 citation statements)

References 26 publications

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“…In Africa, studies done by Cohen, Walaza (21) reported seroprevalence of 29.8 % in South Africa. Ho, Aston (22) recorded a seroprevalence of 25.4 % in Malawi, similar to that of Ope, Katz (23) that reported an incidence rate of 24.5 % in Kenya. This could be attributed to differences in a lot of factors including sample size and assay type used.…”

Section: Discussionsupporting

confidence: 68%

“…Our investigation further revealed that 84.1 % (58/69) were IgM seropositive for influenza A while 15.9 % (11/69) were positive for influenza B virus, signifying epidemiological dominance of influenza A over influenza B virus in the third quarter of 2018 in Lagos, Nigeria. Ho, Aston (22) reported that conversely in low resource settings with high HIV prevalence, there is high incidence of influenza illness and greater risk of hospitalization among HIV infected person which explains the high prevalence rate of influenza A detected in this study. A study in Germany recorded higher seroprevalences of 96.3 % for influenza A and 98 % for influenza B using ELISA method, although the study measured IgG antibody in non-HIV patients (17).…”

Section: Discussionmentioning

confidence: 58%

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Serologic evidence of seasonal influenza A and B viruses in HIV patients on combined antiretroviral therapy in Lagos, Nigeria

Anjorin

Adepoju

2019

Preprint

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We investigated serologic evidence of seasonal influenza A and B, and the possibility of their co-infection in HIV patients on combined antiretroviral therapy (cART) in Lagos, Nigeria. A prospective cross-sectional study was designed. A total of 174 HIV positive patients were bled by venipuncture after filling structured questionnaire at the APIN-LUTH clinic, from August to September, 2018. Clear sera were analysed for the detection and quantitative determination of immunoglobulin M specific antibodies to seasonal influenza A subtypes-H1N1 and H3N2, and influenza B by Enzyme Immunoassay (Demeditec, Germany). Results were analysed with Chi-square at 95 % confidence interval. Demographic characteristics showed median age of 44 (mean 45.1, mode 40, range: 18-74) years. Out of the 174 HIV positive patients, 39.7 % (69/174) were seropositive for influenza A and/or B viruses with 58/69 (84.1 %) being positive for influenza A, 11/69 (16 %) for influenza B, and 9/69 (13.4 %) co-infection of influenza A and B. Of the 69 influenza-seropositive patients, age group 41‒ 50 had the highest seroprevalence of 39.1 % (27/69). Females recorded the highest seropositivity of 65.2 % (45/69). Eighty eight (88) % (61/ 69) were on fixed dose cART while 74 % (51/69) were virologically suppressed with HIV RNA < 400 copies/ml. In addition, 2/69 (2.9 %) were positive for HbsAg. Out of the 19/69 (27.5 %) immunocompromised patients (CD4 < 400 cells/mm3), 4/19 (21.1 %) were severely immunosuppressed (CD4 < 200 cells/mm3). This study revealed serologic evidence of recent circulation of wild influenza A and B viruses in highly suppressed HIV RNA patients on cART. Nonetheless, co-infection with HbsAg and immunocompromised state may further predispose them to serious influenza life threatening complications. Strong advocacy on the need to reduce risk of exposure to influenza, and provision of influenza vaccine in Nigeria are recommended to prevent such complications.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 58%

Serologic evidence of seasonal influenza A and B viruses in HIV patients on combined antiretroviral therapy in Lagos, Nigeria

Anjorin

Adepoju

2019

Preprint

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“…Risk factors for influenzaassociated severe illness (e.g. hospitalization or death) have also been assessed using sentinel surveillance systems [23,[25][26][27] and this could be implemented also in Zambia for influenza and other pathogens.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of the Zambia influenza sentinel surveillance system, 2011–2017

Simusika

Tempia

Chentulo

et al. 2020

BMC Health Serv Res

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Background: Over the past decade, influenza surveillance has been established in several African countries including Zambia. However, information on the on data quality and reliability of established influenza surveillance systems in Africa are limited. Such information would enable countries to assess the performance of their surveillance systems, identify shortfalls for improvement and provide evidence of data reliability for policy making and public health interventions. Methods: We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza surveillance system (ISS) in Zambia during 2011-2017 using 9 attributes: (i) data quality and completeness, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability, (viii) utility, and (ix) sustainability. Each attribute was evaluated using pre-defined indicators. For each indicator we obtained the proportion (expressed as percentage) of the outcome of interest over the total. A scale from 1 to 3 was used to provide a score for each attribute as follows: < 60% (as obtained in the calculation above) scored 1 (weak performance); 60-79% scored 2 (moderate performance); ≥80% scored 3 (good performance). An overall score for each attribute and the ISS was obtained by averaging the scores of all evaluated attributes. Results: The overall mean score for the ISS in Zambia was 2.6. Key strengths of the system were the quality of data generated (score: 2.9), its flexibility (score: 3.0) especially to monitor viral pathogens other than influenza viruses, its simplicity (score: 2.8), acceptability (score: 3.0) and stability (score: 2.6) over the review period and its relatively low cost ($310,000 per annum). Identified weaknesses related mainly to geographic representativeness (score: 2.0), timeliness (score: 2.5), especially in shipment of samples from remote sites, and sustainability (score: 1.0) in the absence of external funds. Conclusions: The system performed moderately well in our evaluation. Key improvements would include improvements in the timeliness of samples shipments and geographical coverage. However, these improvements would result in increased cost and logistical complexity. The ISSS in Zambia is largely reliant on external funds and the acceptability of maintaining the surveillance system through national funds would require evaluation.

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“…This study took place in Chikwawa, a rural district in Southern Malawi with an under-five mortality rate of 66 per 1000 live births [25] and a poverty rate of 82% [26]. Chikwawa has a high burden of malaria, schistosomiasis and malnutrition [27][28][29].…”

Section: Study Settingmentioning

confidence: 99%

“…Potential introduction of an influenza vaccination also requires understanding of acceptability, and there is limited evidence on influenza vaccine acceptability within the Malawian context (25). To support effective design and introduction of control strategies, we examined community perceptions and health seeking about influenza and views on influenza vaccination.…”

Section: Introductionmentioning

confidence: 99%

Dust or disease? Perceptions of influenza in rural Southern Malawi

Phiri

Gooding

Peterson

et al. 2018

Preprint

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Background Influenza virus infections cause between 291 243 and 645 832 deaths annually, with the highest burden in low-income settings. Research in high-income countries has examined public understanding of influenza, but there is little information on views and behaviours about influenza in low-income countries. We explored communities' ideas about the severity, causes, prevention and treatment of influenza in Chikwawa district, Malawi. MethodsWe conducted 64 in-depth interviews with parents of children aged <5 years, and 7 focus groups with community health workers, parents, and traditional healers. Data were analysed thematically and using a framework matrix to compare views between groups. ResultsRespondents held varied ideas about influenza, and many were uncertain about its causes and treatment. Some parents, traditional healers and health workers thought influenza was not severe because they felt it did not cause death or limit activities, but others disagreed. Many saw influenza as a symptom of other conditions, especially malaria and pneumonia, rather than as a disease of its own. Most mentioned dust as the main cause of influenza and believed influenza could be prevented by cleaning the home thoroughly. Treatment seeking for influenza followed different stages, usually starting with home remedies followed by purchasing drugs from groceries and then visiting a health centre. Seeking a clinician tended to be triggered by severe symptoms like high fever or 3 difficulty breathing, and suspicions of malaria or pneumonia. Community health workers provide health education for communities, but some lacked understanding of influenza. ConclusionOur findings suggest uncertainty about the causes and control of influenza among parents and varied levels of understanding among health providers.Strengthening the capacity of community health workers to provide relevant information about influenza prevention and treatment could address parents' interest in further information and support informed health seeking and engagement with future influenza interventions.

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Impact of Human Immunodeficiency Virus on the Burden and Severity of Influenza Illness in Malawian Adults: A Prospective Cohort and Parallel Case-Control Study

Cited by 29 publications

References 26 publications

Serologic evidence of seasonal influenza A and B viruses in HIV patients on combined antiretroviral therapy in Lagos, Nigeria

Serologic evidence of seasonal influenza A and B viruses in HIV patients on combined antiretroviral therapy in Lagos, Nigeria

An evaluation of the Zambia influenza sentinel surveillance system, 2011–2017

Dust or disease? Perceptions of influenza in rural Southern Malawi

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