Abstract
BackgroundWhile southern Africa experiences among the highest mortality rates from respiratory infections, the burden of influenza and respiratory syncytial virus (RSV) in rural areas is poorly understood.MethodsWe implemented facility-based surveillance in Macha, Zambia. Outpatients and inpatients presenting with influenza-like illness (ILI) underwent testing for influenza A, influenza B, and RSV and were prospectively followed for 3 to 5 weeks to assess clinical course. Log-binomial models assessed correlates of infection and clinical severity.ResultsBetween December 2018 and December 2019, 17% of all outpatients presented with ILI and 16% of inpatients were admitted with an acute respiratory complaint. Influenza viruses and RSV were detected in 17% and 11% of outpatient participants with ILI, and 23% and 16% of inpatient participants with ILI, respectively. Influenza (July–September) and RSV (January-April) prevalence peaks were temporally distinct. RSV (relative risk [RR]: 1.78; 95% confidence interval [CI] 1.51–2.11), but not influenza, infection was associated with severe disease among patients with ILI. Underweight patients with ILI were more likely to be infected with influenza A (prevalence ratio [PR]: 1.72; 95% CI 1.04–2.87) and to have severe influenza A infections (RR: 2.49; 95% CI 1.57–3.93).ConclusionsPopulations in rural Zambia bear a sizeable burden of viral respiratory infections and severe disease. The epidemiology of infections in this rural area differs from that reported from urban areas in Zambia.
Highlights
While southern Africa experiences among the highest mortality rates from respiratory infections, the burden of influenza and respiratory syncytial virus (RSV) in rural areas is poorly understood
Urban–rural differences in epidemiology and severity have been previously described in sub-Saharan Africa for many infectious diseases including tuberculosis [12], HIV [13], and malaria [14]
Influenza‐like illness Between December 10, 2018 and December 9, 2019, 3,677 of 21,492 (17%) outpatients presenting to the Macha Hospital outpatient department (OPD) met criteria for influenza-like illness (ILI)
Summary
While southern Africa experiences among the highest mortality rates from respiratory infections, the burden of influenza and respiratory syncytial virus (RSV) in rural areas is poorly understood. In southern Africa their burden is becoming increasingly evident, with each nascent surveillance effort uncovering a considerable prevalence of disease [3, 4]. Available evidence suggests that southern Africa experiences among the highest worldwide influenza- and RSV-related mortality rates [2, 5]. HIV infection, and tuberculosis increase the severity of viral illness and may contribute to mortality [7,8,9]. Rural environments present distinct risk factors for transmission and pathogenesis given lower population density, reduced accessto-care, and higher prevalence of undernutrition and Loevinsohn et al BMC Infect Dis (2021) 21:986 extreme poverty [11]. Urban–rural differences in epidemiology and severity have been previously described in sub-Saharan Africa for many infectious diseases including tuberculosis [12], HIV [13], and malaria [14]
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