The attributable fraction of respiratory syncytial virus among patients of different age with influenza-like illness and severe acute respiratory illness in a high HIV prevalence setting, South Africa, 2012-2016 Running title: The attributable fraction of RSV in South Africa (all ages), South Africa 2012- 2016
Date
2022-11-22
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Abstract
Introduction
The detection of respiratory syncytial virus (RSV) in upper airway samples does not
necessarily infer causality of illness. Calculating the attributable fraction (AF) of RSV in
clinical syndromes could refine disease burden estimates.
Methods
Using unconditional logistic regression models, we estimated the AF of RSV-associated
influenza-like illness (ILI) and severe-acute respiratory illness (SARI) cases by comparing RSVdetection prevalence among ILI and SARI cases to those of healthy controls in South Africa,
2012-2016. The analysis, stratified by HIV serostatus, was conducted in the age categories
<1, 1-4, 5-24, 25-44, 45-64, ≥65 years.
Results
We included 12,048 individuals: 2,687 controls, 5,449 ILI cases and 5,449 SARI cases. RSVAFs for ILI were significant in <1, 1-4, 5-24, 25-44-year age groups: 84.9%(95% confidence
interval (CI) 69.3%-92.6%), 74.6%(95%CI 53.6%-86.0%), 60.8%(95%CI 21.4%-80.5%) and
64.1%(95%CI 14.9%-84.9%), respectively. Similarly, significant RSV-AFs for SARI were
95.3%(95%CI 91.1%-97.5) and 83.4%(95%CI 70.9-90.5) in the <1 and 1-4-year age groups
respectively. In HIV-infected persons, RSV was significantly associated with ILI cases versus
controls in individuals aged 5-44 years.
Conclusion
High RSV-AFs in young children confirm RSV detection is associated severe respiratory
illness in South African children, specifically infants. These estimates will assist with refining
burden estimates and cost effectiveness models
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Keywords
Attributable Fraction; Respiratory syncytial virus; Burden of disease