ArticlePloS one2015
Mortality amongst patients with influenza-associated severe acute respiratory illness, South Africa, 2009-2013.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 6 of them syntheses that pooled it.
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Who cites it
62 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- A Systematic Review of the Markers of Severity in Acute Respiratory Infections to Inform Primary Care Surveillance.Influenza and other respiratory viruses · 2025Pooled it
- The epidemiology of seasonal influenza after the 2009 influenza pandemic in Africa: a systematic review.African health sciences · 2020Pooled it
- Influenza and tuberculosis co-infection: A systematic review.Influenza and other respiratory viruses · 2020Pooled it
- Case fatality rate and viral aetiologies of acute respiratory tract infections in HIV positive and negative people in Africa: The VARIAFRICA-HIV systematic review and meta-analysis.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2019Pooled it
- Risk factors for serious outcomes associated with influenza illness in high- versus low- and middle-income countries: Systematic literature review and meta-analysis.Influenza and other respiratory viruses · 2018Pooled it
- Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review.PloS one · 2015Pooled it
- Causes and Contributing Factors of In-Hospital and Post-Discharge Mortality Among Patients With Severe Acute Respiratory Infection in Low- and Middle-Income Countries: A Scoping Review.Health science reports · 2026Article
- Africa's Struggle to Meet Global Pandemic Influenza Immunization Targets: Lessons for Public Health Policy and Preparedness-A Focus on Ghana.Health science reports · 2026Article
- Prospective clinical surveillance for severe acute respiratory illness and COVID-19 vaccine effectiveness in Kenyan hospitals during the COVID-19 pandemic.BMC infectious diseases · 2024Article
- Comparing adults with severe SARS-CoV-2 or influenza infection: South Africa, 2016-2021.Southern African journal of infectious diseases · 2024Article
- Incidence of influenza virus-associated Severe Acute Respiratory Infections in three districts in 2018 at Gharbia governorate, Egypt.PLOS global public health · 2024Article
- Bioinformatics and system biology approach to identify the influences among COVID-19, influenza, and HIV on the regulation of gene expression.Frontiers in immunology · 2024Article
- Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018-2022.Tropical medicine and health · 2023Article
- The burden of RSV-associated illness in children aged < 5 years, South Africa, 2011 to 2016.BMC medicine · 2023Article
- Healthcare utilization during the first two waves of the COVID-19 epidemic in South Africa: A cross-sectional household survey.PloS one · 2023Article
- COVID-19 severity and in-hospital mortality in an area with high HIV prevalence.Southern African journal of HIV medicine · 2023Article
- Explorative study regarding influenza vaccine hesitancy among HIV-infected patients.Human vaccines & immunotherapeutics · 2022Article
- Severe acute respiratory illness surveillance for influenza in Kenya: Patient characteristics and lessons learnt.Influenza and other respiratory viruses · 2022Article
- The intersecting pandemics of tuberculosis and COVID-19: population-level and patient-level impact, clinical presentation, and corrective interventions.The Lancet. Respiratory medicine · 2022Review
- Epidemiology and Molecular Characterization of Seasonal Influenza Viruses in Iraq.Archives of Razi Institute · 2021Article
2 more citing papers are in PubMed but not listed here.
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Authors and funding
17 authors.
Funding
Abstract
introductionData on the burden and risk groups for influenza-associated mortality from Africa are limited. We aimed to estimate the incidence and risk-factors for in-hospital influenza-associated severe acute respiratory illness (SARI) deaths.
methodsHospitalised patients with SARI were enrolled prospectively in four provinces of South Africa from 2009-2013. Using polymerase chain reaction, respiratory samples were tested for ten respiratory viruses and blood for pneumococcal DNA. The incidence of influenza-associated SARI deaths was estimated at one urban hospital with a defined catchment population.
resultsWe enrolled 1376 patients with influenza-associated SARI and 3% (41 of 1358 with available outcome data) died. In patients with available HIV-status, the case-fatality proportion (CFP) was higher in HIV-infected (5%, 22/419) than HIV-uninfected individuals (2%, 13/620; p = 0.006). CFPs varied by age group, and generally increased with increasing age amongst individuals >5 years (p<0.001). On multivariable analysis, factors associated with death were age-group 45-64 years (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.01-16.3) and ≥65 years (OR 6.5, 95%CI 1.2-34.3) compared to 1-4 year age-group who had the lowest CFP, HIV-infection (OR 2.9, 95%CI 1.1-7.8), underlying medical conditions other than HIV (OR 2.9, 95%CI 1.2-7.3) and pneumococcal co-infection (OR 4.1, 95%CI 1.5-11.2). The estimated incidence of influenza-associated SARI deaths per 100,000 population was highest in children <1 year (20.1, 95%CI 12.1-31.3) and adults aged 45-64 years (10.4, 95%CI 8.4-12.9). Adjusting for age, the rate of death was 20-fold (95%CI 15.0-27.8) higher in HIV-infected individuals than HIV-uninfected individuals.
conclusionInfluenza causes substantial mortality in urban South Africa, particularly in infants aged <1 year and HIV-infected individuals. More widespread access to antiretroviral treatment and influenza vaccination may reduce this burden.
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