Gideon Loevinsohn1, Justin Hardick2, Pamela Sinywimaanzi3, Katherine Z J Fenstermacher4, Kathryn Shaw-Saliba4, Mwaka Monze5, Charlotte A Gaydos2, Richard E Rothman4, Andrew Pekosz6, Philip E Thuma7, Catherine G Sutcliffe8. 1. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 2. Division of Infectious Diseases, Department of Medicine Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 3. Macha Research Trust, Macha, Zambia. 4. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 5. Virology Laboratory, University Teaching Hospital, Lusaka, Zambia. 6. Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA. 7. Macha Research Trust, Macha, Zambia; Virology Laboratory, University Teaching Hospital, Lusaka, Zambia. 8. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA. Electronic address: csutcli1@jhu.edu.
Abstract
OBJECTIVES: The role of respiratory co-infections in modulating disease severity remains understudied in southern Africa, particularly in rural areas. This study was performed to characterize the spectrum of respiratory pathogens in rural southern Zambia and the prognostic impact of co-infections. METHODS: Respiratory specimens collected from inpatient and outpatient participants in a viral surveillance program in 2018-2019 were tested for selected viruses and atypical bacteria using the Xpert Xpress Flu/RSV assay and FilmArray Respiratory Panel EZ. Participants were followed for 3-5 weeks to assess their clinical course. Multivariable regression was used to examine the role of co-infections in influencing disease severity. RESULTS: A respiratory pathogen was detected in 63.2% of samples from 671 participants who presented with influenza-like illness. Common pathogens identified included influenza virus (18.2% of samples), respiratory syncytial virus (RSV) (11.8%), rhinovirus (26.4%), and coronavirus (6.0%). Overall, 6.4% of participants were co-infected with multiple respiratory pathogens. Compared to mono-infections, co-infections were found not to be associated with severe clinical illness either overall (relative risk (RR) 0.72, 95% confidence interval (CI) 0.39-1.32) or specifically with influenza virus (RR 0.80, 95% CI 0.14-4.46) or RSV infections (RR 0.44, 95% CI 0.17-1.11). CONCLUSIONS: Respiratory infections in rural southern Zambia were associated with a wide range of viruses. Respiratory co-infections in this population were not associated with clinical severity.
OBJECTIVES: The role of respiratory co-infections in modulating disease severity remains understudied in southern Africa, particularly in rural areas. This study was performed to characterize the spectrum of respiratory pathogens in rural southern Zambia and the prognostic impact of co-infections. METHODS:Respiratory specimens collected from inpatient and outpatientparticipants in a viral surveillance program in 2018-2019 were tested for selected viruses and atypical bacteria using the Xpert Xpress Flu/RSV assay and FilmArray Respiratory Panel EZ. Participants were followed for 3-5 weeks to assess their clinical course. Multivariable regression was used to examine the role of co-infections in influencing disease severity. RESULTS: A respiratory pathogen was detected in 63.2% of samples from 671 participants who presented with influenza-like illness. Common pathogens identified included influenza virus (18.2% of samples), respiratory syncytial virus (RSV) (11.8%), rhinovirus (26.4%), and coronavirus (6.0%). Overall, 6.4% of participants were co-infected with multiple respiratory pathogens. Compared to mono-infections, co-infections were found not to be associated with severe clinical illness either overall (relative risk (RR) 0.72, 95% confidence interval (CI) 0.39-1.32) or specifically with influenza virus (RR 0.80, 95% CI 0.14-4.46) or RSVinfections (RR 0.44, 95% CI 0.17-1.11). CONCLUSIONS:Respiratory infections in rural southern Zambia were associated with a wide range of viruses. Respiratory co-infections in this population were not associated with clinical severity.
Authors: Gideon Loevinsohn; Mutinta Hamahuwa; Justin Hardick; Pamela Sinywimaanzi; Katherine Z J Fenstermacher; Passwell Munachoonga; Austin Weynand; Mwaka Monze; Yukari C Manabe; Charlotte A Gaydos; Richard E Rothman; Andrew Pekosz; Philip E Thuma; Edgar Simulundu; Catherine G Sutcliffe Journal: Trop Med Int Health Date: 2022-06-08 Impact factor: 3.918