Etiology and Epidemiology of Viral Pneumonia Among Hospitalized Children in Rural Mozambique: A Malaria Endemic Area With High Prevalence of Human Immunodeficiency Virus

• Published in: The Pediatric infectious disease journal Vol. 30; no. 1; pp. 39 - 44
• Main Authors: O'CALLAGHAN-GORDO, Cristina, BASSAT, Quique, ROCA, Anna, MORAIS, Luis, DIEZ-PADRISA, Núria, MACHEVO, Sónia, NHAMPOSSA, Tacilta, NHALUNGO, Delino, SANZ, Sergi, QUINTO, Llarenç, ALONSO, Pedro L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2011
• Subjects: Adenoviridae - isolation & purification; Analysis of Variance; Biological and medical sciences; Child, Preschool; Cross-Sectional Studies; Endemic Diseases; Female; HIV Infections - epidemiology; HIV Infections - parasitology; HIV Infections - virology; HIV-1 - isolation & purification; Human protozoal diseases; Human viral diseases; Humans; Infant; Infectious diseases; Malaria; Malaria - epidemiology; Malaria - parasitology; Malaria - virology; Male; Medical sciences; Mozambique - epidemiology; Nasopharynx - virology; Parasitic diseases; Pneumonia, Viral - epidemiology; Pneumonia, Viral - parasitology; Pneumonia, Viral - virology; Protozoal diseases; Respiratory Syncytial Viruses - isolation & purification; Rhinovirus - isolation & purification; Risk Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral diseases of the respiratory system and ent viral diseases; Mozambique; Africa; Pediatrics; Protozoal disease; Prevalence; respiratory virus; Developing countries; Epidemiology; Respiratory tract; pneumonia; Etiology; Child; Human; Immunopathology; Lung disease; Viral pneumonia; Rural environment; Malaria; Respiratory disease; Retroviridae; AIDS; Hospitalization; Parasitosis; Immune deficiency; Lentivirus; Infection; Virus; HIV; Viral disease; Human immunodeficiency virus
• ISSN: 0891-3668; 1532-0987
• DOI: 10.1097/INF.0b013e3181f232fe

The role of viruses in pediatric pneumonia remains poorly studied in sub-Saharan Africa, where pneumonia-associated mortality is high.
During a 1-year hospital-based surveillance, a nasopharyngeal aspirate (NPA) was collected from children aged <5 years admitted to hospital in rural Mozambique with clinically severe pneumonia. Identification of 12 respiratory viruses was performed by polymerase chain reactions (PCR). Study children were also tested for invasive bacterial infection (IBI), Plasmodium falciparum parasitemia, and HIV.
Almost half (394/807) of the children hospitalized with clinically severe pneumonia had at least one respiratory virus detected. A total of 475 viruses were detected among these 394 children, the most prevalent ones were rhinovirus (41%), adenovirus (21%), and respiratory syncytial virus (11%). Eleven percent of viral infected children had concomitant IBI, 15% had malaria parasites, and 25% had HIV coinfection. Viral infection was 5.5 to 16 times more prevalent among HIV-infected children and incidence rate ratios varied according to virus. Inhospital mortality of viral cases was 9%, being highest among cases with IBI coinfection (odds ratio = 7) or HIV infection (odds ratio = 7).
Study results highlight the high prevalence of respiratory viruses among hospitalized pneumonia cases in Mozambique. HIV infection is an important contributor to the high burden of disease and associated mortality of viral pneumonia. IBI also contributes to a worse prognosis of viral cases. Strategies to prevent mother-to-child transmission of HIV as well as introduction of Hib and pneumococcal vaccines could have a substantial impact on reduction of viral pneumonia and associated mortality among children in rural Africa.