The National Burden of Influenza-Like Illness and Severe Respiratory
Illness Overall and Associated with Nine Respiratory Viruses in South
Africa, 2013-2015
Abstract
Background Estimates of the disease burden associated with different
respiratory viruses are severely limited in low- and middle-income
countries, especially in Africa. Methods We estimated age-specific
numbers and rates of medically and non-medically attended influenza-like
illness (ILI) and severe respiratory illness (SRI) that were associated
with influenza, respiratory syncytial virus (RSV), rhinovirus, human
metapneumovirus, adenovirus, enterovirus and parainfluenza virus types
1-3 after adjusting for the attributable fraction (AF) of virus
detection to illness in South Africa during 2013-2015. Rates were
reported per 100,000 population. Results The mean annual rates were
51,383 and 4,196 for ILI and SRI, respectively. Of these, 26% (for ILI)
and 46% (for SRI) were medically attended. Among outpatients with ILI,
rhinovirus had the highest AF-adjusted rate (7,221), followed by
influenza (6,443) and adenovirus (1,364); whereas, among inpatients with
SRI, rhinovirus had the highest AF-adjusted rate (400), followed by RSV
(247) and influenza (130). Rhinovirus (9,424) and RSV (2,026) had the
highest AF-adjusted rates among children aged <5 years with
ILI or SRI, respectively; whereas rhinovirus (757) and influenza (306)
had the highest AF-adjusted rates among individuals aged ≥65 years with
ILI or SRI, respectively Conclusions There was a substantial burden of
ILI and SRI in South Africa during 2013-2015. Rhinovirus and influenza
had a prominent disease burden among patients with ILI. Rhinovirus had
the highest burden of illness among patients of any age with SRI,
followed by RSV. RSV and influenza were the most prominent causes of SRI
in children and the elderly, respectively.