Risk Factors for Severe Coronavirus Disease 2019 Among Human Immunodeficiency Virus-Infected and -Uninfected Individuals in South Africa, April 2020–March 2022: Data From Sentinel Surveillance-Reference-Cited by-同舟云学术

Risk Factors for Severe Coronavirus Disease 2019 Among Human Immunodeficiency Virus-Infected and -Uninfected Individuals in South Africa, April 2020–March 2022: Data From Sentinel Surveillance

Published:2022-11-02 Issue:12 Volume:9 Page:
ISSN:2328-8957
Container-title:Open Forum Infectious Diseases
language:en
Short-container-title:

Author:

Walaza Sibongile¹²,Tempia Stefano¹²³⁴,von Gottberg Anne¹⁵,Wolter Nicole¹⁵,Bhiman Jinal N¹⁵,Buys Amelia¹,Amoako Daniel¹,Moosa Fahima¹⁵,du Plessis Mignon¹⁵,Moyes Jocelyn¹²,McMorrow Meredith L⁶⁴,Dawood Halima⁷⁸,Variava Ebrahim⁹¹⁰,Reubenson Gary¹¹,Nel Jeremy¹⁰,Zar Heather J¹²,Makhasi Mvuyo¹,Meiring Susan²¹³,Quan Vanessa¹³,Cohen Cheryl¹²

Affiliation:

1. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa

2. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa

3. MassGenics , Atlanta, Georgia , USA

4. Influenza Program, Centers for Disease Control and Prevention , Pretoria , South Africa

5. School of Pathology, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa

6. Influenza Program, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia , USA

7. Department of Medicine, Greys Hospital , Pietermaritzburg , South Africa

8. Caprisa, University of KwaZulu - Natal , Pietermaritzburg , South Africa

9. Department of Medicine, Klerksdorp-Tshepong Hospital Complex , Klerksdorp , South Africa

10. Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa

11. Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital , Johannesburg , South Africa

12. Department of Paediatrics, Red Cross War Memorial Hospital, and South African-Medical Research Council on Child and Adolescent Health, University of Cape Town , South Africa

13. Divison of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa

Abstract

Abstract Background Data on risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization and mortality in high human immunodeficiency virus (HIV) prevalence settings are limited. Methods Using existing syndromic surveillance programs for influenza-like-illness and severe respiratory illness at sentinel sites in South Africa, we identified factors associated with COVID-19 hospitalization and mortality. Results From April 2020 through March 2022, severe acute respiratory syndrome coronavirus 2 was detected in 24.0% (660 of 2746) of outpatient and 32.5% (2282 of 7025) of inpatient cases. Factors associated with COVID-19-associated hospitalization included the following: older age (25–44 [adjusted odds ratio {aOR}= 1.8, 95% confidence interval (CI) = 1.1–2.9], 45–64 [aOR = 6.8, 95% CI = 4.2–11.0] and ≥65 years [aOR = 26.6, 95% CI = 14.4–49.1] vs 15–24 years); black race (aOR, 3.3; 95% CI, 2.2–5.0); obesity (aOR, 2.3; 95% CI, 1.4–3.9); asthma (aOR, 3.5; 95% CI, 1.4–8.9); diabetes mellitus (aOR, 5.3; 95% CI, 3.1–9.3); HIV with CD4 ≥200/mm3 (aOR, 1.5; 95% CI, 1.1–2.2) and CD4 <200/mm3 (aOR, 10.5; 95% CI, 5.1–21.6) or tuberculosis (aOR, 12.8; 95% CI, 2.8–58.5). Infection with Beta (aOR, 0.5; 95% CI, .3–.7) vs Delta variant and being fully vaccinated (aOR, 0.1; 95% CI, .1–.3) were less associated with COVID-19 hospitalization. In-hospital mortality was increased in older age (45–64 years [aOR, 2.2; 95% CI, 1.6–3.2] and ≥65 years [aOR, 4.0; 95% CI, 2.8–5.8] vs 25–44 years) and male sex (aOR, 1.3; 95% CI, 1.0–1.6) and was lower in Omicron-infected (aOR, 0.3; 95% CI, .2–.6) vs Delta-infected individuals. Conclusions Active syndromic surveillance encompassing clinical, laboratory, and genomic data identified setting-specific risk factors associated with COVID-19 severity that will inform prioritization of COVID-19 vaccine distribution. Elderly people with tuberculosis or people with HIV, especially severely immunosuppressed, should be prioritized for vaccination.

Funder

Wellcome Trust

Foreign, Commonwealth and Development Office

US Centers for Disease Control and Prevention

CDC

African Field Epidemiology Network

South African Medical Research Council

African Society of Laboratory Medicine

Africa Centers for Disease Control and Prevention

Bill & Melinda Gates Foundation

National Institute for Communicable Diseases

National Health Laboratory Service, South Africa