Excess mortality associated with influenza among tuberculosis deaths in South Africa, 1999-2009

  • Walaza S
  • Cohen C
  • Nanoo A
 et al. 
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BACKGROUND: Published data on the interaction between influenza and pulmonary tuberculosis (PTB) are limited. We aimed to estimate the influenza-associated mortality among individuals with PTB in South Africa from 1999-2009.

METHODS: We modelled the excess influenza-associated mortality by applying Poisson regression models to monthly PTB and non-tuberculosis respiratory deaths, using laboratory-confirmed influenza as a covariate.

RESULTS: PTB deaths increased each winter, coinciding with influenza virus circulation. Among individuals of any age, mean annual influenza-associated PTB mortality rate was 164/100,000 person-years (n = 439). The rate of non-tuberculosis respiratory deaths was 27/100,000 (n = 1125) for HIV-infected and 5/100,000 (n = 2367) for HIV-uninfected individuals of all ages. Among individuals aged
CONCLUSION: We observed an increased risk of influenza-associated mortality in persons with PTB compared to non-tuberculosis respiratory deaths. If confirmed in other settings, our findings may support recommendations for active inclusion of patients with TB for influenza vaccination and empiric influenza anti-viral treatment of patients with TB during influenza epidemics.

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  • Cheryl CohenNational Institute for Communicable Diseases

  • Sibongile Walaza

  • Ananta Nanoo

  • Adam L. Cohen

  • Johanna McAnerney

  • Claire Von Mollendorf

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