The role of HIV in the household introduction and transmission of influenza in an urban slum, Nairobi, Kenya, 2008-2011. Public

Abstract

Little is known about how HIV affects the transmission dynamics of influenza in sub- Saharan Africa. In this retrospective cohort study of 176 households with known HIV status in an urban slum in Nairobi, Kenya, we used population-based household and clinic surveillance data gathered from 2008 through 2011 to examine the association between the HIV status of household members and their risk of introducing influenza to the home. We also examined the association between the HIV status of laboratory-confirmed influenza index cases in households and the risk of developing influenza-like illness (ILI) among their household contacts.

ILI in a household member was defined as reported or diagnosed cough or sore throat with fever ≥ 38.0°C. Persons with ILI seeking medical care at the local study clinic and consenting to provide nasopharyngeal and oropharyngeal swabs were tested by real-time reverse transcription PCR for influenza infection. Log-binomial models using generalized estimating equations (GEE) to account for household clustering evaluated the association between laboratory-confirmed household influenza index case status among all household members and individual HIV status, as well as the association between secondary ILI status among household contacts and the HIV status of the household influenza index case.

We observed that HIV-positive individuals were not at an elevated risk for introducing influenza to their households, compared to HIV-negative individuals (Risk ratio (RR), 1.35; 95% confidence interval (CI), 0.65 - 2.78). However, our results suggested that HIV- positive index cases were more likely to spread influenza in their households than HIV- negative index cases (RR, 2.36; 95%CI, 1.19 - 4.66), potentially implicating HIV-positive index cases as seeders of household influenza epidemics. Large sample size prospective studies measuring median CD4 counts and clinically confirming reported secondary ILI cases are needed to further evaluate the role of HIV in household influenza transmission. HIV-positive individuals should continue to be a priority for influenza vaccination in regions with high HIV seroprevalence.

Table of Contents

CHAPTER I: LITERATURE REVIEW, 1

CHAPTER II: MANUSCRIPT, 9

ABSTRACT, 9

INTRODUCTION, 12

METHODS, 14

RESULTS, 22

DISCUSSION, 27

REFERENCES, 36

TABLES, 56

FIGURES, 60

CHAPTER III: PUBLIC HEALTH IMPLICATIONS, 62

APPENDICES, 65

ETHICS STATEMENT, 65

ADDITIONAL DISCUSSION, 67

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	Kibera HIV Infectious diseases Household Informal settlement Kenya Influenza transmission Cluster analysis Nairobi Epidemiology
Committee Chair / Thesis Advisor	Brachman, Philip S, Emory University
Committee Members	Mott, Joshua, CDC-Kenya
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) CDC

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