Volume 27, Number 1—January 2021
Research Letter
Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017
Md R. Rahaman
, Karen A. Alroy, Chris A. Van Beneden, Michael S. Friedman, Erin D. Kennedy, Mahmudur Rahman, Arunmozhi Balajee, A.K.M. Muraduzzaman, Tahmina Shirin, Meerjady S. Flora, and Eduardo Azziz-Baumgartner
, Karen A. Alroy, Chris A. Van Beneden, Michael S. Friedman, Erin D. Kennedy, Mahmudur Rahman, Arunmozhi Balajee, A.K.M. Muraduzzaman, Tahmina Shirin, Meerjady S. Flora, and Eduardo Azziz-Baumgartner
Table
Participant characteristics and their associations with severe acute respiratory infection case–control status*
| Characteristics | No. (%) |
Unadjusted OR (95% CI) | p value or aOR (95% CI)† | |
|---|---|---|---|---|
| Case-patients, n = 73 | Controls, n = 146 | |||
| Age, y, n = 219, median (IQR) |
35 (25−50) |
35 (24−50) |
0.949‡ |
|
| Sex, n = 219 | ||||
| F | 8 (11) | 33 (23) | Referent | |
| M |
65 (89) |
113 (77) |
2.37 (1.03–5.44) |
0.041 |
| Duration from illness onset to seeking care at sentinel hospitals (case-patients), d | ||||
| Median (IQR) |
4 (3−5) |
|||
| Education, n = 218 | ||||
| Below secondary | 50 (68) | 103 (71) | Referent | |
| Secondary and above |
23 (32) |
42 (29) |
1.13 (0.61–2.08) |
0.699 |
| Occupation, n = 218 | ||||
| Unemployed | 21 (29) | 35 (24) | Referent | |
| Homemaker | 7 (10) | 33 (23) | 0.35 (0.13–0.94) | 0.037 |
| Farmer | 13 (18) | 9 (6) | 2.41 (0.88–6.59) | 0.087 |
| Poultry worker | 1 (1) | 0 | ||
| Healthcare worker | 0 | 1 (1) | ||
| Other§ |
31 (42) |
67 (46) |
0.77 (0.39–1.54) |
0.459 |
| Monthly income, USD, n = 218 | ||||
| <250¶ | 68 (93) | 126 (86) | Referent | |
| >250 | 1 (1) | 6 (4) | 0.31 (0.04–2.62) | 0.281 |
| Refused to answer |
4 (5) |
13 (9) |
0.57 (0.18–1.82) |
0.342 |
| No. household members, n = 218 | ||||
| <7 | 66 (90) | 131 (90) | Referent | |
| >8 |
7 (10) |
14 (10) |
0.99 (0.38–2.58) |
0.988 |
| Body mass index# category, n = 176 | ||||
| Underweight | 5 (7) | 11 (8) | Referent | |
| Healthy weight | 44 (60) | 95 (65) | 1.02 (0.33–3.11) | 0.974 |
| Overweight | 4 (5) | 15 (10) | 0.59 (0.13–2.70) | 0.494 |
| Obese |
1 (1) |
1 (1) |
2.20 (0.11–42.73) |
0.602 |
| Behavioral factors | ||||
| Current smoker, n = 215 | 16 (22) | 42 (29) | 0.69 (0.35–1.33) | 0.266 |
| Ever smoker, n = 215 | 22 (30) | 53 (36) | 0.77 (0.42–1.41) | 0.400 |
| Betel nut chewer, n = 219 | 12 (16) | 26 (18) | 0.91 (0.43–1.92) | 0.801 |
| Gul user, n = 214** |
2 (3) |
8 (5) |
0.49 (0.10–2.37) |
0.374 |
| Self-reported preexisting conditions, n = 219 | ||||
| Any underlying chronic condition | 34 (47) | 36 (25) | 2.66 (1.47–4.83) | 0.001 |
| Asthma | 26 (36) | 17 (12) | 4.17 (2.08–8.36) | 0.000 |
| Chronic lung disease†† | 2 (3) | 2 (1) | 2.07 (0.29–15.02) | 0.471 |
| Diabetes | 7 (10) | 17 (12) | 0.83 (0.33–2.11) | 0.695 |
| Neurologic disease |
13 (18) |
21 (14) |
1.26 (0.59–2.69) |
0.552 |
| History of allergies, n = 219‡‡ | 20 (27) | 15 (10) | 3.11 (1.48–6.56) | 0.003 |
| Antibiotics for current illness, case-patients | 34 (47) | |||
| Antivirals for current illness, case-patients |
0 |
|||
| Viral pathogens, n = 219 | ||||
| Influenza viruses | 18 (25) | 8 (5) | 5.65 (2.32–13.74)§§ | 11.34 (3.74–34.33)§§ |
| Influenza A(H1N1) | 12 (16) | 3 (2) | 9.38 (2.56–34.41)§§ | 11.38 (2.73–47.42)§§ |
| Unsubtyped influenza A | 5 (7) | 4 (3) | 2.61 (0.68–10.03) | 11.22 (1.63–77.23)¶¶ |
| Influenza C | 1 (1) | 2 (1) | 1.00 (0.09–11.21) | 1.46 (0.10–20.92) |
| Parainfluenza viruses | 4 (5) | 1 (1) | 8.41 (0.92–76.62) | |
| Human rhinovirus | 8 (11) | 11 (8) | 1.51 (0.58–3.94) | 1.35 (0.43–4.27) |
| Human metapneumovirus | 6 (8) | 5 (3) | 2.53 (0.74–8.57) | 1.34 (0.34–5.35) |
| Adenovirus | 1 (1) | 2 (1) | 1.00 (0.09–11.21) | 1.84 (0.14–23.36) |
| Enterovirus | 1 (1) | 3 (2) | 0.66 (0.07–6.48) | 0.77 (0.07–8.81) |
| Human bocavirus | 2 (3) | 1 (1) | 4.08 (0.36–45.80) | 2.48 (0.19–32.45) |
| Coronaviruses |
8 (11) |
10 (7) |
1.67 (0.63–4.44) |
1.30 (0.37–4.55) |
| Bacterial pathogens, n = 219 | ||||
| Streptococcus pneumoniae | 9 (12) | 32 (22) | 0.50 (0.23–1.12) | 0.37 (0.14–0.97)¶¶ |
| Haemophilus influenzae type b | 0 | 4 (3) | ||
| Staphylococcus aureus | 10 (14) | 16 (11) | 1.29 (0.55–3.00) | 1.96 (0.75–5.16) |
| Moraxella catarrhalis | 3 (4) | 5 (3) | 1.21 (0.28–5.20) | 0.38 (0.06–2.53) |
| Bordetella spp. | 2 (3) | 3 (2) | 1.34 (0.22–8.22) | 1.73 (0.19–15.92) |
| Klebsiella pneumoniae | 23 (32) | 34 (23) | 1.52 (0.81–2.83) | 1.21 (0.59–2.47) |
| H. influenzae other than type b | 9 (12) | 24 (16) | 0.71 (0.31–1.63) | 0.69 (0.27–1.77) |
| Mycoplasma pneumoniae |
0 |
1 (1) |
||
| No pathogens detected | 20 (27) | 54 (37) | 0.64 (0.35–1.19) | 0.70 (0.35–1.39) |
*Percentages, where relevant, might not sum to 100 because of rounding. aOR, adjusted odds ratio; IQR, interquartile range; OR, odds ratio. †Adjusted for age, sex, and past medical history, including history of asthma and allergies. ‡Calculated by Wilcoxon rank-sum test. §Other includes day laborer, butcher, businessman, office worker, and any other occupation not listed. ¶Per capita income in Bangladesh in 2015 was $1,314 (3). #Healthy body mass Index range is 18.5–24.9 (4). **Smokeless tobacco constituted of tobacco powder and molasses (5). ††Includes all self-reported lung diseases other than asthma of >3 months’ duration. ‡‡History of allergies included food allergy (n = 21), dust allergy (n = 6), drug allergy (n = 1), and nonspecified allergy (n = 7). §§p<0.001. ¶¶p<0.05.
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