MLW supports the only respiratory virus surveillance in Malawi. We have demonstrated that 58% of severe hospitalised influenza in adults is attributable to HIV, pregnant women are at major risk (Ho PhD 2016) and amongst children with severe respiratory syndromes, RSV and Influenza are major causes but multiple viral co-infections may be a major driver of this syndrome in Malawi. MLW has led post-vaccine surveillance in Blantyre, Mchinji and Karonga since 2011 and has recently shown limited herd effect associated with pneumococcal conjugate vaccine implemen-tation. Mucosal studies have shown increased carriage of pneumococci in HIV infected adults on HAART, continued early acquisition of pneumococci by young infants with siblings a major reservoir of transmissible pneumococci. This has very significant national implications for disease control.
Respiratory infections are the most common cause of adult admission to QECH. A large cohort study has shown that mortality is associated with clinical features including hypoxia, anaemia and failure to stand. Follow-up work showed that only 10% of hypoxic cases were routinely provided oxygen and 90% of hypoxic cases were corrected with simple concentrator oxygen supply. Poor prognosis in pneumonia is also associated with TB or lack of a specific aetiology (Aston PhD 2017).
(PIs: Everett, French)