Burden of serious fungal infections in Zambia

Ref ID: 19398

Author:

L. Chishimba, M. Niven and W. Denning

Author address:

University Hospital of South Manchester, United Kingdom

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Background and rationale Human fungal infections contribute
substantially to human morbidity and mortality. With an increase in
prevalence and incidences of immunosuppressive conditions such as
HIV in Zambia, the incidence is expected to be rising. To date, there
is paucity of data describing the epidemiology of fungal infections in
Zambia. We estimated the burden of fungal infections in Zambia
based on published literature and modelling.
Methods All published epidemiology papers reporting fungal or HIV
infection rates from Zambia were identified. We also extracted
reported data from the WHO, UNICEF, USAID, UNAIDS, Centre for
Infectious Disease Research in Zambia (CIDRZ), Central Statistical
Office (CSO), Ministry of Health (MOH), Tropical Diseases Research
Centre (TDRC), University of Zambia, Centre for Disease Control and
Prevention (CDC). We also extracted reported data from the Interna-
tional Classification of Diseases (ICD) from Ministry of Health as com-
parators. Where no data existed, we used specific populations at risk
and fungal infection frequencies in those populations to estimate
national incidence or prevalence. Data for invasive mycoses, CPA,
IA, ABPA, Asthma and COPD rates were made on assumptions based
on incidence rates reported in the local and international literature.
The denominator included the overall Zambian population, number of patients with HIV/AIDS, respiratory diseases as reported in govern-
mental publications.
Results There are about 13 million people in Zambia (2010), Male:
Female = 1:1.3. About 46.3% of the population are children (0-
14 years), 2.4% are >65 years old (median age 16.5 yrs). HIV/
AIDS – adult prevalence rate is 13.5% (~980,000). Of the 980,000
HIV+patients (2010), about 598,000 patients were not on ARVs in
2011. Assuming the number admitted to the UTH represents 25% of
the total burden, we have estimated 920 CM cases annually. Assum-
ing PCP occurs in 5% HIV+patients (not on ARVs), we estimate that
about 2,990 (ARV naive HIV+) have PCP. TB prevalence (including
HIV+TB) is 47,000, rate 352/100,000 population. TB incidence
(including HIV+TB) is 60,000, rate of 444/100 000 populations
with about 9,000 (23.6%) cases in HIV negative people. Assuming
50% of CPA cases are TB related, we estimate the 5 year period
prevalence of 22,500 CPA cases (assuming 15% annual mortality)
and 4,500 new cases in 2011. We estimate asthma prevalence in
adults to be 910,000 (7% population) and 22,750 ABPA cases
(2.5% adult asthmatics). The estimated severe asthma prevalence is
45,500 (5% asthmatics) and 27,300 SAFS cases (assuming 60% fun-
gal sensitisation in severe asthma). Oral candidiasis 539,000 (55.1%
of HIV+), vaginal candidiasis 174,525 (5% women>15 yrs). It wasn’t
possible to estimate burden of candidemia, IA, mucormycosis and
histoplasmosis because of paucity of data.
Conclusion Using local data and literature estimates of the inci-
dence or prevalence of fungal infections, more than 424,524 people
in Zambia are estimated to suffer from serious fungal infections each
year. Substantial uncertainty surrounds these estimates due to lack
of enough epidemiological data. Therefore, epidemiological studies
are urgently required to validate or modify these estimates.

Abstract Number: p113

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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