Abstract
BackgroundOur understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions.MethodsIn a household study, children testing RSV positive by direct immunofluorescent antibody test (DFA) were enrolled. Nasal washings were scheduled right away, then every three days until day 14, every 7 days until day 28 and every 2 weeks until a maximum of 16 weeks, or until the first DFA negative RSV specimen. The relationship between host factors, illness severity and viral shedding was investigated using Cox regression methods.ResultsFrom 151 families a total of 193 children were enrolled with a median age of 21 months (range 1-164 months), 10% infants and 46% male. The rate of recovery from infection was 0.22/person/day (95% CI 0.19-0.25) equivalent to a mean duration of shedding of 4.5 days (95%CI 4.0-5.3), with a median duration of shedding of 4 days (IQR 2-6, range 1-14). Children with a history of RSV infection had a 40% increased rate of recovery i.e. shorter duration of viral shedding (hazard ratio 1.4, 95% CI 1.01-1.86). The rate of cessation of shedding did not differ significantly between males and females, by severity of infection or by age.ConclusionWe provide evidence of a relationship between the duration of shedding and history of infection, which may have a bearing on the relative role of primary versus re-infections in RSV transmission in the community.
Highlights
Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions
Of the 193 RSV infections 165 were classified as having an upper respiratory tract infection (URTI), 20 as mild lower respiratory tract infection (LRTI), 8 as severe LRTI, and none with very severe LRTI
The proportion of individuals with prior history of infection was 0.53 in children with URTI compared with 0.5 and 0.25 in children with severe LRTI and mild LRTI, respectively. Both the URTI and mild LRTI disease categories had a higher proportion of children in the older (≥18 months) age group compared to the severe LRTI category
Summary
Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions. Our understanding of the mechanisms of persistence and spread of the virus in the population is fundamental to the development of appropriate control methods. In this respect the process of recovery from infection is of intrinsic interest. Primary RSV infection predominantly arises in the first two years of life [5,6,7,8,9,10]. 1 in 100 cases of infant primary RSV infection result in hospitalisation and a far smaller
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