Abstract
BackgroundBetter understanding the etiology-specific incidence of severe acute respiratory infections (SARIs) in resource-poor, rural settings will help further develop and prioritize prevention strategies. To address this gap in knowledge, we conducted a longitudinal study to estimate the incidence of SARIs among children in rural Bangladesh.MethodsDuring June through October 2010, we followed children aged <5 years in 67 villages to identify those with cough, difficulty breathing, age-specific tachypnea and/or danger signs in the community or admitted to the local hospital. A study physician collected clinical information and obtained nasopharyngeal swabs from all SARI cases and blood for bacterial culture from those hospitalized. We tested swabs for respiratory syncytial virus (RSV), influenza viruses, human metapneumoviruses, adenoviruses and human parainfluenza viruses 1–3 (HPIV) by real-time reverse transcription polymerase chain reaction. We calculated virus-specific SARI incidence by dividing the number of new illnesses by the person-time each child contributed to the study.ResultsWe followed 12,850 children for 279,029 person-weeks (pw) and identified 141 SARI cases; 76 (54%) at their homes and 65 (46%) at the hospital. RSV was associated with 7.9 SARI hospitalizations per 100,000 pw, HPIV3 2.2 hospitalizations/100,000 pw, and influenza 1.1 hospitalizations/100,000 pw. Among non-hospitalized SARI cases, RSV was associated with 10.8 illnesses/100,000 pw, HPIV3 1.8/100,000 pw, influenza 1.4/100,000 pw, and adenoviruses 0.4/100,000 pw.ConclusionRespiratory viruses, particularly RSV, were commonly associated with SARI among children. It may be useful to explore the value of investing in prevention strategies, such as handwashing and respiratory hygiene, to reduce respiratory infections among young children in such settings.
Highlights
Acute respiratory infections (ARIs) are one of the leading causes of morbidity and mortality among children in low-income countries
In Bangladesh, ARI is a major cause of death among children aged,5 years [1] where approximately 50,000 children annually die from pneumonia [2]
During 1988–1989, a study in a rural site of Bangladesh estimated the incidence of ARI to be 5.5 episodes per child-year and the incidence of acute lower respiratory infections (ALRIs) to be 0.2 per child-year among children aged,5 years
Summary
Acute respiratory infections (ARIs) are one of the leading causes of morbidity and mortality among children in low-income countries. During July 1999–June 2001, surveillance for ALRIs among a cohort of children aged ,5 years in rural Bangladesh estimated the incidence of ALRI-related hospitalization to be 50.2 per 1,000 child-years of observation [7]. This population-based study investigated the bacterial etiology of ALRIs, but no information on viral etiologies was reported. Better understanding the etiology-specific incidence of severe acute respiratory infections (SARIs) in resourcepoor, rural settings will help further develop and prioritize prevention strategies To address this gap in knowledge, we conducted a longitudinal study to estimate the incidence of SARIs among children in rural Bangladesh
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