Abstract
BackgroundBronchiolitis caused by respiratory syncytial virus (RSV) is a major cause of mortality and morbidity in infants.AimTo describe RSV epidemiology in children in the community in a high-income setting.MethodsWe used stored blood samples from the United Kingdom Born in Bradford cohort study that had been collected at birth, age 1 and 2 years old, tested for IgG RSV postfusion F antibody and linked to questionnaires and primary and hospital care records. We used finite mixture models to classify children as RSV infected/not infected according to their antibody concentrations at age 1 and 2 years. We assessed risk factors for primary RSV infection at each age using Poisson regression models.ResultsThe study cohort included 700 children with cord blood samples; 490 had additional blood samples taken at both ages 1 and 2 years old. Of these 490 children, 258 (53%; 95% confidence interval (CI): 48–57%) were first infected with RSV at age 1, 99 of whom (38%; 95% CI: 33–43%) had been in contact with healthcare during peak RSV season (November–January). Having older siblings, birth in October–June and attending formal childcare were associated with risk of RSV infection in infancy. By age 2, a further 164 of 490 children (33%; 95% CI: 29–38%) had been infected.ConclusionOver half of children experienced RSV infection in infancy, a further one third had evidence of primary RSV infection by age 2, and one in seven remained seronegative by their second birthday. These findings will inform future analyses to assess the cost-effectiveness of RSV vaccination programmes in high-income settings.
Highlights
Respiratory syncytial virus (RSV) is a major cause of respiratory morbidity and mortality in young children, accounting for over 33 million episodes of acute lower respiratory tract infection in children under 5 years old per year globally [1,2]
The short period of immunity induced by natural RSV infection [8], and the seasonal pattern of acute bronchiolitis admissions in temperate countries mean that a successful vaccine will need to induce a stronger immune response than that induced by natural infection [9,10]
We describe the epidemiology of RSV during the first 2 years of life in a cohort of children born in Bradford, United Kingdom (UK)
Summary
Respiratory syncytial virus (RSV) is a major cause of respiratory morbidity and mortality in young children, accounting for over 33 million episodes of acute lower respiratory tract infection in children under 5 years old per year globally [1,2]. Several factors related to the clinical and virological features of RSV challenge the design of an effective vaccination programme, including the very young age at which children are vulnerable to severe RSV morbidity (RSVrelated hospital admissions in the UK peak at 1 month of age [6,7]). The short period of immunity induced by natural RSV infection [8], and the seasonal pattern of acute bronchiolitis admissions in temperate countries mean that a successful vaccine will need to induce a stronger immune response than that induced by natural infection [9,10]. In order to determine who should be vaccinated, and when, to effectively protect young children from infection, detailed data on risk of infection according to age and other characteristics, including family structure, are required
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