Abstract
SummaryObjectivesRespiratory syncytial virus (RSV) pneumonia is a leading cause of infant mortality worldwide. The risk of RSV infection associated with preterm birth is not well-characterized in resource-limited settings. We aimed to obtain precise estimates of risk factors and disease burden of RSV in infants in rural southern Nepal.MethodsPregnant women were enrolled, and along with their infants, followed to six months after birth with active weekly home-based surveillance for acute respiratory illness (ARI). Mid-nasal swabs were obtained and tested for RSV by PCR for all illness episodes. Birth outcomes were assessed at a postpartum home visit.Results311 (9%) of 3509 infants had an RSV ARI. RSV ARI incidence decreased from 551/1000 person-years in infants born between 28 and 31 weeks to 195/1000 person-years in infants born full-term (p = 0.017). Of 220 infants (71%) evaluated in the health system, 41 (19%) visited a hospital or physician. Of 287 infants with an assessment performed, 203 (71%) had a lower respiratory tract infection.ConclusionsIn a rural south Asian setting with intensive home-based surveillance, RSV caused a significant burden of respiratory illness. Preterm infants had the highest incidence of RSV ARI, and should be considered a priority group for RSV preventive interventions in resource-limited settings.
Highlights
Pneumonia is the primary infectious cause of death in children under age five worldwide
In a rural south Asian setting with intensive home-based surveillance, Respiratory syncytial virus (RSV) caused a significant burden of respiratory illness
Preterm infants had the highest incidence of RSV acute respiratory illness (ARI), and should be considered a priority group for RSV preventive interventions in resourcelimited settings. a 2016 The Authors
Summary
Pneumonia is the primary infectious cause of death in children under age five worldwide. Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia, and greater than 99% of deaths due to RSV are estimated to occur in resource-limited settings.[1,2] No vaccine is currently available for RSV, though several are under development for both infants and pregnant women. A large proportion of deaths due to respiratory disease or pneumonia may occur outside of these settings This may lead to an underestimate of true population-based disease burden.[3,4] many studies have not captured the impact of birth outcomes on RSV infection risk.[5] Preterm birth is the primary risk factor for severe RSV disease in developed countries and is an indication for prophylaxis with palivizumab, a monoclonal antibody against RSV.[6] the majority of preterm birth is estimated to occur in Africa and Asia. There is a lack of data from South Asia evaluating the association of preterm birth with RSV disease
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