Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infections: Evidence from an Indonesian Cohort.

Rowena Crow,Kuswandewi Mutyara,Cissy B Kartasasmita,Dwi Agustian,Eric A F Simões

doi:10.3390/v13020331

Abstract

Although risk factors for hospitalization from a respiratory syncytial virus (RSV) are well known, RSV lower respiratory tract infections (LRIs) in the community are much less studied or understood, especially in developing countries. In a prospective, cohort study we studied factors predisposing Indonesian infants and children under 5 years of age to developing RSV LRIs. Subjects were enrolled in two cohorts: a birth cohort and a cross-sectional cohort of children <48 months of age. Subjects were visited weekly at home to identify any LRI, using the World Health Organization’s criteria. RSV etiology was determined through analysis of nasal washings by enzyme immunoassay and polymerase chain reaction. Risk factors for the development of the first documented RSV LRI were identified by multivariate analysis using logistic regression and Cox proportional hazard modeling. Of the 2014 children studied, 999 were enrolled within 30 days of birth. There were 149 first episodes of an RSV. Risk factors for an RSV LRI were poverty (p < 0.01), use of kerosene as a cooking fuel (p < 0.05), and household ownership of rabbits and chickens (p < 0.01). Our findings suggested that in a middle-income country such as Indonesia, with a substantial burden of RSV morbidity and mortality, lower socioeconomic status, environmental air quality, and animal exposure are predisposing factors for developing an RSV LRI.

Highlights

respiratory syncytial virus (RSV) is the most common cause of acute lower lower respiratory tract infections (LRIs) in young children globally as well as an important cause of hospital admissions [1]
Much of our current understanding regarding the development of RSV LRIs in infants and young children relies upon hospital-based studies with few community-based [6,7,8]
The incidence of the first episode of an RSV LRI was relatively low at 7.4% overall

Summary

Introduction

RSV is the most common cause of acute lower LRI in young children globally as well as an important cause of hospital admissions [1]. Estimates of mortality from RSV LRIs in healthy children in developing countries range from 2–7% [3,4], significantly higher than those of both the healthy and high-risk patients from industrialized countries [5]. It is critically important to identify risk factors in developing countries for developing RSV LRIs, and attempt to elucidate possible mechanisms for this higher mortality. Much of our current understanding regarding the development of RSV LRIs in infants and young children relies upon hospital-based studies with few community-based [6,7,8]. While hospital-based studies have identified risk factors on the severity of an RSV infection—-including age, prematurity and underlying immune, pulmonary or cardiac disease [10,11]—-these studies are focused on the most severe infections and underestimate the substantial burden of disease within the community. Epidemiological and environmental studies have further identified factors such as crowding, daycare, and smoke exposure, which increase the severity of RSV infections [12]

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