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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series
Nienke M Scheltema1, Angela Gentile2, Florencia Lucion2
1Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.
Insights
This study identified clinical and socioeconomic factors in children under 5 who died from Respiratory Syncytial Virus (RSV) infection. Perinatal immunisation strategies could significantly reduce RSV-related child mortality, especially in low-income nations.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a major cause of pneumonia mortality in young children globally.
- Clinical data on fatal RSV infections, particularly in diverse socioeconomic settings, remain scarce.
- Understanding characteristics of fatal RSV cases is crucial for effective prevention and intervention strategies.
Purpose of the Study:
- To identify clinical and socioeconomic characteristics of children under 5 years old with RSV-related mortality.
- To analyze data from a large international case series of fatal RSV infections.
- To inform public health strategies aimed at reducing child mortality from RSV.
Main Methods:
- A retrospective case series design was employed.
- An online questionnaire collected individual patient data on clinical and socioeconomic factors.
- Data were gathered from 358 children with RSV-related in-hospital deaths across 23 countries between 1995 and 2015.
Main Results:
- The study included 358 children from 23 countries, with varying proportions from low, middle, and high-income nations.
- Comorbidities were present in a substantial proportion of children, with higher prevalence in high-income countries (70%).
- Median age at death varied significantly by country income level, being youngest in low-income countries (5.0 months).
Conclusions:
- This is the first large case series detailing children who died from community-acquired RSV infection.
- A significant number of children with fatal RSV had underlying comorbidities.
- Perinatal immunization strategies targeting infants under 6 months could substantially decrease RSV-related child mortality, particularly in low- and middle-income countries.
Background:
Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data.
Methods:
In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms "RSV", "respiratory syncytial virus", or "respiratory syncytial viral" combined with "mortality", "fatality", "death", "died", "deaths", or "CFR" for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables.
Findings:
We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3-11·0) in low-income or lower middle-income countries, 4·0 years (2·0-10·0) in upper middle-income countries, and 7·0 years (3·6-16·8) in high-income countries.
Interpretation:
This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries.
Funding:
Bill & Melinda Gates Foundation.
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