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Burden and Risk Factors for Coronavirus Infections in Infants in Rural Nepal
S M Iftekhar Uddin1, Janet A Englund2, Jane Y Kuypers3
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Human coronavirus (HCoV) infections are common in infants in rural Nepal, with higher risks observed after the neonatal period. Household crowding and season influence HCoV ARI incidence in young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Limited knowledge exists on risk factors for symptomatic human coronavirus (HCoV) infections in community-dwelling children.
- This study focused on estimating the disease burden and impact of various factors on HCoV infections in infants from birth to 6 months old in rural Nepal.
Purpose of the Study:
- To estimate the incidence and identify risk factors for HCoV acute respiratory infections (ARIs) in infants up to 6 months of age in rural Nepal.
- To understand the impact of birth-related, maternal, household, and seasonal factors on HCoV infections in this vulnerable population.
Main Methods:
- Prospective, active, weekly surveillance for ARIs was conducted in infants over 3 years.
- Midnasal swabs were collected and tested for HCoV and other viruses using reverse-transcription polymerase chain reaction (RT-PCR).
- Poisson regression was used to model the association between HCoV incidence and potential risk factors.
Main Results:
- 8% of 3505 infants experienced an HCoV ARI within the first 6 months of life.
- HCoV incidence was higher in non-neonates compared to neonates (IRR 2.53) and associated with increased household crowding (IRR 1.13).
- Seasonal peaks were observed in winter and autumn, with 46% of HCoV infections being coinfections with other respiratory viruses.
Conclusions:
- Human coronavirus (HCoV) accounts for a significant proportion of illnesses in young infants in rural Nepal.
- The risk of HCoV infection increases beyond the first month of life, highlighting the need for targeted interventions.
Background:
Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal.
Methods:
Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression.
Results:
Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3-286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52-4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01-1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December-February) and 1 autumn (September-November).
Conclusions:
HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.
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