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Published on: December 10, 2013
Respiratory Syncytial Virus-related Death in Children With Down Syndrome: The RSV GOLD Study
Yvette N Löwensteyn1, Emily W E M Phijffer1, Juliette V L Simons1
1From the Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands.
Insights
Down syndrome (DS) increases the risk of severe respiratory syncytial virus (RSV) infection mortality in children under five. Even without other risk factors, DS poses a significant threat, highlighting the need for targeted prevention strategies beyond maternal vaccination.
Area of Science:
- Pediatrics
- Infectious Diseases
- Genetics
Background:
- Respiratory syncytial virus (RSV) is a leading cause of death in children globally.
- Down syndrome (DS) is an established independent risk factor for severe RSV infection.
- This study investigates the characteristics of children with DS who died from RSV.
Purpose of the Study:
- To describe the demographic and clinical features of children with Down syndrome who experienced mortality due to RSV infection.
- To identify specific risk factors and comorbidities associated with RSV mortality in this population.
- To inform public health strategies for preventing RSV-related deaths in children with DS.
Main Methods:
- A retrospective case series design was employed.
- Data were collected globally through the RSV Global Online Database study.
- Included were children under five with Down syndrome and laboratory-confirmed RSV infection who died.
Main Results:
- 53 cases of children with DS and RSV mortality were identified across 20 countries.
- The median age at death was 6 months; 24.5% had no other risk factors for severe RSV.
- Congenital heart disease was present in 67.9% of cases; hospitalization was longer compared to children without DS.
Conclusions:
- Down syndrome is a significant risk factor for RSV-related mortality, even in the absence of other comorbidities.
- The age distribution of deaths suggests that maternal RSV vaccination alone may not fully protect children with DS.
- Further research and targeted interventions are needed to reduce RSV mortality in children with Down syndrome.
Background:
Respiratory syncytial virus (RSV) is a major cause of mortality in children younger than 5 years worldwide. Systematic reviews have shown that Down syndrome (DS) is an independent risk factor for severe RSV infection. We aimed to describe demographic and clinical characteristics of children with DS who died with RSV infection.
Methods:
We performed a retrospective case series in which data were shared by individual researchers, research networks and physicians worldwide as part of the RSV Global Online Database study. We included children with DS who died when younger than 5 years of age with laboratory-confirmed RSV infection.
Results:
We included 53 children with DS and RSV-related mortality from 20 countries in 5 continents. Five (9.4%) children were from low-income or lower-middle-income countries. Median age at time of death was 6.0 months [interquartile range (IQR): 3.00-12.0]. Thirteen (24.5%) children were born term and had no other risk factors for severe RSV disease. In total, 36 (67.9%) children had congenital heart disease, 8 (15.1%) had chronic lung disease and 1 (1.9%) had congenital immunodeficiency. Duration of hospitalization was significantly longer for children with DS compared with children without DS [median length of stay, 13 days (IQR: 6.8-21.0) vs. 8 days (IQR: 3.0-18.5), P=0.005].
Conclusions:
One-fourth of children with DS and RSV-confirmed death did not have risk factors for severe RSV disease, indicating that DS is an important risk factor for RSV-related mortality. Age distribution at time of death demonstrates that maternal vaccination would not be sufficient to protect children with DS against RSV-related mortality.
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