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Published on: December 10, 2013
Unveiling the Risk Period for Death After Respiratory Syncytial Virus Illness in Young Children Using a
You Li1, Harry Campbell1, Harish Nair1
1Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
Insights
The risk of death from respiratory syncytial virus (RSV) illness is highest in the first month after healthcare contact. This finding helps define a critical window for monitoring infant and young child mortality after RSV infection.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Surveillance
- Epidemiology
Background:
- Respiratory syncytial virus (RSV) is a significant cause of mortality in young children.
- The precise risk period for RSV-related deaths following healthcare presentation remains unclear.
Purpose of the Study:
- To determine the temporal risk of death in young children following an RSV illness episode.
- To identify a practical time window for assessing RSV-related mortality.
Main Methods:
- A self-controlled case series (SCCS) design was employed using Scottish national mortality and RSV surveillance data (2009-2016).
- Deaths from respiratory/circulatory causes in children under 5 years with confirmed RSV infection were analyzed.
- The incidence of death was compared in the first year post-RSV episode versus pre/post-intervals.
Main Results:
- A statistically significant increased risk of mortality was observed in the month following an RSV illness episode.
- Over 90% of deaths within one week post-RSV were attributable to RSV (AF 93.9%).
- Approximately 80% of deaths between one week and one month post-RSV were RSV-attributable (AF 80.3%).
Conclusions:
- An elevated risk of death persists for one month after an RSV illness episode requiring healthcare.
- This timeframe offers a practical window for community-based surveillance of RSV mortality.
- Further research is needed to understand mortality risks beyond the first month post-RSV illness.
Background:
Respiratory syncytial virus (RSV)-related acute lower respiratory infection is an important cause of death in infants and young children. However, little is known about the risk period for RSV-related deaths after presentation to health services with an RSV illness.
Methods:
Using the Scottish national mortality database, we identified deaths from respiratory/circulatory causes (hereafter "respiratory/circulatory deaths") in young children aged <5 years during 2009-2016, whose medical history and records of laboratory-confirmed RSV infections were obtained by linking the mortality database to the national surveillance data set and the Scottish Morbidity Record. We used a self-controlled case series (SCCS) design to evaluate the relative incidence of deaths with respiratory/circulatory deaths in the first year after an RSV episode. We defined the risk interval as the first year after the RSV episode, and the control interval as the period before and after the risk interval until 5 years after birth. Age-adjusted incidence ratio and attributable fraction were generated using the R software package SCCS.
Results:
We included 162 respiratory/circulatory deaths, of which 36 occurred in children with a history of laboratory-confirmed RSV infection. We found that the mortality risk decreased with time after the RSV episode and that the risk was statistically significant for the month after RSV illness. More than 90% of respiratory/circulatory deaths occurring within 1 week after the RSV episode were attributable to RSV (attributable fraction, 93.9%; 95% confidence interval, 77.6%-98.4%), compared with about 80% of those occurring 1 week to 1 month after RSV illness (80.3%; 28.5%-94.6%).
Conclusions:
We found an increased risk of death in the first month after an RSV illness episode leading to healthcare attendance. This provides a practical cutoff time window for community-based surveillance studies estimating RSV-related mortality risk. Further studies are warranted to assess the mortality risk beyond the first month after RSV illness episode.
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