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Published on: December 10, 2013
Mortality From Respiratory Syncytial Virus in Children Under 2 Years of Age: A Prospective Community Cohort Study in
Eric A F Simões1,2, Vibhawari Dani3, Varsha Potdar4
1Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado Aurora, Colorado, USA.
Insights
Respiratory syncytial virus (RSV) causes many infant deaths, particularly in communities with limited healthcare access. This study highlights that most RSV lower respiratory tract infection (LRTI) deaths occur outside hospitals, emphasizing the need for targeted prevention strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a primary cause of infant mortality from lower respiratory tract infections (LRTIs).
- Limited data exist on infant deaths attributed to RSV within community settings.
Purpose of the Study:
- To investigate the burden and mortality associated with RSV-associated LRTIs in infants.
- To determine the proportion of RSV LRTI deaths occurring in community versus hospital settings.
Main Methods:
- Active surveillance was conducted in children under 2 years across 93 villages, 5 primary health centers, and 3 hospitals.
- Nasopharyngeal swabs were collected for RSV detection in severe/very severe LRTIs and all deaths.
- Case fatality ratios and mortality rates were calculated for RSV LRTI cases.
Main Results:
- RSV was detected in a significant proportion of severe and very severe LRTIs, with a high fatality rate (94%) among confirmed cases.
- The majority of RSV LRTI deaths (14 out of 15) occurred in the community, not in hospitals.
- Adjusted RSV LRTI mortality rates were substantial, contributing significantly to overall infant LRTI deaths and postneonatal mortality.
Conclusions:
- Community deaths significantly outweigh hospital deaths from RSV-associated LRTIs.
- Prevention strategies for RSV should prioritize populations with restricted access to healthcare.
- Understanding community-based mortality is crucial for effective RSV control in infants.
Background:
Although respiratory syncytial virus (RSV) is the most important viral cause of lower respiratory tract infection deaths in infants, there are few data on infant community deaths caused by RSV.
Methods:
This was an active surveillance of children younger than 2 years of age in 93 villages, 5 primary health centers, and 3 hospitals serving these villages. Village health workers and counselors at the health facilities monitored all lower respiratory tract infections (LRTIs) in consented subjects. Children with severe, or very severe LRTIs and all who died, had nasopharyngeal swabs collected for detection of RSV by molecular methods.
Results:
In the 12 134 subjects, there were 2064 episodes of severe LRTIs and 1732 of very severe LRTIs, of which 271 and 195, respectively, had RSV. Fifteen of 16 (94%) children with RSV died of LRTIs, 14 in the community and 1 in the hospital. The case fatality ratios for severe RSV LRTIs in the first 6 months of life were 3/52 (7.1%) and 1/36 (2.8%) in the community and hospital, respectively. Of those with very severe LRTIs in the community, 17.6% died. There were no very severe RSV LRTI hospital deaths. The adjusted RSV LRTI mortality rates ranged from 1.0 to 3.0/1000 child-years (CY) overall, and 2.0 to 6.1/1000 CY, accounting for 20% of the LRTI deaths and 10% of the postneonatal infant mortality.
Conclusions:
Community deaths from RSV account for the majority of RSV LRTI deaths, and efforts at prevention should be preferentially directed at populations where access to care is limited.
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