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Respiratory Syncytial Virus Infection Among Hospitalized Infants in Four Middle-Income Countries
Holly M Biggs1, Eric A F Simões2,3, Ilham Abu Khader4
1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Respiratory syncytial virus (RSV) caused nearly one-third of infant hospitalizations for acute illness in four middle-income countries. Young age and low weight-for-age were key predictors of severe RSV illness in infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Understanding the global epidemiology of respiratory syncytial virus (RSV) is crucial for developing effective prevention strategies.
- RSV is a significant cause of acute respiratory illness in infants worldwide.
Purpose of the Study:
- To investigate the burden and risk factors for severe RSV-associated acute illness hospitalizations in infants across four middle-income countries.
- To identify infant characteristics associated with very severe RSV illness.
Main Methods:
- Prospective enrollment of hospitalized infants (<1 year) with acute illness in Albania, Jordan, Nicaragua, and the Philippines (2015-2017).
- Data collection included medical chart review, parental interviews, and post-discharge follow-up.
- Real-time RT-PCR was used to detect RSV in respiratory specimens; logistic regression analyzed factors associated with very severe illness.
Main Results:
- RSV was detected in 31% (1129/3634) of hospitalized infants. The median age of RSV-positive infants was 2.7 months, with 59% being male.
- Very severe illness (ICU admission or supplemental oxygen) occurred in 52% of RSV-positive infants, associated with younger age, low weight-for-age z-score, prior ICU care, and cesarean delivery.
- RSV subgroups A and B co-circulated; subgroup was not linked to severity. Nine (0.8%) RSV-positive infants died, predominantly those under 6 months.
Conclusions:
- RSV accounts for a substantial proportion of infant hospitalizations for acute illness in these middle-income countries.
- Younger age and low weight-for-age are significant predictors of severe RSV illness.
- Targeted RSV prevention strategies for young infants could significantly decrease hospitalizations in middle-income settings.
Background:
Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies.
Methods:
Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, and preterm birth).
Results:
Of 3634 enrolled hospitalized infants, 1129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4-6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; P < .01), low weight-for-age z-score (aOR 1.9, 95% CI: 1.2-2.8; P < .01), ICU care after birth (aOR 1.6, 95% CI: 1.0-2.5; P = .048), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; P = .03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old.
Conclusions:
RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.
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