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Etiology of Acute Lower Respiratory Illness Hospitalizations Among Infants in 4 Countries
John Kubale1, Stephanie Kujawski2,3, Irena Chen4
1Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
Insights
Respiratory syncytial virus (RSV) caused the most acute lower respiratory infection hospitalizations in infants globally. Interventions targeting RSV could significantly reduce infant hospitalizations worldwide.
Area of Science:
- Pediatric infectious diseases
- Global health epidemiology
- Respiratory virology
Background:
- Pneumonia etiology in young children is increasingly understood.
- However, the causes of broader acute lower respiratory infections (ALRIs) in infants remain unclear globally.
Purpose of the Study:
- To assess the prevalence and severity of viral infections causing ALRI hospitalizations in infants.
- To estimate the proportion of ALRI hospitalizations attributable to 21 specific respiratory pathogens.
Main Methods:
- Multicountry study (Albania, Jordan, Nicaragua, Philippines) of hospitalized infants and controls (2015-2017).
- Multiplex real-time reverse transcription polymerase chain reaction (RT-PCR) used to identify 21 respiratory pathogens.
- Bayesian nested partially latent class models applied to estimate pathogen-specific proportions of ALRI hospitalizations.
Main Results:
- Respiratory syncytial virus (RSV) was the largest contributor to ALRI hospitalizations across study sites (ranging from 34.9% to 65.2%).
- RSV's contribution decreased with age but remained the primary driver.
- Rhinovirus/enterovirus and human metapneumovirus were the next most significant contributors.
Conclusions:
- RSV is a major cause of ALRI hospitalizations in infants, especially those under 3 months.
- Emerging vaccines and monoclonal antibodies targeting RSV show promise for reducing the global burden of infant ALRI.
Background:
Recent studies explored which pathogens drive the global burden of pneumonia hospitalizations among young children. However, the etiology of broader acute lower respiratory tract infections (ALRIs) remains unclear.
Methods:
Using a multicountry study (Albania, Jordan, Nicaragua, and the Philippines) of hospitalized infants and non-ill community controls between 2015 and 2017, we assessed the prevalence and severity of viral infections and coinfections. We also estimated the proportion of ALRI hospitalizations caused by 21 respiratory pathogens identified via multiplex real-time reverse transcription polymerase chain reaction with bayesian nested partially latent class models.
Results:
An overall 3632 hospitalized infants and 1068 non-ill community controls participated in the study and had specimens tested. Among hospitalized infants, 1743 (48.0%) met the ALRI case definition for the etiology analysis. After accounting for the prevalence in non-ill controls, respiratory syncytial virus (RSV) was responsible for the largest proportion of ALRI hospitalizations, although the magnitude varied across sites-ranging from 65.2% (95% credible interval, 46.3%-79.6%) in Albania to 34.9% (95% credible interval, 20.0%-49.0%) in the Philippines. While the fraction of ALRI hospitalizations caused by RSV decreased as age increased, it remained the greatest driver. After RSV, rhinovirus/enterovirus (range, 13.4%-27.1%) and human metapneumovirus (range, 6.3%-12.0%) were the next-highest contributors to ALRI hospitalizations.
Conclusions:
We observed substantial numbers of ALRI hospitalizations, with RSV as the largest source, particularly in infants aged <3 months. This underscores the potential for vaccines and long-lasting monoclonal antibodies on the horizon to reduce the burden of ALRI in infants worldwide.
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