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Updated: Jun 20, 2025
An Improved and High Throughput Respiratory Syncytial Virus RSV Micro-neutralization Assay
Published on: January 26, 2019
Respiratory syncytial virus-associated pneumonia in primary care in Malawi
Kimberly Davy1, Elena Koskinas1, Chris Watson2
1School of Medicine, University of Limerick, Limerick V94 T9PX, Ireland.
Insights
Respiratory syncytial virus (RSV) caused 41.6% of pneumonia cases in Malawian children under five. Risk factors included age, birth term, and living conditions, highlighting the need for preventative strategies like vaccines.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Community-acquired pneumonia (CAP) is a leading cause of mortality in children under five globally.
- Respiratory syncytial virus (RSV) is a significant pathogen contributing to pediatric CAP, particularly in low-resource settings.
- Understanding RSV prevalence and associated risk factors in primary care is crucial for effective intervention.
Purpose of the Study:
- To determine the prevalence of RSV in children under five with World Health Organization (WHO)-defined pneumonia in Northern Malawi.
- To identify factors associated with severe RSV-associated CAP in primary care.
Main Methods:
- Prospective cohort study (BIOmarkers TO diagnose PnEumonia - BIOTOPE) conducted in a primary care center in Northern Malawi (March-June 2016).
- Included 494 infants presenting with WHO-defined CAP.
- Univariate logistic regression analysis to identify predictor variables for RSV CAP.
Main Results:
- RSV infection was detected in 205 (41.6%) of the 494 eligible infants.
- Eight factors were associated with increased risk for RSV CAP: age, term birth, June presentation, crowded living, not exclusively breastfed, and lack of zinc/vitamin A supplementation.
- Infants with RSV CAP had lower oxygen saturation (≤92%) and were more likely to have severe pneumonia.
Conclusions:
- RSV-associated CAP in young children is linked to both modifiable and non-modifiable risk factors.
- Further research is needed to identify impactful interventions, potentially including infant or maternal vaccines.
- Understanding seasonal patterns and host/environmental factors is essential for preventing RSV-associated CAP and mortality in developing nations.
Objective:
To identify the prevalence of respiratory syncytial virus (RSV) in a cohort of children under 5 years of age with World Health Organization (WHO)-defined pneumonia and the factors associated with developing severe RSV-associated community-acquired pneumonia (CAP) in primary care in a single centre in Northern Malawi.
Methods:
The BIOmarkers TO diagnose PnEumonia (BIOTOPE) study was a prospective cohort study conducted from March to June 2016 that took place in a primary care centre in Northern Malawi. Data from this study was used to identify the characteristics of children under 5 years of age who presented with RSV and WHO-defined CAP. Means, standard deviations, medians and ranges were calculated for continuous variables. A univariate logistic regression was performed to examine the potential predictor variables.
Results:
Four hundred and ninety-four infants presented with CAP and were eligible for inclusion in the study; RSV infection was detected in 205 (41.6%) of the infants. Eight factors were associated with increased risk for RSV CAP in the univariate model: age, born at term, presenting for care in June, crowded living environment, not being exclusively breastfed, not having received zinc or vitamin A supplementation in the last six months. Infants with RSV were more likely to have an oxygen saturation ≤92% compared to infants with other causes of pneumonia and more likely to have severe pneumonia as defined by the WHO.
Conclusion:
This study supports that RSV-associated CAP is linked to modifiable and non-modifiable risk factors; further research is indicated to determine which interventions would be most impactful. Developing and implementing an infant or maternal vaccine could be a cost-effective way to prevent RSV-associated CAP and mortality in developing nations. More research is needed to understand seasonal patterns of CAP and research over extended periods can offer valuable insights on host, environmental and pathogen-specific factors that contribute to RSV-associated CAP.
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