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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Health-care burden related to respiratory syncytial virus in a resource-constrained setting: a prospective
Senjuti Saha1, Sudipta Saha2, Naito Kanon1
1Child Health Research Foundation, Dhaka, Bangladesh.
Insights
Respiratory syncytial virus (RSV) significantly burdens healthcare in Bangladesh, increasing child mortality risks. Preventive interventions like maternal vaccines could reduce hospital denials and save lives, improving child health.
Area of Science:
- Pediatric Infectious Diseases
- Public Health
- Epidemiology
Background:
- Respiratory syncytial virus (RSV) is a major cause of pediatric hospitalizations globally.
- Limited data exists on RSV burden in resource-limited settings, hindering policy.
- This study assessed RSV's health system impact in Bangladesh.
Purpose of the Study:
- To quantify the burden of RSV on hospital admissions and resource utilization in Bangladesh.
- To evaluate the impact of RSV on mortality among admitted and denied-admission children.
- To model the potential effect of preventive interventions on RSV-related healthcare strain.
Main Methods:
- Prospective surveillance of children aged 0-59 months with respiratory infections at Bangladesh's largest pediatric hospital (2019).
- Analysis of RSV-positive cases, hospital stay duration, and mortality.
- Survival analysis comparing outcomes of denied vs. admitted children.
- Queueing model simulations for vaccine impact assessment.
Main Results:
- RSV was detected in 20.5% of 7191 children with respiratory infections; 1.9% of RSV-positive children died.
- RSV patients occupied 5.5% of total bed days.
- Children denied admission had a 1.56 times higher hazard of death (highest for neonates).
- Vaccines could reduce denials by 677-1289 and potentially prevent 32-469 deaths.
Conclusions:
- RSV significantly strains healthcare in Bangladesh, elevating child mortality risks.
- Preventive strategies, such as RSV prefusion F maternal vaccine or nirsevimab, show potential to reduce healthcare burden.
- Interventions can enhance healthcare capacity and improve child survival in resource-limited settings.
Background:
Respiratory syncytial virus (RSV) is a leading cause of paediatric hospital admissions worldwide, straining health systems. A lack of data on the burden of RSV infections and the impact on health systems in resource-limited settings hinders evidence-based policy decisions. Here, we aimed to assess RSV's burden on the health system in Bangladesh.
Methods:
From January to December, 2019, we conducted a prospective study at Bangladesh's largest paediatric hospital among children aged 0-59 months admitted with a possible respiratory infection, as guided by the WHO RSV hospital-based surveillance case definition. Outcomes for RSV-positive children younger than 5 years were analysed. We also followed up outcomes of children denied hospitalisation due to bed shortages. Adjusted hazard ratios for children denied admission versus admitted were estimated using survival analysis. Monte Carlo simulations with a queueing model were used to estimate the effects of RSV prefusion F maternal vaccine or nirsevimab on admission denials and mortality.
Findings:
Of 40 664 children admitted, 31 692 were younger than 5 years; 19 940 were in study wards. Among 7191 admitted with possible respiratory infections, 6149 (85·5%) had nasopharyngeal swabs taken, with 1261 (20·5%) testing RSV-positive. The median age of children who tested positive for RSV was 3·0 months (IQR 1·0-8·0), with a median hospital stay of 5 days (IQR 4-8); 24 (1·9%) of 1261 died in hospital. 8274 (5·5%) of 151 110 bed days were for children who were positive for RSV. Additionally, of 9169 children denied admission, outcomes were tracked for 3928 and compared with 2845 admitted. The hazard ratio for death was 1·56 (95% CI 1·34 to 1·81) for children denied versus admitted, being highest for neonates at 2·27 (1·87 to 2·75). RSV prefusion F maternal vaccine or nirsevimab could have reduced denials by 677 (95% prediction interval 63 to 1347) and 1289 (684 to 1865), respectively, potentially preventing 130 (-60 to 322) and 258 (32 to 469) deaths.
Interpretation:
RSV strains health care in Bangladesh, increasing mortality risks. Preventive interventions could lessen its impact, boosting health-care capacity and child health in resource-limited settings.
Funding:
The Bill & Melinda Gates Foundation.
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