Challenges to evaluating respiratory syncytial virus mortality in Bangladesh, 2004-2008

Abstract

Background: Acute lower respiratory illness is the most common cause of death among children, globally. Data are not available to make accurate estimates on the global mortality from respiratory syncytial virus (RSV), specifically.

Methods: Respiratory samples collected from children under 5 years of age during 2004 to 2008 as part of population-based respiratory disease surveillance in an urban community in Dhaka, Bangladesh were tested for RSV, human metapneumovirus (HMPV), human parainfluenza virus (PIV) types 1, 2, and 3, influenza and adenovirus by RT-PCR. Verbal autopsy data were used to identify children who died from respiratory illness in a nearby rural community. Significance of the correlation between detections and community respiratory deaths was determined using Spearman's coefficient.

Results: RSV activity occurred during defined periods lasting approximately three months but with no clear seasonal pattern. There was no significant correlation between respiratory deaths and detection of any of the respiratory viruses studied.

Conclusion: Outbreaks of respiratory viruses may not be associated with deaths in children in the study site; however, the few respiratory deaths observed and community-to-community variation in the timing of outbreaks may have obscured an association. An accurate assessment of respiratory virus-associated deaths will require detections and death data to come from the same location and a larger study population.

Figure 1. Nasopharyngeal wash samples collected and laboratory detections, by month, in children under 5 years with acute lower respiratory infection, Dhaka, 2004—2008.

Figure 2. Laboratory detections, by month and year, in children under 5 years with acute lower respiratory infection, Dhaka, 2004—2008.

Figure 3. Deaths from acute lower respiratory illness, Matlab, and RSV detections, Dhaka, among children under 5 years, 2004—2008.

Figure 4. Deaths from acute lower respiratory illness, Matlab, and RSV detections, Dhaka, among children under 5 years, by age group, April 2004–February 2008.