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. 2016 Aug;73(2):145-54.
doi: 10.1016/j.jinf.2016.05.007. Epub 2016 May 27.

Respiratory syncytial virus infection in infants in rural Nepal

Helen Y Chu  1 , Joanne Katz  2 , James Tielsch  3 , Subarna K Khatry  4 , Laxman Shrestha  5 , Steven C LeClerq  4 , Amalia Magaret  6 , Jane Kuypers  6 , Mark Steinhoff  7 , Janet A Englund  8
Affiliations

Respiratory syncytial virus infection in infants in rural Nepal

Helen Y Chu et al. J Infect. 2016 Aug.

Abstract

Objectives: Respiratory syncytial virus (RSV) pneumonia is a leading cause of infant mortality worldwide. The risk of RSV infection associated with preterm birth is not well-characterized in resource-limited settings. We aimed to obtain precise estimates of risk factors and disease burden of RSV in infants in rural southern Nepal.

Methods: Pregnant women were enrolled, and along with their infants, followed to six months after birth with active weekly home-based surveillance for acute respiratory illness (ARI). Mid-nasal swabs were obtained and tested for RSV by PCR for all illness episodes. Birth outcomes were assessed at a postpartum home visit.

Results: 311 (9%) of 3509 infants had an RSV ARI. RSV ARI incidence decreased from 551/1000 person-years in infants born between 28 and 31 weeks to 195/1000 person-years in infants born full-term (p = 0.017). Of 220 infants (71%) evaluated in the health system, 41 (19%) visited a hospital or physician. Of 287 infants with an assessment performed, 203 (71%) had a lower respiratory tract infection.

Conclusions: In a rural south Asian setting with intensive home-based surveillance, RSV caused a significant burden of respiratory illness. Preterm infants had the highest incidence of RSV ARI, and should be considered a priority group for RSV preventive interventions in resource-limited settings.

Keywords: Pneumonia; Preterm birth; Resource-limited setting; Respiratory syncytial virus.

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Figures

Figure 1
Figure 1
Flow diagram showing infants followed in the study from birth until 180 days of age.
Figure 2
Figure 2
A. Seasonality of RSV over three seasons, from 2011 to 2014, in rural southern Nepal using active-home based surveillance. Overall incidence was 213/1000 person-years, while the incidence during RSV epidemic periods was 443/1000 person-years (by year, 2011–2012: 439/1000; 2012–2013: 407/1000; 2013–2014: 518/1000). B. Incidence based graph of RSV by age in months. The incidence of RSV ARI by age was lowest in the first month of life (107/1000 person-years) and higher in each of months two through five (246, 222, 256, and 220/1000 person-years, p < 0.001 for each), but not higher in month six (160/1000 person-years, p = 0.12). C. Incidence based graph of RSV by gestational age (very preterm: 28–31, preterm: 32–34, late-preterm: 35–36, term: >37). By gestational age, the incidence of RSV decreased from 551/1000 person-years in infants born between 28 and 31 weeks to 195/1000 person-years in infants born at 37 weeks or later (Fig. 2C, p = 0.017).
Figure 3
Figure 3
Relationship between disease severity and health-care seeking among infants with RSV infection. Infants with LRTI were no more likely to seek a higher level of care for their illness than those with an URTI (p value for trend = 0.85).
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