. 2017 Oct;5(10):e984-e991.

doi: 10.1016/S2214-109X(17)30344-3.

Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series

Nienke M Scheltema¹, Angela Gentile², Florencia Lucion², D James Nokes³, Patrick K Munywoki⁴, Shabir A Madhi⁵, Michelle J Groome⁵, Cheryl Cohen⁶, Jocelyn Moyes⁷, Kentigern Thorburn⁸, Somsak Thamthitiwat⁹, Hitoshi Oshitani¹⁰, Socorro P Lupisan¹¹, Aubree Gordon¹², José F Sánchez¹³, Katherine L O'Brien¹⁴; PERCH Study Group; Bradford D Gessner¹⁵, Agustinus Sutanto¹⁶, Asuncion Mejias¹⁷, Octavio Ramilo¹⁷, Najwa Khuri-Bulos¹⁸, Natasha Halasa¹⁹, Fernanda de-Paris²⁰, Márcia Rosane Pires²¹, Michael C Spaeder²², Bosco A Paes²³, Eric A F Simões²⁴, Ting F Leung²⁵, Maria Tereza da Costa Oliveira²⁶, Carla Cecília de Freitas Lázaro Emediato²⁶, Quique Bassat²⁷, Warwick Butt²⁸, Hsin Chi²⁹, Uzma Bashir Aamir³⁰, Asad Ali³¹, Marilla G Lucero¹¹, Rodrigo A Fasce³², Olga Lopez³³, Barbara A Rath³⁴, Fernando P Polack³⁵, Jesse Papenburg³⁶, Srđan Roglić³⁷, Hisato Ito³⁸, Edward A Goka³⁹, Diederick E Grobbee⁴⁰, Harish Nair⁴¹, Louis J Bont⁴²

Affiliations

¹ Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.
² Department of Epidemiology, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina.
³ Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK.
⁴ Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Nursing Sciences, Pwani University, Kilifi, Kenya.
⁵ Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
⁶ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
⁷ Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
⁸ Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, UK.
⁹ Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
¹⁰ Department of Virology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan.
¹¹ Research Institute for Tropical Medicine, Alabang Muntinlupa City, Metro Manila Philippines.
¹² Department of Epidemiology, School of Public Health, University of Michigan, MI, USA.
¹³ Department of Medicine, Hospital Infantil Manuel de Jesus Rivera, Managua, Nicaragua.
¹⁴ International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁵ Agence de Medecine Preventive, Paris, France.
¹⁶ West Nusa Tenggara Provincial Government, Lombok, Indonesia.
¹⁷ Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus, OH, USA; Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
¹⁸ Department of Pediatrics, University of Jordan, Aljubeiha, Amman, Jordan.
¹⁹ Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Molecular Biology Laboratory, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil.
²¹ Infection Control Commission, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil.
²² Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA, USA.
²³ Neonatal Division, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
²⁴ Department of Pediatrics and Center for Global Health, University of Colorado, Aurora, CO, USA.
²⁵ Department of Paediatrics, Faculty of Medicine and Chinese University of Hong Kong-University Medical Center Utrecht Joint Research Laboratory of Respiratory Virus and Immunobiology, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China.
²⁶ Health Secretariat of the City of Belo Horizonte, Belo Horizonte, Brazil.
²⁷ ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain.
²⁸ Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia.
²⁹ Department of Pediatric Infectious Disease, MacKay Children's Hospital, Taipei, Taiwan.
³⁰ Department of Virology, National Institute of Health, Islamabad, Pakistan.
³¹ Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
³² Public Health Institute, Ñuñoa, Santiago, Chile.
³³ Hospital Dr. Ernesto Torres Galdames, Iquique, Chile.
³⁴ Vienna Vaccine Safety Initiative, Berlin, Germany; University of Nottingham School of Medicine, Nottingham, UK.
³⁵ Fundacion Infant, Buenos Aires, Argentina.
³⁶ Department of Microbiology, Division of Pediatric Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada.
³⁷ Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia.
³⁸ Department of Pediatrics, Nantan General Hospital, Ueno, Yagichoyagi, Nantan-shi, Kyoto, Japan.
³⁹ School of Health and Related Research, University of Sheffield, Sheffield, UK.
⁴⁰ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Julius Clinical Science, Zeist, Netherlands.
⁴¹ Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴² Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands; ReSViNET Respiratory Syncytial Virus Network, Utrecht, Netherlands. Electronic address: l.bont@umcutrecht.nl.

PMID: 28911764
PMCID: PMC5599304
DOI: 10.1016/S2214-109X(17)30344-3

Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series

Nienke M Scheltema et al. Lancet Glob Health. 2017 Oct.

. 2017 Oct;5(10):e984-e991.

doi: 10.1016/S2214-109X(17)30344-3.

Authors

Affiliations

¹ Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.
² Department of Epidemiology, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina.
³ Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK.
⁴ Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Nursing Sciences, Pwani University, Kilifi, Kenya.
⁵ Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
⁶ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
⁷ Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.
⁸ Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, UK.
⁹ Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
¹⁰ Department of Virology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan.
¹¹ Research Institute for Tropical Medicine, Alabang Muntinlupa City, Metro Manila Philippines.
¹² Department of Epidemiology, School of Public Health, University of Michigan, MI, USA.
¹³ Department of Medicine, Hospital Infantil Manuel de Jesus Rivera, Managua, Nicaragua.
¹⁴ International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁵ Agence de Medecine Preventive, Paris, France.
¹⁶ West Nusa Tenggara Provincial Government, Lombok, Indonesia.
¹⁷ Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus, OH, USA; Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
¹⁸ Department of Pediatrics, University of Jordan, Aljubeiha, Amman, Jordan.
¹⁹ Vanderbilt University Medical Center, Nashville, TN, USA.
²⁰ Molecular Biology Laboratory, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil.
²¹ Infection Control Commission, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil.
²² Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA, USA.
²³ Neonatal Division, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
²⁴ Department of Pediatrics and Center for Global Health, University of Colorado, Aurora, CO, USA.
²⁵ Department of Paediatrics, Faculty of Medicine and Chinese University of Hong Kong-University Medical Center Utrecht Joint Research Laboratory of Respiratory Virus and Immunobiology, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China.
²⁶ Health Secretariat of the City of Belo Horizonte, Belo Horizonte, Brazil.
²⁷ ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain.
²⁸ Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia.
²⁹ Department of Pediatric Infectious Disease, MacKay Children's Hospital, Taipei, Taiwan.
³⁰ Department of Virology, National Institute of Health, Islamabad, Pakistan.
³¹ Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
³² Public Health Institute, Ñuñoa, Santiago, Chile.
³³ Hospital Dr. Ernesto Torres Galdames, Iquique, Chile.
³⁴ Vienna Vaccine Safety Initiative, Berlin, Germany; University of Nottingham School of Medicine, Nottingham, UK.
³⁵ Fundacion Infant, Buenos Aires, Argentina.
³⁶ Department of Microbiology, Division of Pediatric Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada.
³⁷ Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia.
³⁸ Department of Pediatrics, Nantan General Hospital, Ueno, Yagichoyagi, Nantan-shi, Kyoto, Japan.
³⁹ School of Health and Related Research, University of Sheffield, Sheffield, UK.
⁴⁰ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Julius Clinical Science, Zeist, Netherlands.
⁴¹ Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴² Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands; ReSViNET Respiratory Syncytial Virus Network, Utrecht, Netherlands. Electronic address: l.bont@umcutrecht.nl.

PMID: 28911764
PMCID: PMC5599304
DOI: 10.1016/S2214-109X(17)30344-3

Erratum in

Correction to Lancet Glob Health 2017; 5: e984-91.
[No authors listed] [No authors listed] Lancet Glob Health. 2017 Dec;5(12):e1190. doi: 10.1016/S2214-109X(17)30382-0. Epub 2017 Oct 3. Lancet Glob Health. 2017. PMID: 28986050 Free PMC article. No abstract available.

Abstract

Background: Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data.

Methods: In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms "RSV", "respiratory syncytial virus", or "respiratory syncytial viral" combined with "mortality", "fatality", "death", "died", "deaths", or "CFR" for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables.

Findings: We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3-11·0) in low-income or lower middle-income countries, 4·0 years (2·0-10·0) in upper middle-income countries, and 7·0 years (3·6-16·8) in high-income countries.

Interpretation: This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries.

Funding: Bill & Melinda Gates Foundation.

PubMed Disclaimer

Figures

**Figure 1**
Study selection RSV=respiratory syncytial virus.

**Figure 2**
Locations of the respiratory syncytial virus-related deaths in young children included in the analysis Numbers of deaths are given for each country included.

**Figure 3**
Age distribution at the time of RSV-related death in children Low-income or lower middle-income countries (A), upper middle-income countries (B), and high-income countries (C). RSV=respiratory syncytial virus.

See this image and copyright information in PMC

Comment in

Respiratory syncytial virus mortality among young children.
Weinberg GA. Weinberg GA. Lancet Glob Health. 2017 Oct;5(10):e951-e952. doi: 10.1016/S2214-109X(17)30348-0. Lancet Glob Health. 2017. PMID: 28911753 No abstract available.

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1. Shi T, McAllister DA, O'Brien KL, for the RSV Global Epidemiology Network Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017 http://dx.doi.org/10.1016/S0140-6736(17)30938-8 published online July 6. - DOI - PMC - PubMed

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Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series

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Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series

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