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. 2020 Aug;39(8):665-670.
doi: 10.1097/INF.0000000000002666.

Respiratory Syncytial Virus-related Death in Children With Down Syndrome: The RSV GOLD Study

Yvette N Löwensteyn  1 , Emily W E M Phijffer  1 , Juliette V L Simons  1 , Nienke M Scheltema  1 , Natalie I Mazur  1 , Harish Nair  2   3 , Louis J Bont  1   3 ; RSV GOLD Study Group
Affiliations

Respiratory Syncytial Virus-related Death in Children With Down Syndrome: The RSV GOLD Study

Yvette N Löwensteyn et al. Pediatr Infect Dis J. 2020 Aug.

Abstract

Background: Respiratory syncytial virus (RSV) is a major cause of mortality in children younger than 5 years worldwide. Systematic reviews have shown that Down syndrome (DS) is an independent risk factor for severe RSV infection. We aimed to describe demographic and clinical characteristics of children with DS who died with RSV infection.

Methods: We performed a retrospective case series in which data were shared by individual researchers, research networks and physicians worldwide as part of the RSV Global Online Database study. We included children with DS who died when younger than 5 years of age with laboratory-confirmed RSV infection.

Results: We included 53 children with DS and RSV-related mortality from 20 countries in 5 continents. Five (9.4%) children were from low-income or lower-middle-income countries. Median age at time of death was 6.0 months [interquartile range (IQR): 3.00-12.0]. Thirteen (24.5%) children were born term and had no other risk factors for severe RSV disease. In total, 36 (67.9%) children had congenital heart disease, 8 (15.1%) had chronic lung disease and 1 (1.9%) had congenital immunodeficiency. Duration of hospitalization was significantly longer for children with DS compared with children without DS [median length of stay, 13 days (IQR: 6.8-21.0) vs. 8 days (IQR: 3.0-18.5), P=0.005].

Conclusions: One-fourth of children with DS and RSV-confirmed death did not have risk factors for severe RSV disease, indicating that DS is an important risk factor for RSV-related mortality. Age distribution at time of death demonstrates that maternal vaccination would not be sufficient to protect children with DS against RSV-related mortality.

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Conflict of interest statement

L.J.B. has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. University Medical Centre Utrecht (UMCU) has received major funding (>€100,000 per industrial partner) for investigator initiated studies from AbbVie, MedImmune, Janssen, the Bill and Melinda Gates Foundation, Nutricia (Danone) and MeMed Diagnostics. UMCU has received major cash or in kind funding as part of the public private partnership Innovative Medicines Initiative-funded REspiratory Syncytial virus Consortium in EUrope project from GSK, Novavax, Janssen, AstraZeneca, Pfizer and Sanofi. UMCU has received major funding by Julius Clinical for participating in the International Network For Optimal Resistance Monitoring of RSV study sponsored by MedImmune. UMCU has received minor funding for participation in trials by Regeneron and Janssen from 2015 to 2017 (total annual estimate <€20,000). UMCU received minor funding for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, Novavax, Pfizer and Janssen (total annual estimate <€20,000). L.J.B. is the founding chairman of the ReSViNET Foundation. D.E.N. has participated as a member of the speakers’ bureau of AbbVie and speakers’ bureau and advisory board for Sanofi Pasteur. This study was supported by the Bill & Melinda Gates Foundation (grant OPP1148988). Data shared by D.J.N. and colleagues have been collected in studies from Kilifi, Kenya, that received Wellcome Trust funding (102975; 203077). The other authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Inclusion of children with Down syndrome from the RSV GOLD I and II registry.
FIGURE 2.
FIGURE 2.
Distribution of gestational age (GA) (N = 34*) and age in weeks at time of RSV-related death for children with Down syndrome <12 months (N = 38). *Four cases were excluded because they were born prematurely with unknown GA.
FIGURE 3.
FIGURE 3.
Distribution of age in weeks at time of RSV-related death for children with Down syndrome with (N = 28) and without (N = 10) additional risk factors for severe RSV disease <12 months.
See this image and copyright information in PMC

References

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