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. 2023 Jan 1;42(1):1-7.
doi: 10.1097/INF.0000000000003747. Epub 2022 Nov 8.

Nosocomial RSV-related In-hospital Mortality in Children <5 Years: A Global Case Series

Yvette N Löwensteyn  1 , Joukje E Willemsen  1 , Natalie I Mazur  1 , Nienke M Scheltema  1 , Nynke C J van Haastregt  1 , Amber A A Ten Buuren  1 , Ichelle van Roessel  1 , Dunja Scheepmaker  1 , Harish Nair  2   3 , Peter M van de Ven  4 , Louis J Bont  1   3 ; on behalf of the RSV GOLD Study Group
Collaborators, Affiliations

Nosocomial RSV-related In-hospital Mortality in Children <5 Years: A Global Case Series

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

Abstract

Background: According to the World Health Organization, the global burden of nosocomial infections is poorly characterized as surveillance systems are lacking. Nosocomial infections occur at higher rates in low- and lower-middle-income countries (LMICs) than in high-income countries (HICs). Current global RSV burden estimates are largely based on community-acquired infection. We aimed to characterize children with nosocomial RSV-related mortality and to understand the potential impact of RSV immunization strategies.

Materials: RSV GOLD is a global registry of children younger than 5 years who died with laboratory-confirmed RSV infection. We compared clinical and demographic characteristics of children with nosocomial and community-acquired RSV in-hospital mortality.

Results: We included 231 nosocomial and 931 community-acquired RSV-related in-hospital from deaths from 65 countries. Age at death was similar for both groups (5.4 vs. 6 months). A higher proportion of nosocomial deaths had comorbidities (87% vs. 57%; P < 0.001) or was born preterm (46% vs. 24%; P < 0.001) than community-acquired deaths. The proportion of nosocomial deaths among all RSV deaths was lower in LMICs than in upper-middle-income countries (UMICs) and HICs (12% vs. 18% and 26%, respectively).

Conclusions: This is the first global case series of children dying with nosocomial RSV infection. Future infant-targeted immunization strategies could prevent the majority of nosocomial RSV-related deaths. Although nosocomial RSV deaths are expected to occur at highest rates in LMICs, the number of reported nosocomial RSV deaths was low in these countries. Hospital-based surveillance is needed to capture the full burden of nosocomial RSV mortality in LMICs.

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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. 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 IMI-funded RESCEU project from GSK, Novavax, Janssen, AstraZeneca, Pfizer and Sanofi. UMCU has received major funding by Julius Clinical for participating in the INFORM study sponsored by MedImmune. UMCU has received minor funding for participation in trials by Regeneron and Janssen from 2015-2017 (total annual estimate less than €20,000). UMCU received minor funding for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, Novavax, Pfizer, Janssen (total annual estimate less than €20,000). L.J.B. is the founding chairman of the ReSViNET Foundation. H.N. has received grants from Innovative medicines initiative and Pfizer. He has received honorarium from Abbvie, Sanofi, ReViral, Janssen and Novavax. For the remaining authors none were declared.

Figures

FIGURE 1.
FIGURE 1.
Flowchart of included nosocomial RSV deaths.
FIGURE 2.
FIGURE 2.
Location of death for children younger than 5 yrs with nosocomial RSV-related mortality included in the analysis.
FIGURE 3.
FIGURE 3.
Age distribution at time of RSV-related nosocomial in-hospital death for children younger than 5 yrs from LMIC, UMIC and HIC. HIC indicates high-income countries; LMIC, low- and middle-income countries; UMIC, upper-middle-income countries.
See this image and copyright information in PMC

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