Estimates of the national burden of respiratory syncytial virus in Kenyan children aged under 5 years, 2010-2018

Abstract

Background: Respiratory syncytial virus (RSV) is among the leading childhood causes of viral pneumonia worldwide. Establishing RSV-associated morbidity and mortality is important in informing the development, delivery strategies, and evaluation of interventions.

Methods: Using data collected during 2010-2018 from base regions (population-based surveillance studies in western Kenya and the Kilifi Health and Demographic Surveillance Study), we estimated age-specific rates of acute respiratory illness (ARI), severe acute respiratory illness (SARI-defined as hospitalization with cough or difficulty breathing with onset within the past 10 days), and SARI-associated deaths. We extrapolated the rates from the base regions to other regions of Kenya, while adjusting for risk factors of ARI and healthcare seeking behavior, and finally applied the proportions of RSV-positive cases identified from various sentinel and study facilities to the rates to obtain regional age-specific rates of RSV-associated outpatient and non-medically attended ARI and hospitalized SARI and severe ARI that was not hospitalized (non-hospitalized SARI). We applied age-specific RSV case fatality ratios to SARI to obtain estimates of RSV-associated in- and out-of-hospital deaths.

Results: Among Kenyan children aged < 5 years, the estimated annual incidence of outpatient and non-medically attended RSV-associated ARI was 206 (95% credible interval, CI; 186-229) and 226 (95% CI; 204-252) per 1000 children, respectively. The estimated annual rates of hospitalized and non-hospitalized RSV-associated SARI were 349 (95% CI; 303-404) and 1077 (95% CI; 934-1247) per 100,000 children respectively. The estimated annual number of in- and out-of-hospital deaths associated with RSV infection in Kenya were 539 (95% CI; 420-779) and 1921 (95% CI; 1495-2774), respectively. Children aged < 6 months had the highest burden of RSV-associated severe disease: 2075 (95% CI; 1818-2394) and 44 (95% CI 25-71) cases per 100,000 children for hospitalized SARI and in-hospital deaths, respectively.

Conclusions: Our findings suggest a substantial disease burden due to RSV infection, particularly among younger children. Prioritizing development and use of maternal vaccines and affordable long-lasting monoclonal antibodies could help reduce this burden.

Keywords: Burden; Epidemiology; National estimates; Pneumonia; Respiratory syncytial virus.

Fig. 1

Map showing the regions and RSV surveillance sites (Left) and county outlines (right): 1—Mombasa, 2—Kwale, 3—Kilifi, 4—Tana River, 5—Lamu, 6—Taita Taveta, 7—Garissa, 8—Wajir, 9—Mandera, 10—Marsabit, 11—Isiolo, 12—Meru, 13—Tharaka Nithi, 14—Embu, 15—Kitui, 16—Machakos, 17—Makueni, 18—Nyandarua, 19—Nyeri, 20—Kirinyaga, 21—Murang’s, 22—Kiambu, 23—Turkana, 24—West Pokot, 25—Samburu, 26—Trans Nzoia, 27—Uasin Gishu, 28—Elgeyo Marakwet, 29—Nandi, 30—Baringo, 31—Laikipia, 32—Nakuru, 33—Narok, 34—Kajiado, 35—Kericho, 36—Bomet, 37—Kakamega,38—Vihiga,39—Bungoma, 40—Busia, 41—Siaya, 42—Kisumu, 43—Homabay, 44—Migori, 45—Kisii, 46—Nyamira, 47—Nairobi

Fig. 2

Flow chart outlining steps followed in estimating the burden of RSV-associated disease and deaths

Fig. 3

Annual rate (per 1000) of RSV-associated outpatient ARI by region, age and year

Fig. 4

Annual rate (per 100,000) of RSV-associated hospitalized SARI by region, age, and year