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. 2023 Jul 31;12(7):394-405.
doi: 10.1093/jpids/piad042.

Respiratory Syncytial Virus Infection Among Hospitalized Infants in Four Middle-Income Countries

Holly M Biggs  1 , Eric A F Simões  2   3 , Ilham Abu Khader  4 , Mark G Thompson  5 , Aubree Gordon  6 , Danielle R Hunt  7 , Nicholas P DeGroote  1 , Rachael M Porter  5 , Silvia Bino  7 , Basima I Marar  8 , Lionel Gresh  9 , Joanne de Jesus-Cornejo  10 , Gayle Langley  1 , Natalie J Thornburg  1 , Teresa C T Peret  1 , Brett Whitaker  1 , Yange Zhang  1 , Lijuan Wang  1 , Mira C Patel  5 , Meredith McMorrow  1 , William Campbell  7 , Iris Hasibra  7 , Enkeleda Duka  11 , Mahmoud Al-Gazo  4 , John Kubale  12 , Felix Sanchez  13 , Marilla G Lucero  10 , Veronica L Tallo  10 , Eduardo Azziz-Baumgartner  5 , Artan Simaku  7 , Susan I Gerber  1 ; IRIS Network
Collaborators, Affiliations

Respiratory Syncytial Virus Infection Among Hospitalized Infants in Four Middle-Income Countries

Holly M Biggs et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Understanding respiratory syncytial virus (RSV) global epidemiology is important to inform future prevention strategies.

Methods: Hospitalized infants <1-year-old with acute illness were enrolled prospectively in Albania, Jordan, Nicaragua, and Philippines during respiratory seasons in 2015-2017. Medical chart review, parental interview, and post-discharge follow up were conducted. Respiratory specimens were tested using real-time RT-PCR for RSV. Infant characteristics associated with very severe illness (intensive care unit [ICU] admission or receipt of supplemental oxygen) were assessed using logistic regression to adjust for potential confounders (age, sex, study site, and preterm birth).

Results: Of 3634 enrolled hospitalized infants, 1129 (31%) tested positive for RSV. The median age of RSV-positive infants was 2.7 (IQR: 1.4-6.1) months and 665 (59%) were male. Very severe illness in 583 (52%) RSV-positive infants was associated with younger age (aOR 4.1, 95% CI: 2.6-6.5 for 0-2 compared to 9-11-months; P < .01), low weight-for-age z-score (aOR 1.9, 95% CI: 1.2-2.8; P < .01), ICU care after birth (aOR 1.6, 95% CI: 1.0-2.5; P = .048), and cesarean delivery (aOR 1.4, 95% CI: 1.0-1.8; P = .03). RSV subgroups A and B co-circulated at all sites with alternating predominance by year; subgroup was not associated with severity (aOR 1.0, 95% CI: 0.8-1.4). Nine (0.8%) RSV-positive infants died during admission or within ≤30 days of discharge, of which 7 (78%) were <6-months-old.

Conclusions: RSV was associated with nearly a third of infant acute illness hospitalizations in four middle-income countries during the respiratory season, where, in addition to young age, factors including low weight-for-age might be important predictors of severity. RSV prevention strategies targeting young infants could substantially reduce RSV-associated hospitalizations in middle-income countries.

Keywords: Albania; Jordan; Nicaragua; Pediatric; Philippines; Respiratory syncytial virus; bronchiolitis; global health; infant; pneumonia.

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Conflict of interest statement

Potential conflicts of interest. Aubree Gordon serves on a scientific advisory board for Janssen. Eric A.F. Simões reports grants and consulting fees to the institution from Merck & Co. and Pfizer Inc; grants to the institution from Astra Zeneca Inc. Roche Pharmaceuticals and Johnson and Johnson; and consulting fees to the institution from Sanofi Pasteur, Cidara Therapeutics, Adiago Therapeutics and Nuance Pharmaceuticals; manuscript writing support from Pfizer Inc. and Astra Zeneca Inc; support for attending a meeting Astra Zeneca Inc., and participation on a DSMB from Abbvie Inc, GlaxoSmithKline plc, and Bill and Melinda Gates Foundation. None of these are directly related to this manuscript. All other authors report no potential conflicts. Affiliation changes after completion of the work.

Figures

Figure 1.
Figure 1.
Respiratory syncytial virus (RSV) subgroups, weekly number and overall percent positive by site and year, hospitalized infants, Albania (A), Jordan (B), Nicaragua (C), Philippines (D). Enrollment dates by site: Albania, Year 1: 12/1/2015–5/2/2016, Year 2: 11/2/2016–4/15/2017; Jordan, Year 1: 12/27/2015–5/2/2016, Year 2: 11/13/2016–4/20/2017; Nicaragua, Year 1: 6/26/2015–1/29/2016, Year 2: 5/23/2016–3/3/2017); Philippines, 10/1/2015–12/28/2016.
Figure 2.
Figure 2.
Percent of respiratory syncytial virus (RSV)-positive infants with very severe illness, by age category and site.
See this image and copyright information in PMC

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