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. 2023 Dec 1;10(12):ofad553.
doi: 10.1093/ofid/ofad553. eCollection 2023 Dec.

Incidence of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic

Samantha Fry  1 , Kulkanya Chokephaibulkit  2 , Sridevi Pallem  3 , Ouzama Henry  4 , Yongjia Pu  4 , Agnes Akawung  3 , Joon Hyung Kim  4 , Emad Yanni  4 , Antonella Nadia Tullio  4 , Linda Aurpibul  5 , Christine Mui Fong Lee  6 , Ana Ceballos  7 , Khalequ Zaman  8 , Ivonne Abadía de Regalado  9 , Khatija Ahmed  10   11 , Diana Andrea Arias Fernandez  12 , Sri Wahyu Taher  13 , Juliana Caccavo  14 , Conrado Milani Coutinho  15 , Ulises D'Andrea Nores  7 , Tirza De León  16 , Emily Christine D'Silva  17 , Mara De Bernardi  14 , Pablo Dieser  7 , Andrea Falaschi  18   19 , Clara Del Carmen Flores Acosta  20 , Angela Gentile  21 , Ik Hui Teo  22 , Sheena Kotze  23 , Eduardo López-Medina  24   25 , Ruben Luca  26 , Maria Florencia Lucion  21 , Jacinto Blas Iii V Mantaring  27 , Bladimir Marín  12 , Malahleha Moelo  10 , Marisa Márcia Mussi-Pinhata  28 , Jorge Pinto  29 , Thanyawee Puthanakit  30 , Osvaldo Reyes  31   32   33 , Maria Fernanda Roa  34 , María Teresa Rodriguez Brieschke  14 , Camilo Enrique Rodriguez  35   36 , Juan Nicolas Rodriguez Niño  35 , Alexandre Vargas Schwarzbold  37 , Alexandra Sierra Garcia  24   25 , Lavitha Sivapatham  38 , Ruey Soon  39 , Juan Carlos Tinoco  40 , Jesús Arnulfo Velásquez Penagos  41 , Gaël Dos Santos  42
Affiliations

Incidence of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic

Samantha Fry et al. Open Forum Infect Dis. .

Abstract

Background: Incidence data of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRTI) are sparse in low- and middle-income countries (LMICs). We estimated RSV-LRTI incidence rates (IRs) in infants in LMICs using World Health Organization case definitions.

Methods: This prospective cohort study, conducted in 10 LMICs from May 2019 to October 2021 (largely overlapping with the coronavirus disease 2019 [COVID-19] pandemic), followed infants born to women with low-risk pregnancies for 1 year from birth using active and passive surveillance to detect potential LRTIs, and quantitative reverse-transcription polymerase chain reaction on nasal swabs to detect RSV.

Results: Among 2094 infants, 32 (1.5%) experienced an RSV-LRTI (8 during their first 6 months of life, 24 thereafter). Seventeen (0.8%) infants had severe RSV-LRTI and 168 (8.0%) had all-cause LRTI. IRs (95% confidence intervals [CIs]) of first RSV-LRTI episode were 1.0 (.3-2.3), 0.8 (.3-1.5), and 1.6 (1.1-2.2) per 100 person-years for infants aged 0-2, 0-5, and 0-11 months, respectively. IRs (95% CIs) of the first all-cause LRTI episode were 10.7 (8.1-14.0), 11.7 (9.6-14.0), and 8.7 (7.5-10.2) per 100 person-years, respectively. IRs varied by country (RSV-LRTI: 0.0-8.3, all-cause LRTI: 0.0-49.6 per 100 person-years for 0- to 11-month-olds).

Conclusions: RSV-LRTI IRs in infants in this study were relatively low, likely due to reduced viral circulation caused by COVID-19-related nonpharmaceutical interventions.

Clinical trials registration: NCT03614676.

Keywords: epidemiology; incidence; infants; lower respiratory tract illness; respiratory syncytial virus.

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Conflict of interest statement

Potential conflicts of interest. J. H. K., A. N. T., E. Y., O. H., Y. P., and G. D. S. were employees of GSK when the study was designed, initiated, or conducted. J. H. K., A. N. T., E. Y., O. H., and G. D. S. declare they hold or held shares in GSK as part of their remuneration. A. A. and S. P. work for Keyrus Life Science on behalf of GSK. C. d. C. F. A. received payment from GSK for participation in the study, patient consultations, and ultrasounds. E. L. M. declares research grants from GSK, SP, Janssen, MSD, and the World Health Organization. T. P. received research grants from GSK through her institution. C. M. F. L. received consulting fees and payment for travel expenses for an investigator meeting from GSK and reports payment by GSK to Clinical Research Malaysia. A. V. S. declares research grant from GSK and grants or contracts from MSD, AstraZeneca, Esperion, Clover Biopharm, and F2G. L. S. declares payments from GSK to her institution as a research site for this study. R. S. reports study management and funding as principal investigator from GSK. J. B. V. M. declares payment received for a speaker's bureau for Wyeth Nutrition and participation as Chair of institutional review board, Chair of the Department of Health Single Joint Ethics review board, Chair of the Philippine Health Research Ethics Network, and member of the Philippine Health Technology Assessment Council. M. M. M. P. declares payment from GSK to her institution as a research site for this study. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Study design and lower respiratory tract illness (LRTI) surveillance decision tree. aFor active contacts, site staff contacted the parents approximately every week during the respiratory syncytial virus (RSV) season and every month during interseason periods in countries with seasonal RSV transmission, and approximately every 2 weeks in countries with year-round RSV transmission. RSV seasonality by country is shown in Figure 2, and information on how seasons were determined is included in the Supplementary Materials. bFor passive contacts (which occurred throughout the year independently of RSV seasonality), parents contacted the site staff whenever the infant developed (new) symptoms of a respiratory tract illness (RTI), difficulty breathing, or wheezing; if the infant's symptoms worsened; or if there was parental concern (ie, if the parent[s], legally acceptable representative[s], or designate[s] were concerned about the infant's RTI or general health in the context of the RTI and intended to seek medical care). For both active and passive contacts, a protocol-guided phone script was used to ensure all required information was collected. cThe decision for scheduling a visit to assess a possible LRTI and procedures during the visit are explained in the “decision tree for LRTI visit.” Assessment visits were conducted by qualified site staff (ie, physicians, nurses, nurse practitioners, physician's assistants) with documented medical training (ie, medical or nursing license). Abbreviations: COVID-19, coronavirus disease 2019; LRTI, lower respiratory tract illness; RR, respiratory rate; RSV, respiratory syncytial virus; SpO2, blood oxygen saturation measured by pulse oximetry in room air, if feasible.
Figure 2.
Figure 2.
Participant flow diagram. Respiratory syncytial virus (RSV) seasons were defined as described before the coronavirus disease 2019 pandemic and are shown per country and study site (if the transmission season varied for the different sites). Months with RSV transmission for 1 calendar year (from January [J] to December [D]) are highlighted. Information on how the seasons were determined for each site is provided in the Supplementary Materials. Abbreviations: RSV, respiratory syncytial virus; SAE, serious adverse event.
Figure 3.
Figure 3.
Number of respiratory syncytial virus (RSV)–associated lower respiratory tract illness (LRTI) cases (A) and all-cause LRTI cases (B) by country and month of life. LRTI is based on the World Health Organization case definition. The n values indicate the total number of infants in the analysis for each country.
Figure 4.
Figure 4.
Incidence rates of first episode of respiratory syncytial virus (RSV)–associated lower respiratory tract illness (LRTI) (A), severe RSV-LRTI (B), RSV hospitalization (C), and all-cause LRTI (D) by age interval, overall and for each country. Error bars indicate 95% confidence intervals. LRTI is based on the World Health Organization case definition.
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