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. 2024 Jan 2;15(1):116.
doi: 10.1038/s41467-023-44275-y.

Incidence and transmission of respiratory syncytial virus in urban and rural South Africa, 2017-2018

Cheryl Cohen  1   2 , Jackie Kleynhans  3   4 , Jocelyn Moyes  3   4 , Meredith L McMorrow  5   6 , Florette K Treurnicht  3   7 , Orienka Hellferscee  3   7 , Nicole Wolter  3   7 , Neil A Martinson  8   9   10 , Kathleen Kahn  11 , Limakatso Lebina  8 , Katlego Mothlaoleng  8 , Floidy Wafawanaka  11 , Francesc Xavier Gómez-Olivé  11 , Thulisa Mkhencele  3 , Azwifarwi Mathunjwa  3 , Maimuna Carrim  3   7 , Angela Mathee  12 , Stuart Piketh  13 , Brigitte Language  13 , Anne von Gottberg  3   7 , Stefano Tempia  4   6   14
Affiliations

Incidence and transmission of respiratory syncytial virus in urban and rural South Africa, 2017-2018

Cheryl Cohen et al. Nat Commun. .

Abstract

Data on respiratory syncytial virus (RSV) incidence and household transmission are limited. To describe RSV incidence and transmission, we conducted a prospective cohort study in rural and urban communities in South Africa over two seasons during 2017-2018. Nasopharyngeal swabs were collected twice-weekly for 10 months annually and tested for RSV using PCR. We tested 81,430 samples from 1,116 participants in 225 households (follow-up 90%). 32% (359/1116) of individuals had ≥1 RSV infection; 10% (37/359) had repeat infection during the same season, 33% (132/396) of infections were symptomatic, and 2% (9/396) sought medical care. Incidence was 47.2 infections/100 person-years and highest in children <5 years (78.3). Symptoms were commonest in individuals aged <12 and ≥65 years. Individuals 1-12 years accounted for 55% (134/242) of index cases. Household cumulative infection risk was 11%. On multivariable analysis, index cases with ≥2 symptoms and shedding duration >10 days were more likely to transmit; household contacts aged 1-4 years vs. ≥65 years were more likely to acquire infection. Within two South African communities, RSV attack rate was high, and most infections asymptomatic. Young children were more likely to introduce RSV into the home, and to be infected. Future studies should examine whether vaccines targeting children aged <12 years could reduce community transmission.

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Conflict of interest statement

C.C. has received grant support from Sanofi Pasteur, US CDC, Welcome Trust, Programme for Applied Technologies in Health (PATH), Bill & Melinda Gates Foundation and South African Medical Research Council (SA-MRC). A.V.G has received grant support from CDC, ASLM/Africa CDC, SA-MRC, WHO Afro, Fleming Fund, WHO, Wellcome Trust. N.W. reports receiving grants from Sanofi Pasteur, US CDC and the Bill & Melinda Gates Foundation. N.A.M has received a grant to his institution from Pfizer to conduct research in patients with pneumonia. J.M. has received grant support from Sanofi Pasteur and PATH. M.C received the Robert Austrian Award sponsored by Pfizer as well as received funding as part of the South Africa-Pittsburgh Public Health Genomic Epidemiology (SAPPHGenE) training program and reports support for attending meetings and/or travel paid to the institution from Bill and Melinda Gates Foundation. Other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Epidemic curve and results of real-time reverse transcription polymerase chain reaction (rRT-PCR) by study visit at a rural and an urban site, 2017.
Top panel: Number of new cases testing rRT-PCR-positive per study visit and cumulative percentage of individuals infected, a a rural site and b an urban site, South Africa, 2017. Bottom panel: Results of rRT-PCR of individuals enroled in the PHIRST study, at c a rural site and d an urban site, South Africa, 2017. Columns are individual follow up visits and rows are individual participants. Individuals within the same household are numbered consecutively (appear below one another). Follow up visits are coloured white if no sample was tested, light grey if the sample tested negative for RSV and coloured red if the nasopharyngeal swab tested positive for RSV A, green if the sample tested positive for RSV B, orange if the sample tested positive for RSV subgroup A and B and yellow if the sample subgroup could not be determined.
Fig. 2
Fig. 2. Epidemic curve and results of real-time reverse transcription polymerase chain reaction (rRT-PCR) by study visit at a rural and an urban site, 2018.
Top panel: Number of new cases testing rRT-PCR-positive per study visit and cumulative percentage of individuals infected, a a rural site and b an urban site, South Africa, 2018. Bottom panel: Results of rRT-PCR of individuals enroled in the PHIRST study, c a rural site and d an urban site, South Africa, 2018. Columns are individual follow up visits and rows are individual participants. Individuals within the same household are numbered consecutively (appear below one another). Follow up visits are coloured white if no sample was tested, light grey if the sample tested negative for RSV and coloured red if the nasopharyngeal swab tested positive for RSV A, green if the sample tested positive for RSV B, orange if the sample tested positive for RSV subgroup A and B and yellow if the sample subgroup could not be determined.
Fig. 3
Fig. 3. Venn diagram of estimated numbers of RSV infection episodes by symptoms and medical attendance per season in a population of 1000 individuals, a rural and an urban site, South Africa, 2017-2018.
ILI influenza like illness (fever and cough).
Fig. 4
Fig. 4. Rates and symptomatic percentage of RSV infection and illness by age group at a rural and an urban site, South Africa, 2017-2018.
a Rates of RSV infections and RSV-associated illness per 100 person-years and b percentage of episodes by symptom and medical attendance. ILI – influenza-like illness (fever and cough).
See this image and copyright information in PMC

References

    1. Li Y, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022;399:2047–2064. doi: 10.1016/S0140-6736(22)00478-0. - DOI - PMC - PubMed
    1. Shi T, et al. Global disease burden estimates of respiratory syncytial virus-associated acute respiratory infection in older adults in 2015: A systematic review and meta-analysis. J. Infect. Dis. 2021;222:S577–S583. doi: 10.1093/infdis/jiz059. - DOI - PubMed
    1. Mazur, N. et al. Respiratory syncytial virus prevention within reach: the vaccine and monoclonal antibody landscape. Lancet Infect Dis. Published online August 8, 10.1016/S1473-3099(22)00291-2 (2023). - PMC - PubMed
    1. Kampmann B, et al. Bivalent prefusion F vaccine in pregnancy to prevent rsv illness in infants. N. Engl. J. Med. 2023;388:1451–1464. doi: 10.1056/NEJMoa2216480. - DOI - PubMed
    1. Munywoki PK, et al. The source of respiratory syncytial virus infection in infants: a household cohort study in rural Kenya. J. Infect. Dis. 2014;209:1685–1692. doi: 10.1093/infdis/jit828. - DOI - PMC - PubMed

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