2 research outputs found
Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series
Background
Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data.
Methods
In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms “RSV”, “respiratory syncytial virus”, or “respiratory syncytial viral” combined with “mortality”, “fatality”, “death”, “died”, “deaths”, or “CFR” for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables.
Findings
We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3–11·0) in low-income or lower middle-income countries, 4·0 months (2·0–10·0) in upper middle-income countries, and 7·0 months (3·6–16·8) in high-income countries.
Interpretation
This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries
Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study
BACKGROUND: We have previously estimated that respiratory
syncytial virus (RSV) was associated with 22% of all episodes of
(severe) acute lower respiratory infection (ALRI) resulting in
55 000 to 199 000 deaths in children younger than 5 years in
2005. In the past 5 years, major research activity on RSV has
yielded substantial new data from developing countries. With a
considerably expanded dataset from a large international
collaboration, we aimed to estimate the global incidence,
hospital admission rate, and mortality from RSV-ALRI episodes in
young children in 2015. METHODS: We estimated the incidence and
hospital admission rate of RSV-associated ALRI (RSV-ALRI) in
children younger than 5 years stratified by age and World Bank
income regions from a systematic review of studies published
between Jan 1, 1995, and Dec 31, 2016, and unpublished data from
76 high quality population-based studies. We estimated the
RSV-ALRI incidence for 132 developing countries using a risk
factor-based model and 2015 population estimates. We estimated
the in-hospital RSV-ALRI mortality by combining in-hospital case
fatality ratios with hospital admission estimates from
hospital-based (published and unpublished) studies. We also
estimated overall RSV-ALRI mortality by identifying studies
reporting monthly data for ALRI mortality in the community and
RSV activity. FINDINGS: We estimated that globally in 2015, 33.1
million (uncertainty range [UR] 21.6-50.3) episodes of RSV-ALRI,
resulted in about 3.2 million (2.7-3.8) hospital admissions, and
59 600 (48 000-74 500) in-hospital deaths in children younger
than 5 years. In children younger than 6 months, 1.4 million (UR
1.2-1.7) hospital admissions, and 27 300 (UR 20 700-36 200)
in-hospital deaths were due to RSV-ALRI. We also estimated that
the overall RSV-ALRI mortality could be as high as 118 200 (UR
94 600-149 400). Incidence and mortality varied substantially
from year to year in any given population. INTERPRETATION:
Globally, RSV is a common cause of childhood ALRI and a major
cause of hospital admissions in young children, resulting in a
substantial burden on health-care services. About 45% of
hospital admissions and in-hospital deaths due to RSV-ALRI occur
in children younger than 6 months. An effective maternal RSV
vaccine or monoclonal antibody could have a substantial effect
on disease burden in this age group. FUNDING: The Bill &
Melinda Gates Foundation