Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors

Rationale: Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear. Objectives: To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants. Methods: This was a prospective, population-based, crosssectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model. Measurements and Main Results: A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes. Conclusions: RSV was the most frequent cause of mortality in lowincome postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.Fil: Geoghegan, Sarah. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Erviti, Anabella. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Caballero, Mauricio Tomás. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Vallone, Fernando Daniel. Región Sanitaria I. - Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Region Sanitaria I.; ArgentinaFil: Zanone, Stella M.. Fundacion de Endocrinologia Infantil.; ArgentinaFil: Ves Losada, Juan. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Bianchi, Alejandra. Fundacion de Endocrinologia Infantil.; ArgentinaFil: Acosta, Patricio Leandro. Fundacion de Endocrinologia Infantil.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Talarico, Laura Beatriz. Fundacion de Endocrinologia Infantil.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ferretti, Adrian. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Grimaldi, Luciano Alva. Hospital Melendez; ArgentinaFil: Sancilio, Andrea. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Dueñas, Karina. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Sastre, Gustavo. Hospital Zonal General de Agudos Descentralizado Evita; ArgentinaFil: Rodriguez, Andrea. Hospital Zonal General de Agudos Descentralizado Evita; ArgentinaFil: Ferrero, Fernando. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Barboza, Edgar. Hospital Zonal General de Agudos Dr. Narciso Lopez; ArgentinaFil: Gago, Guadalupe Fernández. Hospital de Niños de la Plata; ArgentinaFil: Nocito, Celina. Hospital Interzonal General de Agudos “Dr. Pedro Fiorito"; ArgentinaFil: Flamenco, Edgardo. Hospital Zonal General de Agudos Dr. Arturo Onativia; ArgentinaFil: Perez, Alberto Rodriguez. Hospital Zonal General de Agudos Dr. Alberto Eurnekian; ArgentinaFil: Rebec, Beatriz. Gobierno de la Provincia de Buenos Aires. Hospital Interzonal General de Agudos Presidente Peron; ArgentinaFil: Ferolla, Fausto Martín. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Libster, Romina Paula. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Karron, Ruth A.. No especifíca;Fil: Bergel, Eduardo. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; Argentina. Vanderbilt University; Estados Unido