Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series

Abstract

SummaryBackgroundRespiratory 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.MethodsIn 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.FindingsWe 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 years (2·0–10·0) in upper middle-income countries, and 7·0 years (3·6–16·8) in high-income countries.InterpretationThis 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.FundingBill & Melinda Gates Foundation.

Reduced Nasal Viral Load and IFN Responses in Infants with Respiratory Syncytial Virus Bronchiolitis and Respiratory Failure

“…The greater frequency of non-respiratory co-morbidities in severe cases was another important difference between groups, which is intrinsically associated with the most severe RSV cases (9,31).…”

Respiratory syncytial virus is an “opportunistic” killer

“…The mean age of death was slightly younger in the developing world (4 vs 7 months in industrialized countries). Mean time between onset of symptoms and admission ranged from 5 days in low income to 3 days in higher‐middle and high‐income countries, but less than 50% of families contacted a physician before hospitalization …”

Age‐specific incidence rates and risk factors for respiratory syncytial virus‐associated lower respiratory tract illness in cohort children under 5 years old in the Philippines

“…Despite the burden of this disease, there are no commercially available vaccines and the monoclonal antibody is only a specific measure taken to prevent severe disease in high‐risk infants . The incidence rate (IR) of RSV‐associated lower respiratory illness (RSV‐LRTI) is higher in the first 6 months of life compared with older age groups, and the illness is generally more severe in young infants . For these reasons, it is believed that natural maternal immunity is not enough to prevent severe RSV‐LRTI in early infancy.…”