Human respiratory syncytial virus: prevalence, viral co-infections and risk factors for lower respiratory tract infections in children under 5 years of age at a general hospital in the Democratic Republic of Congo
Abstract:The prevalence of HRSV is high among children visiting the PGHB for ARI. HRSV infection and lower age are independently associated with the risk of ARI being diagnosed as LRTI.
“…Newborns are highly vulnerable to pathogens due to their functional immunological differences from adults as a result of living in a semi-allogeneic sterile environment, where exposure to microbial antigens is limited (3)(4)(5)(6). For example, microorganisms such as respiratory syncytial virus (RSV) cause no or mild disease in adults but induce acute bronchiolitis, viral pneumoniae, and croup in infants, with those between 2 and 6 months of age at the highest risk, especially in low-income countries (7,8).…”
Transplacental transfer of antibodies is essential for conferring protection in newborns against infectious diseases. We assessed the impact of different factors, including gestational age and maternal infections such as HIV and malaria, on the efficiency of cord blood levels and placental transfer of IgG subclasses. We measured total IgG and IgG subclasses by quantitative suspension array technology against 14 pathogens and vaccine antigens, including targets of maternal immunization, in 341 delivering HIV-uninfected and HIV-infected mother-infant pairs from southern Mozambique. We analyzed the association of maternal HIV infection, Plasmodium falciparum exposure, maternal variables and pregnancy outcomes on cord antibody levels and transplacental transfer. Our results show that maternal antibody levels were the main determinant of cord antibody levels. Univariable and multivariable analysis showed that HIV reduced the placental transfer and cord levels of IgG and IgG1 principally, but also IgG2 to half of the antigens tested. P. falciparum exposure and prematurity were negatively associated with cord antibody levels and placental transfer, but this was antigen-subclass dependent. Our findings suggest that lower maternally transferred antibodies may underlie increased susceptibility to infections of HIV-exposed infants. This could affect efficacy of maternal vaccination, especially in sub-Saharan Africa, where there is a high prevalence of HIV, malaria and unfavorable environmental factors.
“…Newborns are highly vulnerable to pathogens due to their functional immunological differences from adults as a result of living in a semi-allogeneic sterile environment, where exposure to microbial antigens is limited (3)(4)(5)(6). For example, microorganisms such as respiratory syncytial virus (RSV) cause no or mild disease in adults but induce acute bronchiolitis, viral pneumoniae, and croup in infants, with those between 2 and 6 months of age at the highest risk, especially in low-income countries (7,8).…”
Transplacental transfer of antibodies is essential for conferring protection in newborns against infectious diseases. We assessed the impact of different factors, including gestational age and maternal infections such as HIV and malaria, on the efficiency of cord blood levels and placental transfer of IgG subclasses. We measured total IgG and IgG subclasses by quantitative suspension array technology against 14 pathogens and vaccine antigens, including targets of maternal immunization, in 341 delivering HIV-uninfected and HIV-infected mother-infant pairs from southern Mozambique. We analyzed the association of maternal HIV infection, Plasmodium falciparum exposure, maternal variables and pregnancy outcomes on cord antibody levels and transplacental transfer. Our results show that maternal antibody levels were the main determinant of cord antibody levels. Univariable and multivariable analysis showed that HIV reduced the placental transfer and cord levels of IgG and IgG1 principally, but also IgG2 to half of the antigens tested. P. falciparum exposure and prematurity were negatively associated with cord antibody levels and placental transfer, but this was antigen-subclass dependent. Our findings suggest that lower maternally transferred antibodies may underlie increased susceptibility to infections of HIV-exposed infants. This could affect efficacy of maternal vaccination, especially in sub-Saharan Africa, where there is a high prevalence of HIV, malaria and unfavorable environmental factors.
“…This nding goes hand in hand with other literatures and studies done to nd if there was an association between acute respiratory infection and RSV presence [27,20,28]. However, in a study on the prevalence of acute respiratory infection caused by RSV, ndings showed that there was an independent association between RSV and the risk of developing an acute respiratory infection, but this speci c study only included children younger than the age of 5 years old, had a larger number of study sample and was done on a shorter period of time (5 months), those differences could have favoured the difference in ndings from that study and this study on RSV in Kinshasa [29].…”
Background: The Democratic Republic of Congo (DRC) with its tropical climate in the past was thought not to house many respiratory viruses, with time and after many outbreaks began researches and surveillance on respiratory viruses circulating in the country. The first was influenza sentinel surveillance which showed that around 10% of suspected samples received were positive for influenza and 90% were negative.This study aimed to screen Respiratory Syncytial Virus (RSV) among the negative influenza samples which were collected during sentinel influenza surveillance, in order to determine the proportion and seasonal factors influencing the RSV.Methods: The samples used were nasopharyngeal swabs collected from different Influenza surveillance sites in Kinshasa: Kalembelembe, Boyambi, Kinshasa General Hospital, Kingasani Hospital Centre and RVA clinic during the period of January to September 2016. A total of 169 Samples were randomly selected for the research and were chosen regardless of the patient’s age, sex, geographic group and symptoms. Molecular analysis was done to determine if the samples were RSV positive or negative at the Institut National de Recherche Biomédicale (INRB) in Kinshasa using real time reverse transcription-polymerase chain reaction (rRT-PCR).Results: Out of the 169 samples that were analysed, 23 cases (13.6%) were positive for RSV. The prevalence was higher in female 65.2% than in male 34.8%, over 95% of RSV infection occurred during the rainy season and among the positive cases 60.9% were from hospitalized patients with severe acute respiratory infection and 39.1% were from influenza-like illness or infection. The largest proportion (78.3%) of RSV positives was found in children under the age of 2 years.Conclusion: This study showed that RSV is found in Kinshasa at most during the rainy season and tend to fade away during the dry season. Children are the most affected especially those younger than 2 years and RSV was more prevalent in female than in male.
“…Only one study provided a prevalence between 41 and 50% [ 1 ]. Finally, three studies provided a prevalence between 51% and 57.5% and were among hospitalised samples [ 13 , 46 ]. Compared to studies that used community samples, studies that used hospitalised samples reported relatively higher prevalence of ALRTIs.…”
Section: Resultsmentioning
confidence: 99%
“…Compared to studies that used community samples, studies that used hospitalised samples reported relatively higher prevalence of ALRTIs. For instance, 6 studies that used hospitalised samples reported prevalence above 30% [ 1 , 13 , 14 , 46 , 49 ]. See details in Table 2 .…”
Section: Resultsmentioning
confidence: 99%
“…The reviewed studies showed that children above the age of 2 years are at higher risk of ALRTIs [ 7 , 13 , 16 , 19 , 25 , 33 , 37 , 43 , 47 ]. However, this evidence is inconclusive because children under 2 years seem highly susceptible to ALRTIs compared to the rest of children under five [ 13 , 16 , 25 ]. Moreover, children under five of teenage mothers [ 16 , 22 , 25 ] and children from mothers above age 35 [ 26 ] are more susceptible to ALRTIs.…”
Background
Acute lower respiratory tract infections (ALRTIs) among children under five are still the leading cause of mortality among this group of children in low and middle-income countries (LMICs), especially countries in sub-Saharan Africa (SSA). This scoping review aims to map evidence on prevalence and risk factors associated with ALRTIs among children under 5 years to inform interventions, policies and future studies.
Methods
A thorough search was conducted via four main databases (PubMed, JSTOR, Web of Science and Central). In all, 3,329 records were identified, and 107 full-text studies were considered for evaluation after vigorous screening and removing duplicates, of which 43 were included in this scoping review.
Findings
Findings indicate a high prevalence (between 1.9% to 60.2%) of ALRTIs among children under five in SSA. Poor education, poverty, malnutrition, exposure to second-hand smoke, poor ventilation, HIV, traditional cooking stoves, unclean fuel usage, poor sanitation facilities and unclean drinking water make children under five more vulnerable to ALRTIs in SSA. Also, health promotion strategies like health education have doubled the health-seeking behaviours of mothers of children under 5 years against ALRTIs.
Conclusion
ALRTIs among children under five still present a significant disease burden in SSA. Therefore, there is a need for intersectoral collaboration to reduce the burden of ALRTIs among children under five by strengthening poverty alleviation strategies, improving living conditions, optimising child nutrition, and ensuring that all children have access to clean water. There is also the need for high-quality studies where confounding variables in ALRTIs are controlled.
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