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      The Burden of Hospitalized Lower Respiratory Tract Infection due to Respiratory Syncytial Virus in Rural Thailand

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          Abstract

          Background

          We describe the epidemiology of hospitalized RSV infections for all age groups from population-based surveillance in two rural provinces in Thailand.

          Methods

          From September 1, 2003 through December 31, 2007, we enrolled hospitalized patients with acute lower respiratory tract illness, who had a chest radiograph ordered by the physician, from all hospitals in SaKaeo and Nakhom Phanom Provinces. We tested nasopharyngeal specimens for RSV with reverse transcriptase polymerase chain reaction (RT-PCR) assays and paired-sera from a subset of patients with IgG enzyme immunoassay. Rates were adjusted for enrollment.

          Results

          Among 11,097 enrolled patients, 987 (8.9%) had RSV infection. Rates of hospitalized RSV infection overall (and radiographically-confirmed pneumonia) were highest among children aged <1 year: 1,067/100,000 (534/100,000 radiographically-confirmed pneumonia) and 1–4 year: 403/100,000 (222/100,000), but low among enrolled adults aged ≥65 years: 42/100,000. Age <1 year (adjusted odds ratio [aOR]  = 13.2, 95% confidence interval [CI] 7.7, 22.5) and 1–4 year (aOR = 8.3, 95% CI 5.0, 13.9) were independent predictors of hospitalized RSV infection.

          Conclusions

          The incidence of hospitalized RSV lower respiratory tract illness among children <5 years was high in rural Thailand. Efforts to prevent RSV infection could substantially reduce the pneumonia burden in children aged <5 years.

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          Most cited references25

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          WHO estimates of the causes of death in children.

          Jennifer Bryce, Cynthia Boschi-Pinto, Kenji Shibuya … (2005)
          Child survival efforts can be effective only if they are based on accurate information about causes of deaths. Here, we report on a 4-year effort by WHO to improve the accuracy of this information. WHO established the external Child Health Epidemiology Reference Group (CHERG) in 2001 to develop estimates of the proportion of deaths in children younger than age 5 years attributable to pneumonia, diarrhoea, malaria, measles, and the major causes of death in the first 28 days of life. Various methods, including single-cause and multi-cause proportionate mortality models, were used. The role of undernutrition as an underlying cause of death was estimated in collaboration with CHERG. In 2000-03, six causes accounted for 73% of the 10.6 million yearly deaths in children younger than age 5 years: pneumonia (19%), diarrhoea (18%), malaria (8%), neonatal pneumonia or sepsis (10%), preterm delivery (10%), and asphyxia at birth (8%). The four communicable disease categories account for more than half (54%) of all child deaths. The greatest communicable disease killers are similar in all WHO regions with the exception of malaria; 94% of global deaths attributable to this disease occur in the Africa region. Undernutrition is an underlying cause of 53% of all deaths in children younger than age 5 years. Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes.
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            Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group.

            B J Marston, J F Plouffe, T File … (2015)
            Pneumonia is the leading cause of death due to infectious diseases in the United States; however, the incidence of most infections causing community-acquired pneumonia in adults is not well defined. We evaluated all adults, residing in 2 counties in Ohio, who were hospitalized in 1991 because of community-acquired pneumonia. Information about risk factors, symptoms, and outcome was collected through interview and medical chart review. Serum samples were collected from consenting individuals during the acute and convalescent phases, and specific etiologic diagnoses were assigned based on results of bacteriologic and immunologic tests. The incidence of community-acquired pneumonia requiring hospitalization in the study counties in 1991 was 266.8 per 100,000 population; the overall case-fatality rate was 8.8%. Pneumonia incidence was higher among blacks than whites (337.7/100,000 vs 253.9/ 100,000; P or = 65 years; P < .001). Extrapolation from study incidence data showed the projected annual number of cases of community-acquired pneumonia requiring hospitalization in the United States to be 485,000. These data provide previously unavailable estimates of the annual number of cases that are due to Legionella species (8000-18,000), Mycoplasma pneumoniae (18,700-108,000), and Chlamydia pneumoniae (5890-49,700). These data provide information about the importance of community-acquired pneumonia and the relative and overall impact of specific causes of pneumonia. The study provides a basis for choosing optimal empiric pneumonia therapy, and allows interventions for prevention of pneumonia to be targeted at groups at greatest risk for serious illness and death.
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              Respiratory syncytial virus is an important cause of community-acquired lower respiratory infection among hospitalized adults.

              Robert Breiman, Dean Erdman, Lauren Marston … (1996)
              Respiratory syncytial virus (RSV), the most important cause of lower respiratory disease in infants and young children, is rarely considered among the causes for community-acquired lower respiratory infection in adults. All noninstitutionalized adults hospitalized with community-acquired pneumonia in two Ohio counties were evaluated between December 1990 and May 1992. Fifty-three (4.4%) of 1195 adults admitted during the RSV seasons and 4 (1.0%) of 390 in the off-season had serologic evidence of RSV infection, making RSV one of the four most common pathogens identified. RSV-infected patients had clinical features (e.g., wheezing and rhonchi) that distinguished them from all non-RSV-infected patients and other features (e.g., nonelevated white blood cell counts) that distinguished them from those infected with bacterial or atypical agents. However, RSV infection was not diagnosed during hospitalization for any of the 57 RSV-infected patients. RSV should be considered in the differential diagnosis for adults hospitalized between November and April with community-acquired lower respiratory infection.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2010
                Publication date (Electronic): 30 November 2010
                Volume: 5
                Issue: 11
                Electronic Location Identifier: e15098
                Affiliations
                [1 ]Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [2 ]National Institute of Health, Thailand Ministry of Public Health, Nonthaburi, Thailand
                [3 ]Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [4 ]International Emerging Infections Program, Thai MOPH-U.S.CDC Collaboration, Nonthaburi, Thailand
                [5 ]Division of Emerging Infections and Surveillance Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                The University of Hong Kong, Hong Kong
                Author notes

                Conceived and designed the experiments: AMF MC DDE DJO HCB. Performed the experiments: MC HCB TCTP RKD PS ST PA WS JF DDE SJO. Analyzed the data: AMF HCB DDE MC TCTP SJO. Contributed reagents/materials/analysis tools: TCTP RKD PS ST PA WS DDE HCB. Wrote the paper: AMF HCB JF SAM DDE SJO.

                [¤]

                Current address: Stimson Center, Washington, D.C., United States of America

                Article
                Publisher ID: PONE-D-10-00924
                DOI: 10.1371/journal.pone.0015098
                PMC ID: 2994907
                PubMed ID: 21152047
                SO-VID: 80a089e4-8185-42bd-85aa-4d0bf87db0d7
                Copyright © This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
                History
                Date received : 16 August 2010
                Date accepted : 21 October 2010
                Page count
                Pages: 7
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Population Biology
                Subject: Epidemiology
                Subject: Infectious Disease Epidemiology
                Subject: Medicine
                Subject: Epidemiology
                Subject: Infectious Disease Epidemiology
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Respiratory Syncytial Virus Infection
                Subject: Viral Pneumonia
                Subject: Public Health
                Subject: Child Health
                Subject: Preventive Medicine
                Subject: Pulmonology
                Subject: Respiratory Infections
                Subject: Lower Respiratory Tract Infections
                Subject: Pediatric Pulmonology

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                ScienceOpen disciplines: Uncategorized

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