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      Epidemiology, Risk Factors, and Outcomes of Respiratory Syncytial Virus Infections in Newborns in Bamako, Mali

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          Abstract

          Background

          Few studies describe the respiratory syncytial virus (RSV) burden in African populations, and most have utilized hospital-based surveillance. In Mali, no community-based studies exist of the incidence or epidemiology of RSV infection. This study provides the first estimates of RSV incidence in Mali.

          Methods

          In a cohort of infants enrolled in a clinical trial of maternal influenza vaccination, we estimate incidence of RSV-associated febrile illness in the first 6 months of life and identify risk factors for RSV infection and progression to severe disease. Infants (N = 1871) were followed from birth to 6 months of age and visited weekly to detect pneumonia and influenza-like illness. Baseline covariates were explored as risk factors for RSV febrile illness and RSV pneumonia or hospitalization.

          Results

          Incidence of RSV illness was estimated at 536.8 per 1000 person-years, and 86% (131/153) of RSV illness episodes were positive for RSV-B. RSV illness was most frequent in the fifth month of life and associated with having older mothers and with lower parity. The incidence of RSV-associated hospitalizations was 45.6 per 1000 person-years. Among infants with RSV illness, males were more likely to be hospitalized. The incidence of RSV pneumonia was 29 cases per 1000 person-years.

          Conclusions

          In the first 6 months of life, Malian infants have a high incidence of RSV illness, primarily caused by RSV-B. Prevention of early RSV will require passive protection via maternal immunization in pregnancy. Mali is the first country where RSV-B has been identified as the dominant subtype, with potential implications for vaccine development.

          Abstract

          This first report of community-based surveillance for respiratory syncytial virus (RSV) infection in Mali showed that RSV-B was the dominant subtype, in contrast to other regions. Incidence was high early in life, before infant vaccination is a viable strategy.

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          The estimation of the basic reproduction number for infectious diseases.

          K Dietz (1992)
          The basic reproduction number R0 is the number of secondary cases which one case would produce in a completely susceptible population. It depends on the duration of the infectious period, the probability of infecting a susceptible individual during one contact, and the number of new susceptible individuals contacted per unit of time. Therefore R0 may vary considerably for different infectious diseases but also for the same disease in different populations. The key threshold result of epidemic theory associates the outbreaks of epidemics and the persistence of endemic levels with basic reproduction numbers greater than one. Because the magnitude of R0 allows one to determine the amount of effort which is necessary either to prevent an epidemic or to eliminate an infection from a population, it is crucial to estimate R0 for a given disease in a particular population. The present paper gives a survey about the various estimation methods available.
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            New Ballard Score, expanded to include extremely premature infants.

            J. L. Ballard, J. Khoury, K Wedig … (1991)
            The Ballard Maturational Score was refined and expanded to achieve greater accuracy and to include extremely premature neonates. To test validity, accuracy, interrater reliability, and optimal postnatal age at examination, the resulting New Ballard Score (NBS) was assessed for 578 newly born infants and the results were analyzed. Gestational ages ranged from 20 to 44 weeks and postnatal ages at examination ranged from birth to 96 hours. In 530 infants, gestational age by last menstrual period was confirmed by agreement within 2 weeks with gestational age by prenatal ultrasonography (C-GLMP). For these infants, correlation between gestational age by NBS and C-GLMP was 0.97. Mean differences between gestational age by NBS and C-GLMP were 0.32 +/- 1.58 weeks and 0.15 +/- 1.46 weeks among the extremely premature infants (less than 26 weeks) and among the total population, respectively. Correlations between the individual criteria and C-GLMP ranged from 0.72 to 0.82. Interrater reliability of NBS, as determined by correlation between raters who rated the same subgroup of infants, ws 0.95. For infants less than 26 weeks of gestational age, the greatest validity (97% within 2 weeks of C-GLMP) was seen when the examination was performed before 12 hours of postnatal age. For infants at least 26 weeks of gestational age, percentages of agreement with C-GLMP remained constant, averaging 92% for all postnatal age categories up to 96 hours. The NBS is a valid and accurate gestational assessment tool for extremely premature infants and remains valid for the entire newborn infant population.
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              Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: Systematic review and meta–analysis

              Ting Shi, Evelyn Balsells, Elizabeth Wastnedge … (2015)
              Background Respiratory syncytial virus (RSV) is the most common pathogen identified in young children with acute lower respiratory infection (ALRI) as well as an important cause of hospital admission. The high incidence of RSV infection and its potential severe outcome make it important to identify and prioritise children who are at higher risk of developing RSV–associated ALRI. We aimed to identify risk factors for RSV–associated ALRI in young children. Methods We carried out a systematic literature review across 4 databases and obtained unpublished studies from RSV Global Epidemiology Network (RSV GEN) collaborators. Quality of all eligible studies was assessed according to modified GRADE criteria. We conducted meta–analyses to estimate odds ratios with 95% confidence intervals (CI) for individual risk factors. Results We identified 20 studies (3 were unpublished data) with “good quality” that investigated 18 risk factors for RSV–associated ALRI in children younger than five years old. Among them, 8 risk factors were significantly associated with RSV–associated ALRI. The meta–estimates of their odds ratio (ORs) with corresponding 95% confidence intervals (CI) are prematurity 1.96 (95% CI 1.44–2.67), low birth weight 1.91 (95% CI 1.45–2.53), being male 1.23 (95% CI 1.13–1.33), having siblings 1.60 (95% CI 1.32–1.95), maternal smoking 1.36 (95% CI 1.24–1.50), history of atopy 1.47 (95% CI 1.16–1.87), no breastfeeding 2.24 (95% CI 1.56–3.20) and crowding 1.94 (95% CI 1.29–2.93). Although there were insufficient studies available to generate a meta–estimate for HIV, all articles (irrespective of quality scores) reported significant associations between HIV and RSV–associated ALRI. Conclusions This study presents a comprehensive report of the strength of association between various socio–demographic risk factors and RSV–associated ALRI in young children. Some of these amenable risk factors are similar to those that have been identified for (all cause) ALRI and thus, in addition to the future impact of novel RSV vaccines, national action against ALRI risk factors as part of national control programmes can be expected to reduce burden of disease from RSV. Further research which identifies, accesses and analyses additional unpublished RSV data sets could further improve the precision of these estimates.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Infect Dis
                Journal ID (iso-abbrev): Clin. Infect. Dis
                Journal ID (publisher-id): cid
                Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Publisher: Oxford University Press (US )
                ISSN (Print): 1058-4838
                ISSN (Electronic): 1537-6591
                Publication date (Print): 01 January 2020
                Publication date (Electronic): 27 February 2019
                Publication date PMC-release: 27 February 2019
                Volume: 70
                Issue: 1
                Pages: 59-66
                Affiliations
                [1 ] Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore
                [2 ] Centre pour le Developpement des Vaccins , Bamako, Mali
                Author notes
                Correspondence: A. G. Buchwald, University of Maryland School of Medicine, Center for Vaccine Development and Global Health, HSF1, Rm 480, 655 W Baltimore St, Baltimore, MD 21201 ( andreabuchwald@ 123456umaryland.edu ).
                Author information
                http://orcid.org/0000-0001-6503-6459
                Article
                Publisher ID: ciz157
                DOI: 10.1093/cid/ciz157
                PMC ID: 6912158
                PubMed ID: 30810160
                SO-VID: 903200a5-6380-43e7-8874-0cabc3ec8b19
                Copyright © © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 November 2018
                Date accepted : 22 February 2019
                Page count
                Pages: 8
                Funding
                Funded by: Bill & Melinda Gates Foundation 10.13039/100000865
                Award ID: OPP1002744
                Categories
                Subject: Articles and Commentaries

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: pneumonia,acute respiratory infection,active surveillance,rsv
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: pneumonia, acute respiratory infection, active surveillance, rsv

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