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- Title
Association of Respiratory Syncytial Virus Infection and Underlying Risk Factors for Death Among Young Infants Who Died at University Teaching Hospital, Lusaka Zambia.
- Authors
Forman, Leah S; Macleod, William; Mwananyanda, Lawrence; Kwenda, Geoffrey; Pieciak, Rachel; Mupila, Zachariah; Murphy, Caitriona; Thea, Donald; Chikoti, Chilufya; Yankonde, Baron; Ngoma, Benard; Chimoga, Charles; Gill, Christopher J
- Abstract
Background Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections and child mortality. While RSV disease burden is highest in low- and middle-income countries, most knowledge about risk factors for fatal RSV disease comes from high-income settings. Methods Among infants aged 4 days to <6 months who died at University Teaching Hospital in Lusaka, Zambia, we tested nasopharyngeal swabs obtained postmortem for RSV using reverse transcriptase–quantitative polymerase chain reaction. Through a systematic review of death certificates and hospital records, we identified 10 broad categories of underlying medical conditions associated with infant deaths. We used backward-selection models to calculate adjusted and unadjusted risk ratios (RRs) for the association between each underlying condition and RSV status. Results From 720 infant deaths, 6% (44) were RSV-positive, 70% were <4 weeks old, and 54% were male. At least 1 underlying condition was found in 85% of infants, while 63% had ≥2. Prematurity/low birth weight (53% [384]) and complications of labor and delivery (32% [230]) were the most common conditions. Congenital cardiac conditions were significantly associated with an increased risk of RSV infection (4%, 32; adjusted RR: 3.57; 95% CI: 1.71–7.44). No other underlying conditions were significantly associated with RSV. Conclusions Other than congenital cardiac conditions, we found a lack of association between RSV and underlying risk factors. This differs from high-income settings, where RSV mortality is concentrated among high-risk infants. In this population, birth-related outcomes are the highest mortality risk factors. Improved neonatal care remains crucial in the fight against neonatal mortality.
- Subjects
ZAMBIA; ACADEMIC medical centers; INFANT death; RESPIRATORY syncytial virus infections; DISEASE complications; CHILDREN
- Publication
Clinical Infectious Diseases, 2021, Vol 73, pS180
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab466