Respiratory syncytial virus after 100,000 infant deaths

Respiratory syncytial virus (RSV) was responsible for more than 100,000 deaths in children under five worldwide in 2019, according to a study by Australian and international researchers.

The researchers examined RSV disease burden in narrow age groups, reporting that in 2019 there were more than 45,000 deaths in infants under six months old, with one in five of the total worldwide cases of RSV in this age group.

RSV is the predominant cause of acute lower respiratory tract infection in young children and our updated estimates show that children aged six months and younger are particularly vulnerable, especially with cases increasing due to COVID-19 restrictions worldwide are reduced and the majority of young children born in the last two years have never been exposed to RSV (and therefore have no immunity to this virus) .With numerous RSV vaccine candidates in the pipeline, our estimates are helping by narrow age ranges “to identify groups that need to be prioritized, including pregnant people, so that children in the youngest age groups can be protected, similar to current strategies that provide vaccines for whooping cough, typhoid and tetanus for pregnant people,” said Harish Nair, University of Edinburgh, UK, co-author of the paper published in The Lancet.

Worldwide, there were 33 million RSV-associated acute lower respiratory tract infections in children under the age of five in 2019, resulting in 3.6 million hospital admissions, 26,300 hospital deaths and 101,400 RSV additional deaths overall. (including deaths in the community), according to the study authors. This accounts for one in 50 or 2% of annual deaths due to any cause in this age range.

For children under six months old, there were 6.6 million RSV-associated acute lower respiratory infections worldwide in 2019. , or 2.1% of annual deaths due to any cause.

Based on estimates of hospital versus total RSV mortality rates, only 26%, or about one in four RSV-associated deaths, occur in a hospital worldwide. This is particularly evident in low- and middle-income countries, where the case-to-death rate in hospital for children is below 1.4%, compared with 0.1% in high-income countries. Overall, 97% of RSV deaths occurred in children under five in low- and middle-income countries.

“Our study estimates that three-quarters of RSV deaths occur outside of a hospital setting. This gap is even greater in LMICs, particularly in children under six months of age, where more than 80% of deaths occur in the community. This reflects the fact that access to and availability of hospital care in these regions is still limited: early identification of cases in the community and referral for hospitalization of sick children (especially those with low oxygen saturation in peripheral blood), and universal effective and affordable immunization programs will be essential in advance, “said Xin Wang, co-author of the study, Nanjing Medical University, China and University of Edinburgh, UK.

The authors acknowledged some limitations with this study. Variations in factors such as study setting, precise case definition for acute lower respiratory tract infection (ALRI), access to health care and search behavior, and eligibility for RSV testing may affect estimates of mortality rates produced in the modeling. The distribution by age groups was also limited by the data available for the study. In addition, all data were collected for the COVID-19 pandemic; it is unknown how the COVID-19 pandemic could affect the RSV disease burden in the long run.

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Respiratory syncytial virus after 100,000 infant deaths

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