Academic journal article Bulletin of the World Health Organization

An Epidemiological Study of RSV Infection in the Gambia. (Research)

Academic journal article Bulletin of the World Health Organization

An Epidemiological Study of RSV Infection in the Gambia. (Research)

Article excerpt

Introduction

Respiratory syncytial virus (RSV) is the most important cause of acute lower respiratory tract infections (ALRI) in early childhood in industrialized countries (1-3). Outbreaks occur annually during the winter months in temperate climates (1, 4, 5). A high proportion of children become infected when they encounter the virus for the first time, and almost all children become infected the second time (4, 6, 7).

In a study from Washington (DC), 40% of all RSV infections in children in their first year of life involved the lower respiratory tract, and 1% of infected infants had to be admitted to hospital (4, 6). In a study from Houston, 33% of children with an RSV infection had a lower respiratory tract infection, and 1.6% had to be hospitalized (8). The sex distribution among children with RSV infections severe enough to be admitted to hospital in industrialized countries is 1.5-2:1 (boys:girls) (9-11), but the distribution between sexes in milder cases is more equal (5, 10, 12, 13).

Reinfection with RSV is common. A study in Tecumseh, Michigan, found that 20% of children aged 5-9 years became infected or reinfected within one year of the original episode (14). The reinfection rate was 10% in children aged 15-19 years and 3-6% in adults aged 20-50 years.

In developing countries, few studies have attempted to quantify the importance of ALRI caused by RSV (15-20). Reported incidence rates vary between 18 per 1000 children younger than one year for hospitalization with RSV-associated ALRI in Bedouins in southern Israel (18) to 198 per 1000 child-years for children aged up to 18 months in a community-based study from Colombia (15).

To obtain more information about the importance of RSV infection in developing countries, we started surveillance for RSV in the western region of the Gambia in 1993. This paper reports the epidemiology of RSV infection leading to hospital admission and the spread of infection in the community on the basis of data collected between 1993 and 1997.

Methods

Hospital surveillance

Surveillance for RSV disease was undertaken in the only three hospitals in the western region of the Gambia that regularly admit children with ALRI and at which oxygen is available:

* The Royal Victoria Hospital in Banjul on the coast, which is the paediatric referral hospital for the western half of the Gambia.

* The Medical Research Council Hospital in Fajara, approximately 15 km from Banjul, which serves a mainly periurban population.

* Sibanor Mission Hospital, 80 km inland, which serves a mainly rural population.

Surveillance started at the Royal Victoria and Medical Research Council hospitals in October 1993 and in Sibanor in January 1994. For the purpose of this report, surveillance ended in December 1997. Children admitted to the hospitals were screened for RSV disease by study personnel if they presented to hospital during working days (Monday to Friday), they had an admission diagnosis of any form of ALRI (as documented in the case chart by the hospital physicians), they were younger than two years and their guardians consented. Children who were admitted overnight, at weekends or on public holidays were screened the next working day, if they were available on the ward for nasopharyngeal aspirates to be taken. Children with clinical measles were not sampled. The clinical spectrum of disease of these cases has been described (21).

At the same time, details of all ALRI admissions were retrieved from the routine discharge records kept in the study hospitals during the study.

Community study

A community study to obtain information about the spread of RSV in the compounds in which infected children lived took place in 1993-94. Compounds--in which members of an extended family share a common central space and some social tasks, such as cooking--are the usual unit of residence in the Gambia. …

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