Background Better understanding the etiology-specific incidence of severe acute respiratory infections (SARIs) in resource-poor, rural settings will help further develop and prioritize prevention strategies. To address this gap in knowledge, we conducted a longitudinal study to estimate the incidence of SARIs among children in rural Bangladesh. Methods During June through October 2010, we followed children aged <5 years in 67 villages to identify those with cough, difficulty breathing, age-specific tachypnea and/or danger signs in the community or admitted to the local hospital. A study physician collected clinical information and obtained nasopharyngeal swabs from all SARI cases and blood for bacterial culture from those hospitalized. We tested swabs for respiratory syncytial virus (RSV), influenza viruses, human metapneumoviruses, adenoviruses and human parainfluenza viruses 1–3 (HPIV) by real-time reverse transcription polymerase chain reaction. We calculated virus-specific SARI incidence by dividing the number of new illnesses by the person-time each child contributed to the study. Results We followed 12,850 children for 279,029 person-weeks (pw) and identified 141 SARI cases; 76 (54%) at their homes and 65 (46%) at the hospital. RSV was associated with 7.9 SARI hospitalizations per 100,000 pw, HPIV3 2.2 hospitalizations/100,000 pw, and influenza 1.1 hospitalizations/100,000 pw. Among non-hospitalized SARI cases, RSV was associated with 10.8 illnesses/100,000 pw, HPIV3 1.8/100,000 pw, influenza 1.4/100,000 pw, and adenoviruses 0.4/100,000 pw. Conclusion Respiratory viruses, particularly RSV, were commonly associated with SARI among children. It may be useful to explore the value of investing in prevention strategies, such as handwashing and respiratory hygiene, to reduce respiratory infections among young children in such settings.
References
[1]
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ORC Macro (2005) Bangladesh Demographic and Health Survey 2004. Dhaka, Bangladesh and Calverton, Maryland [USA]: National Institute of Population Research and Training, Mitra and Associates, and ORC Macro.
[2]
Rudan I, Boschi-Pinto C, Biloglav Z, Mulhollandd K, Campbelle H (2008) Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization 86: 408–416. doi: 10.2471/blt.07.048769
[3]
Ahmed S, Siddique AK, Iqbal A, Rahman FKMN, Islam MN, et al. (2010) Causes for Hospitalizations at Upazila Health Complexes in Bangladesh. Journal of Health, Population and Nutrition 28: 399–404. doi: 10.3329/jhpn.v28i4.6047
[4]
National Institute of Population Research and Training (NIPORT), Mitra and Associates, Macro International (2009) Bangladesh Demographic and Health Survey 2007. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and Macro International.
[5]
Bangladesh Bureau of Statistics (2010) Statistical Pocket Book 2010.
[6]
Zaman K, Baqui AH, Yunus, Sack RB, Bateman OM, et al. (1997) Acute Respiratory Infections in Children: A Community-based Longitudinal Study in Rural Bangladesh. Journal of Tropical Pediatrics 43: 133–137. doi: 10.1093/tropej/43.3.133
[7]
Baqui AH, Rahman M, Zaman K, Arifeen SE, Chowdhury HR, et al. (2007) A Population-based Study of Hospital Admission Incidence Rate and Bacterial Aetiology of Acute Lower Respiratory Infections in Children Aged Less Than Five Years in Bangladesh. Journal of Health, Population and Nutrition 25: 179–188.
[8]
World Health Organization (2008) International Health Regulations (2005), 2nd ed. Geneva.
[9]
Pan American Health Organization (2006) PAHO-CDC Generic Protocol for Influenza Surveillance Washington DC. pp. PAHO/HDM/CD/V/411/406.
[10]
Shek LP-C, Lee B-W (2003) Epidemiology and seasonality of respiratory tract virus infections in the tropics. Paediatric Respiratory Reviews 4: 105–111. doi: 10.1016/s1526-0542(03)00024-1
[11]
Murray EL, Klein M, Brondi L, McGowan JE Jr, Vanmels C, et al.. (2011) Rainfall, household crowding, and acute respiratory infections in the tropics. Epidemiology and Infection: doi:10.1017/S0950268811000252.
[12]
Zaman RU, Alamgir ASM, Rahman M, Azziz-Baumgartner E, Gurley ES, et al. (2009) Influenza in Outpatient ILI Case-Patients in National Hospital-Based Surveillance, Bangladesh, 2007–2008. PLoS ONE 4: e8452 doi:8410.1371/journal.pone.0008452.
[13]
ICDDR B (2009) Health and Demographic Surveillance System - Matlab, v. 41. Registration of health and demographic events 2007, Scientific Report No. 106. Dhaka: ICDDR,B.
[14]
icddr b (2012) Health and Demographic Surveillance System - Matlab, v. 44. Registration of health and demographic events 2010, Scientific Report No. 115. Dhaka: icddr,b.
[15]
ICDDR B (2011) Health and Demographic Surveillance System - Matlab, v. 43. Registration of health and demographic events 2009, Scientific Report No. 114. Dhaka: ICDDR,B.
[16]
CDC (2009) CDC protocol of realtime RTPCR for influenza A (H1N1). In: WHO Collaborating Centre for influenza CfDCaP, editor. Atlanta.
[17]
Clinical and Laboratory Standard Institute (CLSI) (2010) Performance Standards for Antimicrobial Susceptibility Testing; 20th Informational Supplement. Wayne, PA: Clinical and Laboratory Standard Institute.
[18]
Bhat N, Wright JG, Broder KR, Murray EL, Greenberg ME, et al. (2005) Influenza-Associated Deaths among Children in the United States, 2003–2004. The New England Journal of Medicine 353: 2559–2567. doi: 10.1056/nejmoa051721
[19]
World Health Organization, UNICEF (2008) Integated Management of Childhood Illness chart booklet. Geneva: Department of Child and Adolescent Health and Development (CAH).
[20]
Do AHL, van Doorn HR, Nghiem MN, Bryant JE, Hoang THT, et al. (2011) Viral Etiologies of Acute Respiratory Infections among Hospitalized Vietnamese Children in Ho Chi Minh City, 2004–2008. PLoS ONE 6: e18176. doi: 10.1371/journal.pone.0018176
[21]
Olsen SJ, Thamthitiwat S, Chantra S, Chittaganpitch M, Fry AM, et al.. (2010) Incidence of respiratory pathogens in persons hospitalized with pneumonia in two provinces in Thailand. Epidemiology and Infection.
[22]
Bezerra PGM, Britto MCA, Correia JB, Duarte MdCMB, Fonceca AM, et al. (2011) Viral and Atypical Bacterial Detection in Acute Respiratory Infection in Children Under Five Years. PLoS ONE 6: e18928. doi: 10.1371/journal.pone.0018928
[23]
Nokes D, Ngama M, Bett A, Abwao J, Munywoki P, et al. (2009) Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance. Clinical Infectious Diseases 49: 1341–1349. doi: 10.1086/606055
[24]
Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, et al. (2009) The Burden of Respiratory Syncytial Virus Infection in Young Children. The New England Journal of Medicine 360: 588–598. doi: 10.1056/nejmoa0804877
[25]
Nair H, Simoes EAF, Rudan I, Gessner BD, Azziz-Baumgartner E, et al.. (2013) Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. The Lancet.
[26]
Centers for Disease Control and Prevention (CDC) (2010) Respiratory Syncytial Virus Infection (RSV)-Prophylaxis and High-Risk Groups.
[27]
Minnesota Department of Human Services (2012) MHCP Policy and PA Criteria for Synagis (palivisumab) 2012–2013 RSV Season.
[28]
Rudraraju R, Jones B, Sealy R, Surman S, Hurwitz J (2013) Respiratory Syncytial Virus: Current Progress in Vaccine Development. Viruses 5: 577–594. doi: 10.3390/v5020577
[29]
Geevarghese B, Simoes EA (2012) Antibodies for prevention and treatment of respiratory syncytial virus infections in children. Antiviral Therapy 17: 201–211. doi: 10.3851/imp2061
[30]
Jefferson T, Del Mar C, Dooley L, Ferroni E, Al-Ansary LA, et al.. (2010) Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev: CD006207.
[31]
Godoy P, Castilla JS, Delgado-Rodriguez M, Martin V, Soldevila N, et al.. (2012) Effectiveness of hand hygiene and provision of information in preventing influenza cases requiring hospitalization. Preventive Medicine.
[32]
Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, et al.. (2011) Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt Emerging Infectious Diseases: [Epub ahead of print].
[33]
Isaacs D, Dickson H, O’Callaghan C, Sheaves R, Winter A, et al. (1991) Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus. Arch Dis Child 66: 227–231. doi: 10.1136/adc.66.2.227
[34]
Nair H, Brooks WA, Katz M, Roca A, Berkley JA, et al. (2011) Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. The Lancet 378: 1917–1930. doi: 10.1016/s0140-6736(11)61051-9
[35]
Brooks WA, Goswami D, Rahman M, Nahar K, Fry AM, et al.. (2010) Influenza is a Major Contributor to Childhood Pneumonia in a Tropical Developing Country. The Pediatric Infectious Disease Journal 29: 216–221 210.1097/INF.1090b1013e3181bc1023fd.
[36]
Azziz-Baumgartner E, Alamgir ASM, Rahman M, Homaira N, Sohel BM, et al. (2012) Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008–2010. Bulletin of the World Health Organization 90: 12–19. doi: 10.2471/blt.11.090209
[37]
Clara W, Armero J, Rodriguez D, Lozano Cd, Bonilla L, et al.. (2012) Estimated incidence of influenza-virus-associated severe pneumonia in children in El Salvador, 2008–2010. Bulletin of the World Health Organization.
[38]
Brooks WA, Erdman D, Terebuh P, Klimov A, Goswami D, et al. (2007) Human Metapneumovirus Infection among Children, Bangladesh. Emerging Infectious Diseases 13: 1611–1613. doi: 10.3201/eid1310.070337
[39]
Homaira N, Luby SP, Petri WA, Vainionpaa R, Rahman M, et al. (2012) Incidence of respiratory virus- associated pneumonia in urban poor young children of Dhaka, Bangladesh,; 2009–2011. PLoS ONE 7: e32056 doi:32010.31371/journal.pone.0032056.
[40]
Niang MN, Diop OM, Sarr FD, Goudiaby D, Malou-Sompy H, et al. (2010) Viral Etiology of Respiratory Infections in Children Under 5 Years Old Living in Tropical Rural Areas of Senegal: The EVIRA Project. Journal of Medical Virology 82: 866–872. doi: 10.1002/jmv.21665
[41]
Stockman LJ, Brooks WA, Streatfield PK, Rahman M, Goswami D, et al. (2013) Challenges to Evaluating Respiratory Syncytial Virus Mortality in Bangladesh, 2004–2008. PLoS ONE 8: e53857. doi: 10.1371/journal.pone.0053857
[42]
Naheed A, Saha SK, Breiman RF, Khatun F, Brooks WA, et al. (2009) Multihospital Surveillance of Pneumonia Burden among Children Aged <5 Years Hospitalized for Pneumonia in Bangladesh. Clinical Infectious Diseases 48: S82–S89. doi: 10.1086/596485
[43]
Cham G, Yan S, Hoon HB, Seow E (2009) Predicting Positive Blood Cultures in Patients presenting with Pneumonia at an Emergency Department in Singapore. Annals Academy of Medicine Singapore 38: 508–514.
[44]
Shoma S, Rahman M, Yasmin M (2001) Rapid Detection of Haemophilus influenzae Type b in Bangladeshi Children with Pneumonia and Meningitis by PCR and Analysis of Antimicrobial Resistance. Journal of Health Population and Nutrition 19: 268–274.
[45]
Saha S, Darmstadt G, Naheed A, Arifeen S, Islam M, et al. (2011) Improving the Sensitivity of Blood Culture for Streptococcus pneumoniae. Journal of Tropical Pediatrics 57: 192–196. doi: 10.1093/tropej/fmq070
[46]
Sakthivel SK, Whitaker B, Lu X, Oliveira DBL, Stockman LJ, et al. (2012) Comparison of fast-track diagnostics respiratory pathogens multiplex real-time RT-PCR assay with in-house singleplex assays for comprehensive detection of human respiratory viruses. Journal of Virological Methods 185: 259–266. doi: 10.1016/j.jviromet.2012.07.010
[47]
Kodani M, Yang G, Conklin LM, Travis TC, Whitney CG, et al. (2011) Application of TaqMan Low-Density Arrays for Simultaneous Detection of Multiple Respiratory Pathogens. Journal of Clinical Microbiology 9: 2175–2182. doi: 10.1128/jcm.02270-10
[48]
Jarvinen A-K, Laakso S, Piiparinen P, Aittakorpi A, Lindfors M, et al. (2009) Rapid identification of bacterial pathogens using a PCR- and microarray-based assay. BMC Microbiology 9: 161. doi: 10.1186/1471-2180-9-161
[49]
Azzari C, Cortimiglia M, Moriondo M, Canessa C, Lippi F, et al. (2011) Pneumococcal DNA is not detectable in the blood of healthy carrier children by real-time PCR targeting the lytA gene. J Med Microbiol 60: 710–714. doi: 10.1099/jmm.0.028357-0
[50]
ICDDRB (2010) Surveillance updates. Health and Science Bulletin 8: 18–20.
[51]
HKI/IPHN (2002) Nutrition and Health Surveillance in Chittagong Division. HKI, Dhaka.
