Defining RSV: clinical prediction of respiratory syncytial virus-associated disease in children under five years of age in Bondo District, Kenya, 2007-2009. Open Access

Abstract

Pneumonia is one of the leading causes of global under five mortality, with respiratory syncytial virus (RSV) as a common etiology. Detection of RSV is especially challenging without laboratory access. Therefore we aimed to create a clinical case definition to identify RSV disease in resource poor settings. Data were collected from children under five years of age admitted to inpatient facilities in Bondo District, Kenya, between 2007-2009. Children were tested for RSV using real-time polymerase chain reaction if they presented with World Health Organization-classified severe or very severe pneumonia, influenza-like illness, or symptoms of an upper respiratory tract infection. We used logistic regression to find a model that predicted RSV disease in our study population and used this model to calculate odds ratios of disease according to different clinical patterns of presentation. Of the 2 970 children under five years admitted to an inpatient service, 46.3% were tested for RSV and of those, 10.7% had laboratory-confirmed RSV. The odds of disease were highest among those children presenting with difficulty breathing, chest wall indrawing, and hypoxemia (SpO 2 <95%). The odds ratio was highest for children with all three of these symptoms, however was still significantly elevated when either two out of three symptoms or a single symptom were present. We suggest that a case definition that includes the clinical features of difficulty breathing, chest wall indrawing, and hypoxemia would allow for detection of RSV-associated disease in the absence of laboratory resources, which could decrease RSV-associated morbidity and mortality in developing countries.

Table of Contents

Chapter 1: Literature Review. 1

Global Childhood Pneumonia. 1

Burden of Respiratory Syncytial Virus. 2

Respiratory Syncytial Virus. 5

RSV Disease Presentation and Management. 6

Current Prophylactic Measures. 7

RSV Vaccine Development. 8

Immunology. 8

Target Populations for Vaccine Development. 8

RSV Vaccines in Development. 10

Challenges to Future RSV Vaccine Development. 10

Chapter 2: Manuscript. 16

Introduction. 16

Methods. 17

Laboratory Methods. 17

Definitions. 18

Data Analysis. 18

Results. 19

Discussion. 21

References. 24

Tables. 26

Figures. 29

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	pediatrics Kenya respiratory syncytial virus
Committee Chair / Thesis Advisor	Omer, Saad B, Emory University
Partnering Agencies	CDC

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