Brian Rha1, Rebecca M Dahl1,2, Jocelyn Moyes3,4, Alison M Binder1,5, Stefano Tempia6,7, Sibongile Walaza3,4, Daoling Bi1, Michelle J Groome8,9, Ebrahim Variava10,11,12, Fathima Naby13, Kathleen Kahn14,15,16, Florette Treurnicht3, Adam L Cohen6,7,17, Susan I Gerber1, Shabir A Madhi3,8,9, Cheryl Cohen3,4. 1. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia. 2. Maximus Federal, Atlanta, Georgia. 3. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa. 4. School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa. 5. Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee. 6. Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia. 7. Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa. 8. Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, Johannesburg, South Africa. 9. Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa. 10. Department of Medicine, Faculty of Health Sciences, Johannesburg, South Africa. 11. Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborative Centre for HIV/AIDS and TB, Johannesburg, South Africa. 12. Department of Medicine, Klerksdorp Tshepong Hospital, South Africa. 13. Department of Paediatrics, Pietermaritzburg Metropolitan Hospitals, University of KwaZulu-Natal, South Africa. 14. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 15. Centre for Global Health Research, Umeå University, Sweden. 16. INDEPTH Network, Accra, Ghana. 17. Department of Immunizations, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection (ALRTI) in young children, but data on surveillance case definition performance in estimating burdens have been limited. METHODS: We enrolled children aged <5 years hospitalized for ALRTI (or neonatal sepsis in young infants) through active prospective surveillance at 5 sentinel hospitals in South Africa and collected nasopharyngeal aspirates from them for RSV molecular diagnostic testing between 2009 and 2014. Clinical data were used to characterize RSV disease and retrospectively evaluate the performance of respiratory illness case definitions (including the World Health Organization definition for severe acute respiratory infection [SARI]) in identifying hospitalized children with laboratory-confirmed RSV according to age group (<3, 3-5, 6-11, 12-23, and 24-59 months). RESULTS: Of 9969 hospitalized children, 2723 (27%) tested positive for RSV. Signs and symptoms in RSV-positive children varied according to age; fever was less likely to occur in children aged <3 months (57%; odds ratio [OR], 0.8 [95% CI, 0.7-0.9]) but more likely in those aged ≥12 months (82%; OR, 1.7-1.9) than RSV-negative children. The sensitivity (range, 55%-81%) and specificity (range, 27%-54%) of the SARI case definition to identify hospitalized RSV-positive children varied according to age; the lowest sensitivity was for infants aged <6 months. Using SARI as the case definition would have missed 36% of RSV-positive children aged <5 years and 49% of those aged <3 months; removing the fever requirement from the definition recovered most missed cases. CONCLUSION: Including fever in the SARI case definition lowers the sensitivity for RSV case detection among young children hospitalized with an ALRTI and likely underestimates its burden. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2018.
BACKGROUND:Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection (ALRTI) in young children, but data on surveillance case definition performance in estimating burdens have been limited. METHODS: We enrolled children aged <5 years hospitalized for ALRTI (or neonatal sepsis in young infants) through active prospective surveillance at 5 sentinel hospitals in South Africa and collected nasopharyngeal aspirates from them for RSV molecular diagnostic testing between 2009 and 2014. Clinical data were used to characterize RSV disease and retrospectively evaluate the performance of respiratory illness case definitions (including the World Health Organization definition for severe acute respiratory infection [SARI]) in identifying hospitalized children with laboratory-confirmed RSV according to age group (<3, 3-5, 6-11, 12-23, and 24-59 months). RESULTS: Of 9969 hospitalized children, 2723 (27%) tested positive for RSV. Signs and symptoms in RSV-positive children varied according to age; fever was less likely to occur in children aged <3 months (57%; odds ratio [OR], 0.8 [95% CI, 0.7-0.9]) but more likely in those aged ≥12 months (82%; OR, 1.7-1.9) than RSV-negative children. The sensitivity (range, 55%-81%) and specificity (range, 27%-54%) of the SARI case definition to identify hospitalized RSV-positive children varied according to age; the lowest sensitivity was for infants aged <6 months. Using SARI as the case definition would have missed 36% of RSV-positive children aged <5 years and 49% of those aged <3 months; removing the fever requirement from the definition recovered most missed cases. CONCLUSION: Including fever in the SARI case definition lowers the sensitivity for RSV case detection among young children hospitalized with an ALRTI and likely underestimates its burden. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2018.
Entities:
Keywords:
South Africa; case definitions; respiratory syncytial virus; respiratory tract infections; surveillance
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