Importance of nosocomial respiratory syncytial virus infections in an African setting.
OBJECTIVE
To define the importance of nosocomial-acquired respiratory syncytial virus (RSV) infection in an area with a high prevalence of paediatric HIV-1 infection.


METHODS
A prospective study was performed that involved all children hospitalized to a general paediatric ward during the course of an RSV epidemic. These children were screened within 24 h of admission and subsequently at 3-4 day intervals for RSV infection using a direct immunofluorescence assay.


RESULTS
RSV was detected in 36 (11.8%) of the 305 children upon initial investigation. Fourteen (38.9%) of the 36 children with community-acquired RSV infection were HIV-1 infected. Repeat sampling for RSV infection was performed in 130 children who tested negative for RSV infection on initial screening and who were hospitalized for > or =3 days. Nosocomial acquisition of RSV occurred among 11.5% of these children, of whom 33% were HIV-1 infected. Fourteen (93.3%) of the children with nosocomial RSV acquisition were clinically symptomatic and treated for 'nosocomial-sepsis'. Furthermore, RSV was isolated from 54% of all children who were investigated for clinically diagnosed nosocomial sepsis. Two (13%) of 15 children with nosocomial RSV infection died; both had other underlying medical conditions.


CONCLUSIONS
RSV is an important under-recognized cause of nosocomial infection and sepsis among children in this African country. Active interventions are warranted in addressing this problem, as has been successfully undertaken in developed countries.
Madhi
Shabir A
SA
Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Bertsham, South Africa. shabir.madhi@nhls.ac.za
Ismail
Kuraysha
K
O'Reilly
Cathryn
C
Cutland
Clare
C
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission*; D003906:Developing Countries; D004196:Disease Outbreaks; D005260:Female; D015497:HIV-1; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission*; D018113:Respiratory Syncytial Virus, Human; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology