title: Importance of nosocomial respiratory syncytial virus infections in an African setting.
abstract: 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.
authors.affiliation: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Bertsham, South Africa. shabir.madhi@nhls.ac.za
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Kuraysha
authors.initials: K
authors.lastname: Ismail
authors.forename: Cathryn
authors.initials: C
authors.lastname: O'Reilly
authors.forename: Clare
authors.initials: C
authors.lastname: Cutland
mesh_terms: 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