title: Factors associated with increased risk of progression to respiratory syncytial virus-associated pneumonia in young Kenyan children.
abstract: OBJECTIVE
  To identify factors associated with developing severe respiratory syncytial virus (RSV) pneumonia and their commonality with all-cause lower respiratory tract infection (LRTI), in order to isolate those risk factors specifically associated with RSV-LRTI and identify targets for control.
  
  
  METHODS
  A birth cohort of rural Kenyan children was intensively monitored for acute respiratory infection (ARI) over three RSV epidemics. RSV was diagnosed by immunofluorescence of nasal washings collected at each ARI episode. Cox regression was used to determine the relative risk of disease for a range of co-factors.
  
  
  RESULTS
  A total of 469 children provided 937 years of follow-up, and experienced 857 all-cause LRTI, 362 RSV-ARI and 92 RSV-LRTI episodes. Factors associated with RSV-LRTI, but not RSV-ARI, were severe stunting (z-score < or =-2, RR 1.7 95%CI 1.1-2.8), crowding (increased number of children, RR 2.6, 1.0-6.5) and number of siblings under 6 years (RR 2.0, 1.2-3.4). Moderate and severe stunting (z-score < or =-1), crowding and a sibling aged over 5 years sleeping in the same room as the index child were associated with increased risk of all-cause LRTI, whereas higher educational level of the primary caretaker was associated with protection.
  
  
  CONCLUSIONS
  We identify factors related to host nutritional status (stunting) and contact intensity (crowding, siblings) which are distinguishable in their association with RSV severe disease in infant and young child. These factors are broadly in common with those associated with all-cause LRTI. The results support targeted strategies for prevention.
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya. eokiro@nairobi.kemri-wellcome.org
authors.forename: Emelda A
authors.initials: EA
authors.lastname: Okiro
authors.forename: Mwanajuma
authors.initials: M
authors.lastname: Ngama
authors.forename: Ann
authors.initials: A
authors.lastname: Bett
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cane
authors.forename: Graham F
authors.initials: GF
authors.lastname: Medley
authors.forename: D
authors.initials: D
authors.lastname: James Nokes
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003441:Crowding; D018450:Disease Progression; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D017817:Nasal Lavage Fluid / Q000821:virology; D009752:Nutritional Status; D011024:Pneumonia, Viral / Q000453:epidemiology*; D012044:Regression Analysis; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis / Q000453:epidemiology*; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D012307:Risk Factors