Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.
BACKGROUND
Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resource-poor settings remains poorly defined.


METHODS
We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated for the well-defined population.


RESULTS
Of 25,149 hospital admissions, 7359 patients (29%) had severe or very severe pneumonia, of whom 6026 (82%) were enrolled. RSV prevalence was 15% (20% among infants) and 27% during epidemics (32% among infants). The proportion of case patients aged 3 months was 65%, and the proportion aged 6 months was 43%. Average annual hospitalization rates were 293 hospitalizations per 100,000 children aged <5 years (95% confidence interval, 271-371 hospitalizations per 100,000 children aged <5 years) and 1107 hospitalizations per 100,000 infants (95% confidence interval, 1012-1211 hospitalizations per 100,000 infants). Hospital admission rates were double in the region close to the hospital. Few patients with RSV infection had life-threatening clinical features or concurrent serious illnesses, and the associated mortality was 2.2%.


CONCLUSIONS
In this low-income setting, rates of hospital admission with RSV-associated pneumonia are substantial; they are comparable to estimates from the United States but considerably underestimate the burden in the full community. An effective vaccine for children aged >2 months (outside the age group of poor responders) could prevent a large portion of RSV disease. Severity data suggest that the justification for RSV vaccination will be based on the prevention of morbidity, not mortality.
Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya. jnokes@kilifi.kemriwellcome.org
D James
DJ
Nokes
Mwanajuma
M
Ngama
Anne
A
Bett
John
J
Abwao
Patrick
P
Munywoki
Mike
M
English
J Anthony G
JA
Scott
Patricia A
PA
Cane
Graham F
GF
Medley
D002675:Child, Preschool; D005843:Geography; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D011024:Pneumonia, Viral / Q000453:epidemiology*; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000821:virology