title: Malnutrition: a risk factor for severe respiratory syncytial virus infection and hospitalization.
abstract: BACKGROUND
  Longitudinal information examining the effect of poor infant growth on respiratory syncytial virus (RSV) severity is limited. Children hospitalized with RSV lower respiratory infection represent those at the severe end of the disease spectrum.
  
  
  METHODS
  We followed up a cohort of 12,191 infants enrolled in a previous pneumococcal vaccine trial in Bohol, Philippines. Exposure measures were weight for age z-score at the first vaccination visit (median age 1.8 months) as well as the growth (the difference in weight for age z-score) between the first and third vaccination visits. The outcome was hospitalization with RSV lower respiratory infection.
  
  
  RESULTS
  Children with a weight for age z-score ≤ -2 at their first vaccination visit had the highest rate of hospitalization with RSV lower respiratory infection, but this association was only evident in children whose mothers had >10 years of education (hazard ratio: 3.38; 95% confidence interval: 1.63-6.98). Children who had lower than median growth between their first and third vaccinations had a higher rate of RSV-associated hospitalization than those with growth above the median (hazard ratio: 1.34; 95% confidence interval: 1.02-1.76).
  
  
  CONCLUSIONS
  Poor infant growth increases the risk for severe RSV infection leading to hospitalization.
authors.affiliation: From the *School of Population Health; †Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia; ‡Research Institute of Tropical Medicine, Manila, the Philippines; §Department of Vaccines and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland; ¶Barbara Hardy Institute, University of South Australia, Adelaide, Australia; ‖University of Colorado Denver, School of Medicine; Center for Global Health, Colorado School of Public Health; and **Children's Hospital Colorado, Aurora, CO.
authors.forename: Stuart
authors.initials: S
authors.lastname: Paynter
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.forename: Marilla G
authors.initials: MG
authors.lastname: Lucero
authors.forename: Veronica
authors.initials: V
authors.lastname: Tallo
authors.forename: Hannah
authors.initials: H
authors.lastname: Nohynek
authors.forename: Philip
authors.initials: P
authors.lastname: Weinstein
authors.forename: Gail
authors.initials: G
authors.lastname: Williams
authors.forename: Peter D
authors.initials: PD
authors.lastname: Sly
authors.forename: Eric A F
authors.initials: EA
authors.lastname: Simões
mesh_terms: D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology*; D009035:Mothers / Q000706:statistics & numerical data; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000453:epidemiology*; D022261:Respiratory Syncytial Virus Vaccines / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022261:Respiratory Syncytial Virus Vaccines