title: Population-based Incidence and Etiology of Community-acquired Neonatal Viral Infections in Bangladesh: A Community-based and Hospital-based Surveillance Study.
abstract: BACKGROUND
  The etiology of >90% of cases of suspected neonatal infection remains unknown. We conducted community-based surveillance in conjunction with hospital-based surveillance in a rural region in Bangladesh from June 2006 to September 2007 to assess the incidence and etiology of community-acquired viral infections among neonates.
  
  
  METHODS
  Community health workers (CHWs) assessed neonates at home on days 0, 2, 5 and 8 after birth and referred cases of suspected illness to the hospital (CHW surveillance). Among neonates with clinically suspected upper respiratory tract infection (URTI), pneumonia, sepsis and/or meningitis, virus identification studies were conducted on nasal wash, cerebrospinal fluid and/or blood specimens. In the hospital-based surveillance, similar screening was conducted among all neonates (referred by CHWs and self-referred) who were admitted to the hospital.
  
  
  RESULTS
  CHW surveillance found an incidence rate of 15.6 neonatal viral infections per 1000 live births with 30% of infections identified on the day of birth. Among neonates with suspected sepsis, a viral etiology was identified in 36% of cases, with enterovirus accounting for two-thirds of those infections. Respiratory syncytial virus was the most common etiologic agent among those with viral pneumonia (91%) and URTI (68%). There was a low incidence (1.2%) of influenza in this rural population.
  
  
  CONCLUSIONS
  Viral infections are commonly associated with acute newborn illness, even in the early neonatal period. The estimated incidence was 5-fold greater than reported previously for bacterial infections. Low-cost preventive measures for neonatal viral infections are urgently needed.
authors.affiliation: From the *International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; †Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; ‡Measure Demographic Health Surveys, United States Agency for International Development, Washington, DC; §Department of Pediatrics, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh; ¶Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; ‖Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; **Department of Epidemiology, Center for Global Health, Colorado School of Public Health, Aurora, Colorado; ††Section of Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado; ‡‡Department of Child Health, ICDDR,B, Dhaka, Bangladesh; §§Department of Microbiology, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom; ¶¶National Institutes Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom; and ‖‖Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Farzin
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Yoonjoung
authors.initials: Y
authors.lastname: Choi
authors.forename: Nawshad Uddin
authors.initials: NU
authors.lastname: Ahmed
authors.forename: Eric A F
authors.initials: EA
authors.lastname: Simoes
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Al-Emran
authors.forename: Sanwarul
authors.initials: S
authors.lastname: Bari
authors.forename: Syed M
authors.initials: SM
authors.lastname: Rahman
authors.forename: Ishtiaq
authors.initials: I
authors.lastname: Mannan
authors.forename: Derrick
authors.initials: D
authors.lastname: Crook
authors.forename: Habibur Rahman
authors.initials: HR
authors.lastname: Seraji
authors.forename: Nazma
authors.initials: N
authors.lastname: Begum
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D001769:Blood / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology; D017714:Community-Acquired Infections / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D009296:Nasal Cavity / Q000821:virology; D011446:Prospective Studies; D012424:Rural Population; D014777:Virus Diseases / Q000453:epidemiology*