title: Respiratory syncytial virus infection in infants in rural Nepal.
abstract: Respiratory syncytial virus (RSV) pneumonia is a leading cause of infant mortality worldwide. The risk of RSV infection associated with preterm birth is not well-characterized in resource-limited settings. We aimed to obtain precise estimates of risk factors and disease burden of RSV in infants in rural southern Nepal.
  
  
  
  Pregnant women were enrolled, and along with their infants, followed to six months after birth with active weekly home-based surveillance for acute respiratory illness (ARI). Mid-nasal swabs were obtained and tested for RSV by PCR for all illness episodes. Birth outcomes were assessed at a postpartum home visit.
  
  
  
  311 (9%) of 3509 infants had an RSV ARI. RSV ARI incidence decreased from 551/1000 person-years in infants born between 28 and 31 weeks to 195/1000 person-years in infants born full-term (p = 0.017). Of 220 infants (71%) evaluated in the health system, 41 (19%) visited a hospital or physician. Of 287 infants with an assessment performed, 203 (71%) had a lower respiratory tract infection.
  
  
  
  In a rural south Asian setting with intensive home-based surveillance, RSV caused a significant burden of respiratory illness. Preterm infants had the highest incidence of RSV ARI, and should be considered a priority group for RSV preventive interventions in resource-limited settings.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA. Electronic address: helenchu@uw.edu.
authors.forename: Helen Y
authors.initials: HY
authors.lastname: Chu
authors.affiliation: Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of Global Health, George Washington University, Washington, D.C., USA.
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi, Sarlahi District, Nepal.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: Department of Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors.forename: Laxman
authors.initials: L
authors.lastname: Shrestha
authors.affiliation: Nepal Nutrition Intervention Project-Sarlahi, Sarlahi District, Nepal.
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Kuypers
authors.affiliation: Department of Global Health, Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Steinhoff
authors.affiliation: Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Englund
mesh_terms: D017281:Cost of Illness; D005260:Female; D006295:Health Resources; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology / Q000821:virology; D011247:Pregnancy; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012423:Rural Health
keywords: Pneumonia; Preterm birth; Resource-limited setting; Respiratory syncytial virus