title: Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors.
abstract: Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear.
  
  
  
  To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants.
  
  
  
  This was a prospective, population-based, cross-sectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model.
  
  
  
  A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes.
  
  
  
  RSV was the most frequent cause of mortality in low-income postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Sarah
authors.initials: S
authors.lastname: Geoghegan
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Anabella
authors.initials: A
authors.lastname: Erviti
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Mauricio T
authors.initials: MT
authors.lastname: Caballero
authors.affiliation: 2 Región VI, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vallone
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Stella M
authors.initials: SM
authors.lastname: Zanone
authors.affiliation: 3 Hospital de Alta Complejidad El Cruce "Dr. Néstor Kirchner," Florencio Varela, Argentina.
authors.forename: Juan Ves
authors.initials: JV
authors.lastname: Losada
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Patricio L
authors.initials: PL
authors.lastname: Acosta
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Talarico
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Ferretti
authors.affiliation: 4 Hospital Zonal General de Agudos "Lucio Meléndez," Adrogué, Argentina.
authors.forename: Luciano Alva
authors.initials: LA
authors.lastname: Grimaldi
authors.affiliation: 5 Hospital Interzonal General de Agudos "Evita," Lanús, Argentina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sancilio
authors.affiliation: 5 Hospital Interzonal General de Agudos "Evita," Lanús, Argentina.
authors.forename: Karina
authors.initials: K
authors.lastname: Dueñas
authors.affiliation: 6 Hospital Zonal General de Agudos Descentralizado "Evita Pueblo," Berazategui, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Sastre
authors.affiliation: 6 Hospital Zonal General de Agudos Descentralizado "Evita Pueblo," Berazategui, Argentina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: 7 Hospital General de Niños "Pedro de Elizalde," Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ferrero
authors.affiliation: 8 Hospital Zonal General de Agudos "Dr. Narciso López," Lanús, Argentina.
authors.forename: Edgar
authors.initials: E
authors.lastname: Barboza
authors.affiliation: 9 Institute for Development and Research in Pediatrics "Prof. Dr. Fernando E. Viteri," Children's Hospital of La Plata (Min Sal/CIC-PBA), La Plata, Argentina.
authors.forename: Guadalupe Fernández
authors.initials: GF
authors.lastname: Gago
authors.affiliation: 10 Hospital Interzonal General de Agudos "Dr. Pedro Fiorito," Avellaneda, Argentina.
authors.forename: Celina
authors.initials: C
authors.lastname: Nocito
authors.affiliation: 11 Hospital Zonal General de Agudos "Dr. Arturo Oñativia," Rafael Calzada, Argentina.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Flamenco
authors.affiliation: 12 Hospital Zonal General de Agudos "Dr. Alberto Eurnekián," Ezeiza, Argentina.
authors.forename: Alberto Rodriguez
authors.initials: AR
authors.lastname: Perez
authors.affiliation: 13 Hospital Interzonal General de Agudos "Presidente Perón," Avellaneda, Argentina.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rebec
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: F Martin
authors.initials: FM
authors.lastname: Ferolla
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Romina
authors.initials: R
authors.lastname: Libster
authors.affiliation: 14 Johns Hopkins University, Baltimore, Maryland; and.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Karron
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bergel
authors.affiliation: 1 Fundación INFANT, Buenos Aires, Argentina.|15 Vanderbilt University, Nashville, Tennessee.
authors.forename: Fernando P
authors.initials: FP
authors.lastname: Polack
mesh_terms: D001118:Argentina / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D011030:Pneumothorax / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D012136:Respiratory Syncytial Viruses; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: bacterial superinfections; mortality; pneumothorax; respiratory syncytial virus