Nosocomial RSV-related In-hospital Mortality in Children <5 Years: A Global Case Series
Authors: Yvette N Löwensteyn, Joukje E Willemsen, Natalie I Mazur, Nienke M Scheltema, Nynke C J van Haastregt, Amber A A Ten Buuren, Ichelle van Roessel, Dunja Scheepmaker, Harish Nair, Peter M van de Ven, Louis J Bont, on behalf of the RSV GOLD Study Group, Josep Estrada, Angela Gentile, Maria Florencia Lucion, Marcela Echavarria, Noelia Reyes, Fernando P Polack, Mauricio T Caballero, Annette Alafaci, Nigel Crawford, Jenny Thompson, Warwick Butt, Nusrat Homaira, Adam Jaffe, Gemma Saravanos, Philip Britton, Christoph Binder, Angelika Berger, Bernhard Resch, Fahmida Chowdhury, Md Ariful Islam, Senjuti Saha, Samir Saha, José Gareca Perales, Felipe Cotrim de Carvalho, Sergio de Andrade Nishioka, Maria Tereza da Costa Oliveira, Carla Cecília de Freitas Lázaro Emediato, Heloisa Giamberardino, Jane Melissa Webler, Regina GrigolliCesar, Daniel Jarovsky, Daniela Gregória Bomfim Prado da Silva, Patricia Gomes de Matos Bezerra, Maria do Carmo Menezes Bezerra Duarte, Fernanda de-Paris, Márcia Rosane Pires, Sonia M Raboni, Tani Sagna, Serge Diagbouga, Daniel Garros, Michael Hawkes, Joanne M Langley, Jill Mutch, Kirk Leifso, Shaun K Morris, Waison Wong, Bosco A Paes, Jesse Papenburg, Franco Diaz, Rodrigo A Fasce, Olga Lopez, Ting F Leung, Wei Su, Chiang Chun Yuan, Zhengde Xie, Junhong Ai, Evelyn Obando Belalcazar, Jaime Fernández-Sarmiento, Ledys Izquierdo, Rubén Lasso, Rosalba Pardo-Carrero, Pablo Vasquez, Eliana Zemanate, Srđan Roglić, Thea K Fischer, Sune Rubak, Mette Holm, Domenica de Mora, Alfredo Bruno, Jenny Ojeda, Lida Zamora, Erica Dueger, Terho Heikkinen, Gilles Cambonie, Jean-Christophe Dubus, Melina Messaoudi, Juliet Bryant, Haoua Tall, Bradford D Gessner, Dominique Ploin, Come Horvat, Nour Hanna, Christian Vogelberg, Christoph Härtel, Andrea Streng, Johannes Liese, Barbara A Rath, Jürgen Seidenberg, Geeske Stelljes, Evangeline Obodai, John Kofi Odoom, Irini Eleftheriou, Maria Tsolia, Vassiliki Papaevangelou, Elpiniki Kartsiouni, Tapan Dhole, Sheetal Verma, Rashmi Ranjan Das, Ashish Satav, Agustinus Sutanto, Dario Prais, Orli Megged, Francesca Tortora, Fabrizio Chiusolo, Giovanni Gabutti, Kazuki Iio, Satoshi Kusuda, Hitoshi Oshitani, Hisato Ito, Najwa Khuri-Bulos, Loai Saadah, Iman Basheti, Sandra S Chaves, Gideon Emukule, Patrick K Munywoki, D James Nokes, Grieven Paul Otieno, Ieva Silina, Abdulla Alfraij, Mohammad Alghounaim, Ghassan Dbaibo, Rima Hanna-Wakim, Yoke-Fun Chan, Jamal I-Ching Sam, Teck-Hock Toh, Jeffrey Soon-Yit Lee, David Pace, Socorro P Lupisan, Marilla G Lucero, Daniel E Noyola, Andreu ComasGarcía, Túfaria Mussá, Brigitte Buiteman, Diederick E Grobbee, Rosalie Linssen, Namrata Prasad, José F Sánchez, Uzma Bashir Aamir, Qalab Abbas, Abdul Momin Kazi, Sidra Asif Khan, Rodrigo DeAntonio, Xavier Saez-Llorens, Juana Del Valle-Mendoza, Wojciech Feleszko, Karolina Dumycz, Sara Cristina de Tavares Ferreira, Ana Beatriz de Sousa Pereira Luzio Vaz, Mohammed Ahmed Abdullah Qashnon, Khalid Alansari, Eun Hwa Choi, Yae-Jean Kim, Eun Lee, Eun-Ae Yang, Hyun Mi Kang, Kirill Stolyarov, Thoon Koh Cheng, Kee Thai Yeo, Chee Fu Yung, Stefan Grosek, Marko Pokorn, Cheryl Cohen, Shabir A Madhi, Michelle J Groome, Jocelyn Moyes, Marietjie Venter, Adele Visser, Cristina O'Callaghan-Gordo, Quique Bassat, Cristina Calvo, Xavier Carbonell-Estrany, Francisco J Elola, Manuel Sánchez Luna, Rosa Rodriguez Fernandez, Cristian Launes, Carmen Muñoz-Almagro, J A A Sampath Jayaweera, Martin W Weber, Joachim Luthander, Ulrich Heininger, Daniel Trachsel, Claudia E Kuehni, Cristina Ardura-Garcia, Chia-Yu Chi, Hsin Chi, Shuenn-Nan Chiu, Jou-Kou Wang, Yhu-Chering Huang, Piyarat Suntarattiwong, Somsak Thamthitiwat, Nasamon Wanlapakorn, Aida Borgi, Ahmed Ayari, Imen Bel Hadj, Khadija Boussetta, Benan Bayrakci, Esra Koçkuzu, Muhterem Duyu, Sule Gökçe, Aykut Eşki, Tanil Kendirli, Emrah Gün, Edward A Goka, Simon Nadel, Marwa Ghazaly, Kentigern Thorburn, Paul S McNamara, Soledad Menta, Nicolás Monteverde, Sebastián González-Dambrauskas, Dianna M Blau, Katherine Horton, Robert F Breiman, Andrea Buchwald, Helen Chu, Leah Forman, Christopher J Gill, Lawrence Mwananyanda, Aubree Gordon, Natasha Halasa, Danielle Hessong, Diego Raul Hijano, Kim J Allison, Matthew S Kelly, Veena Kumar, Asuncion Mejias, Octavio Ramilo, Katherine O'Brien, Saad B Omer, Thyyar Ravindranath, Steven L Shein, Ananya Parlapalli, Eric A F Simões, Michael C Spaeder, Pham Thi Minh Hong, Tran Anh Tuan, Mohammed Al Amad, Abdul Wahed Al Serouri
Journal: Pediatr Infect Dis J (2023)
MeSH terms: Cross Infection / epidemiology, Child, Hospital Mortality, Hospitals, Humans, Infant, Newborn, Research

Background:
According to the World Health Organization, the global burden of nosocomial infections is poorly characterized as surveillance systems are lacking. Nosocomial infections occur at higher rates in low- and lower-middle-income countries (LMICs) than in high-income countries (HICs). Current global RSV burden estimates are largely based on community-acquired infection. We aimed to characterize children with nosocomial RSV-related mortality and to understand the potential impact of RSV immunization strategies.
Materials:
RSV GOLD is a global registry of children younger than 5 years who died with laboratory-confirmed RSV infection. We compared clinical and demographic characteristics of children with nosocomial and community-acquired RSV in-hospital mortality.
Results:
We included 231 nosocomial and 931 community-acquired RSV-related in-hospital from deaths from 65 countries. Age at death was similar for both groups (5.4 vs. 6 months). A higher proportion of nosocomial deaths had comorbidities (87% vs. 57%; P < 0.001) or was born preterm (46% vs. 24%; P < 0.001) than community-acquired deaths. The proportion of nosocomial deaths among all RSV deaths was lower in LMICs than in upper-middle-income countries (UMICs) and HICs (12% vs. 18% and 26%, respectively).
Conclusions:
This is the first global case series of children dying with nosocomial RSV infection. Future infant-targeted immunization strategies could prevent the majority of nosocomial RSV-related deaths. Although nosocomial RSV deaths are expected to occur at highest rates in LMICs, the number of reported nosocomial RSV deaths was low in these countries. Hospital-based surveillance is needed to capture the full burden of nosocomial RSV mortality in LMICs.