Deaths Attributed to Respiratory Syncytial Virus in Young Children in High–Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS)
Authors: Blau Dianna M , Baillie Vicky L , Els Toyah , Mahtab Sana , Mutevedzi Portia , Keita Adama Mamby , Kotloff Karen L , Mehta Ashka , Sow Samba O , Tapia Milagritos D , Tippett Barr Beth A , Oluoch Benard O , Onyango Clayton , Revathi Gunturu , Verani Jennifer R , Abayneh Mahlet , Assefa Nega , Madrid Lola , Oundo Joseph O , Scott J Anthony G , Bassat Quique , Mandomando Inacio , Sitoe Antonio , Valente Marta , Varo Rosauro , Bassey Ima-Abasi , Cain Carrie Jo , Jambai Amara , Ogbuanu Ikechukwu , Ojulong Julius , Alam Muntasir , El Arifeen Shams , Gurley Emily S , Rahman Afruna , Rahman Mustafizur , Waller Jessica L , Dewey Betsy , Breiman Robert F , Whitney Cynthia G , Madhi Shabir A ,   CHAMPS Consortium, Adam Yasmin , Agaya Janet , Ajanovic Sara , Alemu Addisu , Ali Solomon , Aol George , Badji Henry , Bari Sanwarul , Bramugy Justina , Bunn James , Chawana Richard , Chowdhury Atique Iqbal , Fairchild Karen D , Fentaw Surafel , Flora Meerjady Sabrina , Gethi Dickson , Govender Nelesh P , Greene Carol L , Gure Tadesse , Hale Martin , Hurtado Juan Carlos , Igunza Kitiezo Aggrey , Islam Farzana , Kristie Johnson J , Keita Tatiana , Khagayi Sammy , Khan Iqbal Ansary , Koka Rima , Kone Diakaridia , Kourouma Nana , Kuria Magdalene N , Lako Sandra , Lala Sanjay G , Lombaard Hennie , Luke Ronita , Misore Thomas , Mitei Paul K , Ibrahim Alexander M , Moultrie Andrew , Murila Florence V , Myburgh Nellie , Nyamthimba Peter , Oliech Richard , Omore Richard , Onwuchekwa Uma U , Orlien Stian M S , Othieno Louis , Otieno Peter , Otieno Kephas , Ouma Gregory , Owuor Benard , Parveen Shahana , Petersen Karen L , Rahman Mahbubur , Rakislova Natalia , Rogena Emily A , Sanogo Doh , Shirin Tahmina , Sidibe Diakaridia , Sissoko Seydou , Solomon Fatima , Sorour Gillian , Sylvester Squire James , Swart Peter J , Temesgen Fikremelekot , Tennant Sharon M , Thwala Bukiwe Nana , Traore Cheick Bougadari , Velaphi Sithembiso , Vitorino Pio , Wadula Jeannette , Yeshi Melisachew Mulatu 
Published: May 2021

Abstract

Background
Lower respiratory tract infections are a leading cause of death in young children, but few studies have collected the specimens needed to define the role of specific causes. The Child Health and Mortality Prevention Surveillance (CHAMPS) platform aims to investigate causes of death in children aged &lt;5 years in high–mortality rate settings, using postmortem minimally invasive tissue sampling and other advanced diagnostic techniques. We examined findings for deaths identified in CHAMPS sites in 7 countries in sub-Saharan Africa and south Asia to evaluate the role of respiratory syncytial virus (RSV).

Methods
We included deaths that occurred between December 2016 and December 2019. Panels determined causes of deaths by reviewing all available data including pathological results from minimally invasive tissue sampling, polymerase chain reaction screening for multiple infectious pathogens in lung tissue, nasopharyngeal swab, blood, and cerebrospinal fluid samples, clinical information from medical records, and verbal autopsies.

Results
We evaluated 1213 deaths, including 695 in neonates (aged &lt;28 days), 283 in infants (28 days to &lt;12 months), and 235 in children (12–59 months). RSV was detected in postmortem specimens in 67 of 1213 deaths (5.5%); in 24 deaths (2.0% of total), RSV was determined to be a cause of death, and it contributed to 5 other deaths. Younger infants (28 days to &lt;6 months of age) accounted for half of all deaths attributed to RSV; 6.5% of all deaths in younger infants were attributed to RSV. RSV was the underlying and only cause in 4 deaths; the remainder (n = 20) had a median of 2 (range, 1–5) other conditions in the causal chain. Birth defects (n = 8) and infections with other pathogens (n = 17) were common comorbid conditions.

Conclusions
RSV is an important cause of child deaths, particularly in young infants. These findings add to the substantial body of literature calling for better treatment and prevention options for RSV in high–mortality rate settings.