Global Respiratory Syncytial Virus–Related Infant Community Deaths
Authors: Mazur Natalie I , Löwensteyn Yvette N , Willemsen Joukje E , Gill Christopher J , Forman Leah , Mwananyanda Lawrence M , Blau Dianna M , Breiman Robert F , Madhi Shabir A , Mahtab Sana , Gurley Emily S , El Arifeen Shams , Assefa Nega , Scott J Anthony G , Onyango Dickens , Tippet Barr Beth A , Kotloff Karen L , Sow Samba O , Mandomando Inacio , Ogbuanu Ikechukwu , Jambai Amara , Bassat Quique ,   CHAMPS Network the RSV GOLD Study Group, Thamthitiwat Somsak , Gentile Angela , Lucion Maria Florencia , Pires Márcia Rosane , de-Paris Fernanda , Gordon Aubree , Sánchez José Félix , Lucero Marilla G , Lupisan Socorro P , Gessner Bradford D , Tall Haoua , Halasa Natasha , Khuri-Bulos Najwa , Nokes D James , Munywoki Patrick K , Otieno Grieven P , O’Brien Katherine L , Oshitani Katherine L , da Costa Oliveira Maria Tereza , de Freitas Lázaro Emediato Carla Cecília , Ali Asad , Aamir Uzma Bashir , Noyola Daniel E , Cohen Cheryl , Moyes Jocelyn , Giamberardino Heloisa Ihle Garcia , Webler Jane Melissa , de Matos Bezerra Patricia Gomes , Bezerra Duarte Maria do Carmo Menezes , Chu Helen Y , Das Rashmi Ranjan , Weber Martin W , Homaira Nusrat , Jaffe Adam , Sturm-Ramirez Katharine M , Su Wei , Yuan Chiang Chun , Chaves Sandra , Emukule Gideon O , de Andrade Nishioka Sergio , de Carvalho Felipe Cotrim , Gökçe Şule , Raboni Sonia M , Hawkes Michael , Messaoudi Melina , Bryant Juliet , Dbaibo Ghassan S , Hanna-Wakim Rima , Sampath Jayaweera J A A , Stolyarov Kirill , Suntarattiwong Piyarat , Mussá Tufária , Bruno Alfredo , de Mora Domenica , Wanlapakorn Nasamon , de Xie Zheng , Ai Junhong , Ojeda Jenny , Zamora Lida , Obodai Evangeline , Odoom John Kofi , Ismail Maha Talaat , Buchwald Andrea , O’Callaghan-Gordo Cristina , Fernandez-Sarmiento Jaime , Obando-Belalcazar Evelyn , Dhole Tapan , Verma Sheetal , Eşki Aykut , Ozturk Kartal G , Al Amad Mohammed , Al Serouri Abdul Wahed , FunChan Yoke , Sam Jamal I-Ching , Jarovsky Daniel , da Silva Daniella Gregória Bomfim Prado , Perales José Gareca , Toh Teck-Hock , Yit Jeffrey Lee Soon , Kendirli Tanil , Gun Emrah , Sagna Tani , Diagbouga Serge , Chowdhury Fahmida , Islam Md Ariful , Venter Marietjie , Visser Adele , Pham Minh-Hong , Vásquez-Hoyos Pablo , González-Dambrauskas Sebastián , Rubio Franco Díaz , Karsies Todd , Zemanate Eliana , Izquierdo Ledys , Palomino Rubén Lasso , Pardo-Carrero Rosalba , Grigolli-Cesar Reginna , Menta Soledad , Monteverde Nicolás , Duyu Muhterem , Saha Senjuti , Saha Samir K , Kelly Matthew , Echavarria Marcela , Tran Tuan , Borgi Aida , Ayari Ahmed , Caballero Mauricio T , Polack Fernando P , Omer Saad , Kazi Abdul Momin , Simões Eric A F , Satav Ashish , Bont Louis J 
Published: June 2021

Abstract

Background
Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with &gt;99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized.

Methods
The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths &lt;6 months occurring in the community with in-hospital.

Results
We studied 829 RSV-related deaths &lt;1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred &lt;6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P &lt; .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P &lt; 0.0001).

Conclusions
We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines.