Respiratory Syncytial Virus-Associated Mortality Among Young Infants in Karachi, Pakistan: A Prospective Postmortem Surveillance Study

Abdul Momin Kazi; Obianuju G Aguolu; Waliyah Mughis; Nazia Ahsan; Saima Jamal; Ayub Khan; Hanya M Qureshi; Inci Yildirim; Fauzia A Malik; Saad B Omer

doi:10.1093/cid/ciab488

Respiratory Syncytial Virus-Associated Mortality Among Young Infants in Karachi, Pakistan: A Prospective Postmortem Surveillance Study

Clin Infect Dis. 2021 Sep 2;73(Suppl_3):S203-S209. doi: 10.1093/cid/ciab488.

Authors

Abdul Momin Kazi¹, Obianuju G Aguolu^{2

3}, Waliyah Mughis¹, Nazia Ahsan¹, Saima Jamal¹, Ayub Khan¹, Hanya M Qureshi², Inci Yildirim^{2

4}, Fauzia A Malik³, Saad B Omer^{2

3

5

6}

Affiliations

¹ Department of Pediatrics, The Aga Khan University, Karachi, Pakistan.
² Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA.
³ Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
⁴ Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
⁵ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.
⁶ Yale School of Nursing, Yale University, New Haven, Connecticut, USA.

Abstract

Background: Respiratory syncytial virus (RSV) is an important cause of infant morbidity and mortality and a potential target for maternal immunization strategies. However, data on the role of RSV in young infant deaths in developing countries are limited.

Methods: We conducted a community-based mortality surveillance from August 2018-March 2020 for infants ≤6 months in Karachi, Pakistan. We tested (reverse transcription-polymerase chain reaction) nasopharyngeal swabs from deceased infants for presence of RSV. We performed verbal autopsies and calculated odds of RSV-associated mortality with 95% CIs and used multivariable logistic regression to evaluate associations.

Results: We collected 490 nasopharyngeal specimens from 1280 eligible infant deaths. There were 377/490 (76.9%) live births and 14/377 (3.7%; 95% CI: 1.8-5.6) were RSV positive. Most deaths occurred in neonates (254/377; 67.4%), males (226/377; 59.9%), and respiratory illnesses (206/377; 54.6%). Postneonatal age (10/14, 71.4%; OR: 5.5; 95% CI: 1.7-18.0), respiratory symptoms (12/14, 85.7%; OR: 5.2; 1.2-23.7), and high RSV season (9/14, 64.3%; OR: 4.4; 1.4-13.3) were associated with RSV mortality. In multivariable logistic regression analysis, respiratory symptoms (OR: 6.6; 95% CI: 1.3-32.5), RSV seasonality (6.1; 1.8-20.4), and age (9.2; 2.6-33.1) were significant predictors of RSV-associated mortality.

Conclusions: RSV has a significant mortality burden in early infancy in Karachi, Pakistan. Age, RSV seasonality, and respiratory symptoms were significant predictors of RSV-associated mortality. Our findings have implications for clinical management of young infants with cold-like symptoms, policy development, and research regarding maternal immunization against RSV during pregnancy, in resource-constrained, low-income, and vaccine-hesitant populations.

Keywords: community-based mortality surveillance; maternal vaccine; respiratory syncytial virus; verbal autopsy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autopsy
Female
Humans
Infant
Infant, Newborn
Male
Pakistan / epidemiology
Pregnancy
Prospective Studies
Respiratory Syncytial Virus Infections* / epidemiology
Respiratory Syncytial Virus, Human*

Abstract

Publication types

MeSH terms

Grants and funding