Five-year cohort study of hospitalization for respiratory syncytial virus associated lower respiratory tract infection in African children

ObjectivesTo describe the epidemiology of respiratory syncytial virus (RSV) associated lower respiratory tract infection (RSV-LRTI) hospitalizations in South African children over a 5-year period, and determine the impact of gestational age (GA) on the incidence of RSV-LRTI hospitalization.Study designA cohort of 39 836 children, 6.47% of whom were HIV infected, enrolled into a phase 3 trial were prospectively studied for respiratory viruses when hospitalized for LRTI.ResultsThe incidence of hospitalization for RSV-LRTI was 19.4 per 1000 in HIV uninfected children and 2.5-fold (95% CI 2.04–3.03) greater in HIV infected children (45.0 per 1000). The incidence of RSV-LRTI was 4.9-fold greater (95% CI 3.9–6.8) in children born at <36 weeks of gestational age (GA) and repeat hospitalizations for RSV-LRTI was 3.7-fold (95% CI 1.4–9.4) more likely in these children (7.3%) than children born at ≥36 weeks of GA (1.9%). The burden of RSV-LRTI was greater in children born at <32 weeks of GA than those born at 32–35 weeks of GA between 6–12 months (P = 0.008) and 12–24 months of age (P = 0.001). The RSV epidemic occurred at the end of the rainy season and peaked when the monthly temperatures were at its lowest each year.