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Epidemiology of respiratory syncytial virus in a community birth cohort of infants in the first 2 years of life

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Abstract

Respiratory syncytial virus (RSV) is the most common virus identified in children hospitalised with acute respiratory infections. However, less is known about RSV in community settings. This report describes RSV epidemiology in the community, including acute illness episodes, healthcare burden, and risk factors in Australian children during the first 2-years of life. A community-based, birth cohort from Brisbane, Australia, followed children until their second birthday. Parents completed daily respiratory symptom and illness-burden diaries. Weekly parent-collected nasal swabs were analysed for RSV by real-time polymerase chain reaction assays. Serum RSV-neutralising antibodies were assayed at age 3 years. Overall, 158 children provided 11,216 swabs, of which 104 were RSV-positive (85 incident episodes). RSV incidence in the first 2 years of life was 0.46 (95% CI = 0.37–0.58) episodes per child-year. Incidence increased with age and formal childcare attendance and was highest in autumn. Of 82 episodes linked with symptom data, 60 (73.2%) were symptomatic, 28 (34.1%) received community-based medical care, and 2 (2.4%) led to hospitalisation. Viral load was higher in symptomatic than asymptomatic infections. In 72 children, RSV-specific antibody seroprevalence was 94.4% at age 3 years.

Conclusion: RSV incidence increased after age 6-months with approximately three-quarters of infections symptomatic and most infections treated in the community.

What is known

•RSV is a major cause of hospitalisation for acute lower respiratory infections in infants and young children, especially in the first 6 months of life.

•However, limited data exist on the overall burden in young children at the community level.

What is new

•RSV incidence in the community increases after age 6 months, and by 3 years, most children have been infected.

•About one-quarter of RSV infections were asymptomatic in children aged < 2 years, and approximately 60% of children with RSV-related symptoms had a healthcare contact of any kind with most managed within the community.

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Data availability

De-identified participant data, the data dictionary, and related documents (e.g. case report forms) will be made available on written request to the senior author. Requests must be accompanied by a formal protocol for the use of the data and approval from the relevant Human Research Ethics Committees. A written and signed data access agreement will be required.

Code availability

Contact corresponding author.

Abbreviations

ALRI:

Acute lower respiratory infection

AOM:

Acute otitis media

ARI:

Acute respiratory infection

Ct:

Cycle threshold

ELLF:

Early Life Lung Function

ERV-3:

Endogenous retrovirus-3

IQR:

Interquartile range

ORChID:

Observational Research in Childhood Infectious Diseases

PCR:

Polymerase chain reaction

RSV:

Respiratory syncytial virus

URI:

Upper respiratory infection

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Acknowledgements

The authors acknowledge the generosity of the study families who participated in the study and the efforts of the recruitment nurses and volunteer staff members for administrative assistance.

Funding

The Observational Research in Childhood Infectious Diseases (ORChID) study was supported by the Australian National Health and Medical Research Council (NHMRC; GNT615700) and a programme grant from the Children’s Hospital Foundation Queensland (50006). The Early Life Lung Function study was also supported by the NHMRC (GNT1078600).

Author information

Authors and Affiliations

  1. Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast, Queensland, 4222, Australia

    Mari D. Takashima, Keith Grimwood & Robert S. Ware

  2. School of Medicine, Griffith University Nathan Campus, QLD, Nathan, 4111, Australia

    Mari D. Takashima

  3. Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, 4215, Australia

    Keith Grimwood

  4. Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, 4101, Australia

    Peter D. Sly

  5. Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, 4072, Australia

    Peter D. Sly, Keith J. Chappell & Daniel Watterson

  6. The Australian National University, Canberra, Australian Capital Territory, 2600, Australia

    Stephen B. Lambert

  7. School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, 4072, Australia

    Keith J. Chappell & Daniel Watterson

Authors
  1. Mari D. Takashima
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  2. Keith Grimwood
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  3. Peter D. Sly
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  4. Stephen B. Lambert
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  5. Keith J. Chappell
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  6. Daniel Watterson
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  7. Robert S. Ware
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Contributions

This study analysed data from the ORChID birth cohort. MT conceptualised and designed this study, analysed and interpreted the data, drafted, reviewed and revised the manuscript. KG conceptualised and designed the ORChID cohort and this study, interpreted the data, and reviewed and revised the manuscript. PDS conceptualised and designed this study, interpreted the data, and reviewed and revised the manuscript. SBL conceptualised and designed the ORChID cohort and this study, interpreted the data, and reviewed and revised the manuscript. DW conducted the laboratory investigation and reviewed and revised the manuscript. KJC conducted the laboratory investigation and reviewed and revised the manuscript. RSW conceptualised and designed the ORChID cohort and this study, analysed and interpreted the data, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Mari D. Takashima.

Ethics declarations

Ethics approval

The Children’s Health Queensland (HREC/10/QRCH/16), the Royal Brisbane and Women’s Hospital (HREC/10/QRBW/125), and The University of Queensland (2010000820) Human Research Ethics Committees approved the study.

Consent to participate

Individual mothers consented to participate antenatally for their children’s participation. Mothers were re-consented at the start of the ELLF study.

Consent for publication

Individual mothers consented for publication antenatally for their children’s participation. Mothers were re-consented at the start of the ELLF study.

Conflict of interest

The authors declare no conflict of interest.

Additional information

Communicated by Nicole Ritz

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Takashima, M.D., Grimwood, K., Sly, P.D. et al. Epidemiology of respiratory syncytial virus in a community birth cohort of infants in the first 2 years of life. Eur J Pediatr 180, 2125–2135 (2021). https://doi.org/10.1007/s00431-021-03998-0

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