The burden of RSV-associated illness in children aged <5 years, South Africa, 2011 to 2016

Abstract

AbstractBackgroundVaccines and monoclonal antibodies to protect the very young infant against respiratory syncytial virus (RSV)-associated illness are effective for limited time periods. We aimed to estimate age-specific burden to guide implementation strategies and cost effectiveness analyses.MethodsWe combined case-based surveillance and ecological data to generate a national estimate of the burden of RSV-associated acute respiratory illness (ARI) and severe acute respiratory illness (SARI) in South African children aged <5 years (2011-2016), including adjustment for attributable fraction. We estimated the RSV burden by month of life in the <1-year age group, by 3-month intervals until 2 years and then 12 monthly intervals to <5 years for medically and non-medically attended illness.ResultsWe estimated a mean annual total (medically and non-medically attended) of 264,112 (95% Confidence interval (CI) 134,357-437,187) cases of RSV-associated ARI and 96,220 (95% CI 66,470-132,844) cases of RSV-associated SARI (4.7% and 1.7% of the population aged <5 years, respectively). RSV-associated ARI incidence was highest in 2 month-old infants (18,361/100,000 population, 95% CI 9,336-28,466). The highest incidence of RSV-associated SARI was in the <1-month age group 14,674/100,000 (95% CI 11,175-19,645). RSV-associated deaths were highest in the first and second month of life (8.7 deaths/100 000 (95% CI 6.3-11.2) and 8.7 deaths/100 000 (95% CI 6.4-11.4), respectively).ConclusionDue to the high burden of RSV-associated illness, specifically SARI cases in young infants, maternal vaccination and monoclonal antibody products delivered at birth could prevent significant RSV-associated disease burden.