• Sarah Geoghegan, Anabella Erviti, Mauricio T Caballero, Fernando Vallone, Stella M Zanone, Juan Ves Losada, Alejandra Bianchi, Patricio L Acosta, Laura B Talarico, Adrian Ferretti, Luciano Alva Grimaldi, Andrea Sancilio, Karina Dueñas, Gustavo Sastre, Andrea Rodriguez, Fernando Ferrero, Edgar Barboza, Guadalupe Fernández Gago, Celina Nocito, Edgardo Flamenco, Alberto Rodriguez Perez, Beatriz Rebec, F Martin Ferolla, Romina Libster, Ruth A Karron, Eduardo Bergel, and Fernando P Polack.
• 1 Fundación INFANT, Buenos Aires, Argentina.
• Am. J. Respir. Crit. Care Med. 2017 Jan 1; 195 (1): 96-103.

RationaleRespiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear.ObjectivesTo determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants.MethodsThis was a prospective, population-based, cross-sectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model.Measurements And Main ResultsA total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes.ConclusionsRSV was the most frequent cause of mortality in low-income postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.

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