• Azadeh Farzin, Samir K Saha, Abdullah H Baqui, Yoonjoung Choi, Nawshad Uddin Ahmed, Eric A F Simoes, Shams El Arifeen, Hassan M Al-Emran, Sanwarul Bari, Syed M Rahman, Ishtiaq Mannan, Derrick Crook, Habibur Rahman Seraji, Nazma Begum, Robert E Black, Mathuram Santosham, Gary L Darmstadt, and Bangladesh Projahnmo-2 (Mirzapur) Study Group.
• From the *International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; †Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; ‡Measure Demographic Health Surveys, United States Agency for International Development, Washington, DC; §Department of Pediatrics, Kumudini Women's Medical College, Mirzapur, Tangail, Bangladesh; ¶Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; ‖Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; **Department of Epidemiology, Center for Global Health, Colorado School of Public Health, Aurora, Colorado; ††Section of Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado; ‡‡Department of Child Health, ICDDR,B, Dhaka, Bangladesh; §§Department of Microbiology, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom; ¶¶National Institutes Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom; and ‖‖Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
• Pediatr. Infect. Dis. J. 2015 Jul 1; 34 (7): 706-11.

BackgroundThe etiology of >90% of cases of suspected neonatal infection remains unknown. We conducted community-based surveillance in conjunction with hospital-based surveillance in a rural region in Bangladesh from June 2006 to September 2007 to assess the incidence and etiology of community-acquired viral infections among neonates.MethodsCommunity health workers (CHWs) assessed neonates at home on days 0, 2, 5 and 8 after birth and referred cases of suspected illness to the hospital (CHW surveillance). Among neonates with clinically suspected upper respiratory tract infection (URTI), pneumonia, sepsis and/or meningitis, virus identification studies were conducted on nasal wash, cerebrospinal fluid and/or blood specimens. In the hospital-based surveillance, similar screening was conducted among all neonates (referred by CHWs and self-referred) who were admitted to the hospital.ResultsCHW surveillance found an incidence rate of 15.6 neonatal viral infections per 1000 live births with 30% of infections identified on the day of birth. Among neonates with suspected sepsis, a viral etiology was identified in 36% of cases, with enterovirus accounting for two-thirds of those infections. Respiratory syncytial virus was the most common etiologic agent among those with viral pneumonia (91%) and URTI (68%). There was a low incidence (1.2%) of influenza in this rural population.ConclusionViral infections are commonly associated with acute newborn illness, even in the early neonatal period. The estimated incidence was 5-fold greater than reported previously for bacterial infections. Low-cost preventive measures for neonatal viral infections are urgently needed.

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