Journal Article

Incidence and transmission of respiratory syncytial virus in urban and rural South Africa, 2017-2018

Kleynhans, Jackie, Wolter, Nicole, Tempia, Stefano, Martinson, Neil A., McMorrow, Meredith L., Wafawanaka, Floidy, Treurnicht, Florette K., Cohen, Cheryl, Mkhencele, Thulisa, von Gottberg, Anne, Mothlaoleng, Katlego, Kahn, Kathleen, Mathunjwa, Azwifarwi, Language, Brigitte, Moyes, Jocelyn, Hellferscee, Orienka, Lebina, Limakatso, Piketh, Stuart, Carrim, Maimuna, Mathee, Angela, Gómez-Olivé, Francesc Xavier

2024

Overview

Data on respiratory syncytial virus (RSV) incidence and household transmission are limited. To describe RSV incidence and transmission, we conducted a prospective cohort study in rural and urban communities in South Africa over two seasons during 2017-2018. Nasopharyngeal swabs were collected twice-weekly for 10 months annually and tested for RSV using PCR. We tested 81,430 samples from 1,116 participants in 225 households (follow-up 90%). 32% (359/1116) of individuals had ≥1 RSV infection; 10% (37/359) had repeat infection during the same season, 33% (132/396) of infections were symptomatic, and 2% (9/396) sought medical care. Incidence was 47.2 infections/100 person-years and highest in children <5 years (78.3). Symptoms were commonest in individuals aged <12 and ≥65 years. Individuals 1-12 years accounted for 55% (134/242) of index cases. Household cumulative infection risk was 11%. On multivariable analysis, index cases with ≥2 symptoms and shedding duration >10 days were more likely to transmit; household contacts aged 1-4 years vs. ≥65 years were more likely to acquire infection. Within two South African communities, RSV attack rate was high, and most infections asymptomatic. Young children were more likely to introduce RSV into the home, and to be infected. Future studies should examine whether vaccines targeting children aged <12 years could reduce community transmission. Respiratory syncytial virus (RSV) causes a high burden of disease in children, particularly in lower- and middle-income countries. In this prospective household-based observational cohort study in South Africa, the authors estimate the incidence of RSV and identify risk factors for transmission.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 631/326/596/2563 / 692/699/1785 / 692/700/478/174 / Child / Child, Preschool / Children / Cohort analysis / Health risks / Households / Humanities and Social Sciences / Humans / Incidence / Infant / Infections / multidisciplinary / Observational studies / Prospective Studies / Respiratory syncytial virus / Respiratory Syncytial Virus Infections / Respiratory Syncytial Virus, Human - genetics / Risk factors / Science / Science (multidisciplinary) / Signs and symptoms / South Africa - epidemiology / Urban areas / Viruses