Background: Respiratory syncytial virus (RSV) is a well-recognized cause of lower respiratory tract infections in early childhood in industrialized countries, but less is known about RSV infection in developing countries.
Methods: Four outbreaks of RSV infection that occurred between 1993 and 1996 in The Gambia, West Africa, were studied. RSV was sought by immunofluorescent staining of nasopharyngeal aspirate samples among young children who presented with respiratory infections at three hospitals in the Western Region of the country.
Results: Five hundred seventy-four children with RSV infection were identified. The median ages of children seen in 1993 through 1996 were 3, 7, 8 and 5 months, respectively. Sixty-two percent of children <6 months old were boys. Thirteen children (2.4%) had conditions considered to increase the risk of severe RSV infection. On physical examination crepitations were heard in 80% of the children admitted to hospital, whereas wheezes were heard in only 39%. Eighty (16%) children received oxygen because of hypoxemia. Nine of 255 blood cultures (3.5%) were positive: 4 Streptococcus pneumoniae; 2 Haemophilus influenzae type b; 2 Staphylococcus aureus; and 1 Enterobacter agglomerans. Thirteen children died (2.4%). During the 4 study years 90, 25, 75 and 95% of isolates typed were RSV Subgroup A, respectively.
Conclusions: RSV is a significant cause of lower respiratory tract infection in young children in The Gambia, causing epidemics of bronchiolitis. It poses a significant burden on the health system, especially through the demand for supplementary oxygen. The clinical spectrum of RSV disease in The Gambia is similar to that seen in developed countries; concomitant bacterial infections are uncommon.
PIP: Respiratory syncytial virus (RSV) is a well-recognized cause of lower respiratory tract infections during early childhood in industrialized countries. The study of 4 RSV infection outbreaks which occurred during 1993-96 in The Gambia led to the identification of RSV infection in 574 children through the immunofluorescent staining of nasopharyngeal aspirate samples among children of median age 3-8 months who presented with respiratory infections at 3 hospitals in the Western region of the country. 13 children had conditions thought to increase the risk of severe RSV infection, with crepitations heard during physical examinations in 80% of children admitted to the hospital and wheezes heard in 39%. 80 children were given oxygen because of hypoxemia. 9 of 255 blood cultures were positive for the following pathogens: 4 Streptococcus pneumoniae, 2 Haemophilus influenzae type b, 2 Staphylococcus aureus, and 1 Enterobacter agglomerans. 13 children died. 90% of isolates typed during year 1 were RSV subgroup A, 25% in the second year of study, 75% in year 3, and 95% in year 4. These findings demonstrate that RSV is a significant cause of lower respiratory tract infection in young children in The Gambia, causing epidemics of bronchiolitis. It is most likely cost-effective to prevent RSV infection through vaccination.