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Clin Infect Dis. 2018 Oct 30;67(10):1507-1514. doi: 10.1093/cid/ciy317.

Burden and Risk Factors for Coronavirus Infections in Infants in Rural Nepal.

Author information

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
2
Seattle Children's Hospital and Research Institute, Seattle.
3
Molecular Virology Laboratory, School of Medicine, Seattle.
4
Harborview Medical Center, University of Washington, Seattle.
5
Global Health Center, Cincinnati Children's Hospital Medical Center, Ohio.
6
Nepal Nutrition Intervention Project-Sarlahi, Kathmandu.
7
Department of Global Health, Milken Institute School of Public Health, George Washington University, D.C.
8
Department of Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

Abstract

Background:

Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal.

Methods:

Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression.

Results:

Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3-286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52-4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01-1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December-February) and 1 autumn (September-November).

Conclusions:

HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.

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