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Clin Infect Dis. 2019 Feb 27. pii: ciz157. doi: 10.1093/cid/ciz157. [Epub ahead of print]

Epidemiology, Risk Factors, and Outcomes of Respiratory Syncytial Virus Infections in Newborns in Bamako, Mali.

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Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA.
Centre pour le Developpement des Vaccins - Mali, Bamako, Mali.



Few studies describe the Respiratory Syncytial Virus (RSV) burden in African populations, and most have utilized hospital-based surveillance. In Mali, no community-based studies exist of the incidence or epidemiology of RSV infection. This study provides the first estimates of RSV incidence in Mali.


In a cohort of infants enrolled in a clinical trial of maternal influenza vaccination, we estimate incidence of RSV-associated febrile illness in the first six months of life, and identify risk factors for RSV infection and progression to severe disease. Infants (N = 1,871) were followed from birth to six months of age and visited weekly to detect pneumonia and influenza-like illness. Baseline covariates were explored as risk factors for RSV-febrile illness and RSV-pneumonia or hospitalization.


Incidence of RSV-illness was estimated at 536.8 per 1,000 person-years, and 86% (131/153) of RSV-illness episodes were positive for RSV B. RSV-illness was most frequent in the fifth month of life and associated with having older mothers, and lower parity. The incidence of RSV-associated hospitalizations was 45.6 per 1,000 person-years. Among infants with RSV-illness, males were more likely to be hospitalized. The incidence of RSV-pneumonia was 29 cases per 1,000 person-years.


In the first six months of life, Malian infants have a high incidence of RSV illness, primarily caused by RSV B. Prevention of early RSV will require passive protection via maternal immunization in pregnancy. Mali is the first country where RSV B had been identified as the dominant subtype, with potential implications for vaccine development.


Pneumonia; RSV; active surveillance; acute respiratory infection


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