The following is the summary of “Nosocomial RSV-related In-hospital Mortality in Children <5 Years: A Global Case Series” published in the January 2023 issue of Pediatric Infectious Disease Journal by Yvette N, et al.

Due to a lack of surveillance systems, the global burden of nosocomial infections is poorly understood, as reported by the World Health Organization. Low and middle-income nations (LMICs) have a greater rate of nosocomial infections than high-income ones (HICs). Present estimates of the worldwide burden of Respiratory Syncytial Virus (RSV) are primarily based on infection acquired in the community. Their  study’s objectives were to describe the demographics of children who died from RSV in hospitals and to analyze the potential benefits of RSV vaccination programs. The RSV GOLD database is a worldwide register of children younger than 5 years old who died from RSV infection proven in the laboratory. 

Researchers examined demographic and clinical data from in-hospital deaths caused by RSV in children who contracted the virus in the hospital against those who contracted the virus outside of the hospital. Investigators compiled data on 231 nosocomial and 931 community-acquired RSV-related hospitalization fatalities from 65 countries. Both groups had an equivalent average age of death (5.4 vs. 6 months). Nosocomial fatalities were more likely to involve comorbidities (87% vs. 57%; P<0.001) or prematurity (46% vs. 24%; P<0.001). Lower middle income countries (LMICs) had a lower percentage of RSV deaths attributable to nosocomial causes (12%) compared to upper middle income countries (UMICs) and high income countries (26%).

This is the first global case study of pediatric deaths attributable to nosocomial RSV infection, the authors write. The bulk of nosocomial RSV-related deaths could be avoided with future immunization initiatives aimed at infants. Low- and middle-income countries (LMICs) are where you’d expect to see the largest incidence of nosocomial RSV mortality, but that’s not the case. Nosocomial RSV mortality in LMICs can only be fully captured through hospital-based surveillance.