Incidence of respiratory virus illness and hospitalizations in a Panama and El Salvador birth cohort, 2014–2018

BACKGROUND: Respiratory viruses remain a key cause of early childhood illness, hospitalization, and death globally. The recent pandemic has rekindled interest in the control of respiratory viruses among paediatric populations. We estimate the burden of such viruses among children <2 years. METHODS: Enrolled neonates were followed until two years of age. Weekly active symptom monitoring for the development of acute respiratory illnesses (ARI) defined as cough, rhinorrhoea, difficulty breathing, asthenia, anorexia, irritability, or vomiting was conducted. When the child had ARI and fever, nasopharyngeal swabbing was performed, and samples were tested through singleplex RT-PCR. Incidence of respiratory viruses was calculated by dividing the number of laboratory-confirmed detections by the person-time accrued during weeks when that virus was detectable through national surveillance then corrected for under-ascertainment among untested children. FINDINGS: During December 2014–November 2017, 1567 enrolled neonates contributed 2,186.9 person-years (py). Six in ten (64·4%) children developed ARI (total 2493 episodes). Among children <2 years, incidence of respiratory syncytial virus (RSV)-associated ARI episodes (21·0, 95%CI 19·3–22·8, per 100py) and rhinovirus-associated (20·5, 95%CI 20·4–20·7) were similar and higher than parainfluenza 1–3-associated (14·2, 95%CI 12·2–16·1), human metapneumovirus-associated (9·2, 95%CI 7·7–10·8), influenza-associated (5·9, 95%CI 4·4–7·5), and adenovirus-associated ARI episodes (5·1, 95%CI 5·0–5·2). Children aged <3 months had the highest rates of RSV ARI (49·1, 95%CI 44·0–54·1 per 100py) followed by children aged 3–5 (25·1, 95%CI 20·1–30·0), 6–11 (17·6, 95%CI 13·2–21·9), and 12–23 months (11·9, 95%CI 10·8–12·9). One in ten children with RSV was referred to the hospital (2·5, 95%CI 2·1–2·8, per 100py). INTERPRETATION: Children frequently developed viral ARI and a substantive proportion required hospital care. Such findings suggest the importance of exploring the value of new interventions and increasing uptake of existing prevention measures to mitigate burden of epidemic-prone respiratory viruses. FUNDING: The study was supported by the Centers for Disease Control and Prevention.