Respiratory Syncytial Virus Incidence and Severity in a Community-Based Prospective Cohort of Children Aged 0–14 Years

BACKGROUND: Respiratory syncytial virus (RSV) is a substantial source of severe illnesses including acute lower respiratory infections (ALRIs) like pneumonia. However, its burden in older children remains less well understood. METHODS: Using a community-based prospective cohort, we assessed the burden of symptomatic reverse-transcription polymerase chain reaction–confirmed RSV among Nicaraguan children aged 0–14 years from 2011 to 2016. ALRI was defined as physician diagnosis of pneumonia, bronchiolitis, bronchitis, or bronchial hyperreactivity. RESULTS: Between 2011 and 2016, 2575 children participated in the cohort. Of these, 630 (24.5%) had at least 1 episode of symptomatic RSV and 194 (7.5%) had multiple episodes. Subtype was identified in 571 (69.3%) episodes with 408 (71.5%) RSV-A, 157 (27.5%) RSV-B, and 6 (1%) positive for both. Children aged <2 years displayed the highest incidence of symptomatic RSV, with 269.3 cases per 1000 person-years (95% confidence interval [CI], 242.1–299.5). Beyond 2 years, incidence (95% CI) of symptomatic RSV decreased rapidly: 145.6 (129.9–163.1), 37.9 (31.9–45.0), and 19.3 (14.9–25.0) cases per 1000 person-years among children aged 2–4, 5–9, and 10–14 years, respectively. Incidence of RSV-associated ALRI was highest in children aged <2 years (85.95 per 1000 person-years [95% CI, 71.30–103.61]): 2.1, 9.5, and 17.3 times that of participants aged 2–4, 5–9, and 10–14 years, respectively. Children <2 years old were significantly more likely to have an RSV-associated hospitalization (P < .001). CONCLUSIONS: There is a substantial burden of symptomatic and severe RSV in children. While older children did present with RSV, the rates of symptomatic and severe RSV decreased by as much as 95% beyond age 5.