RSV-associated hospitalizations in Bangladeshi children under five: Unveiling the disease burden

OBJECTIVES: Respiratory Syncytial Virus (RSV) is a leading cause of acute lower respiratory tract infections among children under five years of age globally. Despite its significant health burden, data on RSV infection in this age group in Bangladesh are limited. This study aims to estimate the prevalence of RSV among hospitalized Bangladeshi children under five years of age and to explore its distribution across key demographic factors, including age, sex, and geographic region. METHODS: We designed the study based on the hospital-based influenza surveillance conducted by icddr,b, enrolling children who presented with severe acute respiratory infections (SARI) or influenza-like illness (ILI) symptoms. Both nasopharyngeal and oropharyngeal swabs from each participant were collected and subjected to real-time RT-PCR for RSV detection. Data were analyzed using descriptive statistics, chi-square tests and multiple logistic regression. RESULTS: From October 2022 to December 2024, we enrolled 8203 patients with SARI and ILI, of whom 2758 tested positive for RSV. RSV was detected at a significantly higher proportion among SARI cases 2583 (36 %), compared to ILI cases 175 (16 %) (p < 0.001). Infants under six months exhibited the highest infection proportion (44 %), with prevalence decreasing with age. RSV activity in Bangladesh begins in the southern districts in August and peaks nationwide between October and December. CONCLUSIONS: This study highlights a significant RSV burden among children less than six months of age with SARI. These findings emphasize the need for targeted age-specific control measures to reduce hospitalization.