Population-based incidence of severe acute respiratory virus infections among children aged <5 years in rural Bangladesh, June–October 2010

Sharifa Nasreen, Stephen P Luby, W Abdullah Brooks, Nusrat Homaira, Abdullah Al Mamun, Mejbah Uddin Bhuiyan, Mustafizur Rahman, Dilruba Ahmed, Jaynal Abedin, Mahmudur Rahman, A S M Alamgir, Alicia M Fry, Peter Kim Streatfield, Anisur Rahman, Joseph Bresee, Marc-Alain Widdowson, Eduardo Azziz-Baumgartner

Research output: Contribution to journalA1: Web of Science-articlepeer-review


BACKGROUND: Better understanding the etiology-specific incidence of severe acute respiratory infections (SARIs) in resource-poor, rural settings will help further develop and prioritize prevention strategies. To address this gap in knowledge, we conducted a longitudinal study to estimate the incidence of SARIs among children in rural Bangladesh.

METHODS: During June through October 2010, we followed children aged <5 years in 67 villages to identify those with cough, difficulty breathing, age-specific tachypnea and/or danger signs in the community or admitted to the local hospital. A study physician collected clinical information and obtained nasopharyngeal swabs from all SARI cases and blood for bacterial culture from those hospitalized. We tested swabs for respiratory syncytial virus (RSV), influenza viruses, human metapneumoviruses, adenoviruses and human parainfluenza viruses 1-3 (HPIV) by real-time reverse transcription polymerase chain reaction. We calculated virus-specific SARI incidence by dividing the number of new illnesses by the person-time each child contributed to the study.

RESULTS: We followed 12,850 children for 279,029 person-weeks (pw) and identified 141 SARI cases; 76 (54%) at their homes and 65 (46%) at the hospital. RSV was associated with 7.9 SARI hospitalizations per 100,000 pw, HPIV3 2.2 hospitalizations/100,000 pw, and influenza 1.1 hospitalizations/100,000 pw. Among non-hospitalized SARI cases, RSV was associated with 10.8 illnesses/100,000 pw, HPIV3 1.8/100,000 pw, influenza 1.4/100,000 pw, and adenoviruses 0.4/100,000 pw.

CONCLUSION: Respiratory viruses, particularly RSV, were commonly associated with SARI among children. It may be useful to explore the value of investing in prevention strategies, such as handwashing and respiratory hygiene, to reduce respiratory infections among young children in such settings.

Original languageEnglish
Article numbere89978
JournalPLoS ONE
Issue number2
Publication statusPublished - 2014


  • Bangladesh/epidemiology
  • Child, Preschool
  • Disease Outbreaks/history
  • History, 21st Century
  • Humans
  • Incidence
  • Infant
  • Longitudinal Studies
  • Orthomyxoviridae/genetics
  • Parainfluenza Virus 1, Human/genetics
  • Parainfluenza Virus 2, Human/genetics
  • Parainfluenza Virus 3, Human/genetics
  • RNA Virus Infections/epidemiology
  • Real-Time Polymerase Chain Reaction
  • Respiratory Syncytial Viruses/genetics
  • Respiratory Tract Infections/epidemiology
  • Reverse Transcriptase Polymerase Chain Reaction
  • Statistics, Nonparametric


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