Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Apr 9, 2019; 8(2): 33-42
Published online Apr 9, 2019. doi: 10.5409/wjcp.v8.i2.33
Prevalence of respiratory syncytial virus infection among children hospitalized with acute lower respiratory tract infections in Southern India
Sandesh Kini, Bhuvanesh Sukhlal Kalal, Sara Chandy, Ranjani Shamsundar, Anita Shet
Sandesh Kini, Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
Bhuvanesh Sukhlal Kalal, Department of Biochemistry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, Karnataka, India
Sara Chandy, Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Thiruvalla 689101, Kerala, India
Ranjani Shamsundar, Department of Microbiology, St. John’s Medical College, Bengaluru 560034, Karnataka, India
Anita Shet, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
Author contributions: Kini S and Kalal BS contributed equally to this work. Shet A and Kini S designed the study; Kini S and Kalal BS recruited the children, collected samples and data; Kalal BS and Shamsundar R performed laboratory experiments; Kini S and Kalal BS analysed data and wrote the manuscript; Chandy S, Shamsundar R and Shet A gave technical support and conceptual advice; Shet A critically reviewed the manuscript and supervised the whole study process; all authors read and approved the final manuscript.
Institutional review board statement: Ethical clearance was obtained from the Institutional Ethics Committee (IRB No 134/2008) at St. Johns Medical College Hospital prior to initiating the study.
Informed consent statement: Informed consent was obtained from the caregivers of eligible children.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Anita Shet, MD, PhD, Full Professor, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
Telephone: +1-410-5022629
Received: November 30, 2018
Peer-review started: November 30, 2018
First decision: January 9, 2019
Revised: February 20, 2019
Accepted: February 27, 2019
Article in press: February 27, 2019
Published online: April 9, 2019

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory infections among children.


To investigate the proportion of RSV and non-RSV respiratory viral infections among hospitalized children ≤ 5 years.


Hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections (ALRI), admitted between August 2011-August 2013, were included. Cases were defined as laboratory-confirmed RSV and non-RSV respiratory viruses by direct fluorescence assay from the nasopharyngeal wash.


Of 383 1-59 mo old children hospitalized with an acute lower respiratory infection, 33.9% (130/383) had evidence of viral infection, and RSV was detected in 24.5% (94/383). Co-infections with RSV and other respiratory viruses (influenza A or B, adenovirus, para influenza 1, 2 or 3) were seen in children 5.5% (21/383). Over 90% of the RSV-positive children were under 2 years of age. RSV was detected throughout the year with peaks seen after the monsoon season. Children hospitalized with RSV infection were more likely to have been exposed to a shorter duration of breastfeeding of less than 3 mo. RSV positive children had a shorter hospital stay, although there were significant complications requiring intensive care. Use of antibiotics was high among those with RSV and non-RSV viral infections.


Our study provides evidence of a high proportion of RSV and other virus-associated ALRI among hospitalized children in India. RSV infection was associated with fewer days of hospital stay compared to other causes of lower respiratory infections. A high level of antibiotic use was seen among all respiratory virus-associated hospitalizations. These results suggest the need for implementing routine diagnostics for respiratory pathogens in order to minimize the use of unnecessary antibiotics and plan prevention strategies among pediatric populations.

Keywords: Respiratory syncytial virus, Acute lower respiratory infections, Children, Epidemiology, India, Respiratory viral infection

Core tip: The study shows that a significant proportion of young children hospitalized for acute lower respiratory tract infection were associated with respiratory syncytial virus (RSV) and other viral infections. Early diagnosis of viral infections using a simple test such as the RSV and viral direct fluorescence assay test, in settings where PCR is not feasible, would be useful in the timely institution of appropriate care, minimization of antibiotic overuse, and appropriate follow-up care for complications and sequelae, potentially leading to a reduction of costs of medical care.