Predictors of Poor Outcomes Among Infants with Respiratory Syncytial Virus-associated Acute Lower Respiratory Infection in Botswana

Abstract

Background: Acute lower respiratory infection (ALRI) is the leading infectious cause of death among children worldwide, and respiratory syncytial virus is the most common cause of ALRI. The majority of deaths occur in low- and middle-income countries, but there is a dearth of data on risk factors for poor outcomes in these settings. We endeavored to identify clinical and microbiome-related factors associated with poor outcomes among children hospitalized with RSV-ALRI in Gaborone, Botswana. Methods: Children 1-23 months of age presenting for care at Princess Marina Hospital who met the World Health Organization (WHO) definition of clinical pneumonia were enrolled in this prospective study and followed until hospital discharge or death. Nasopharyngeal swabs were collected for respiratory viral testing and microbiome analysis. Results: Young age (<6 months), household use of wood as a cooking fuel, moderate or severe malnutrition, and oxygen saturation <90% on room air were independent predictors of clinical nonresponse at 48 hours. Among HIV-uninfected infants 6 months of age or younger, HIV exposure was associated with a higher risk of in-hospital mortality. Nasopharyngeal microbiome composition and diversity were not associated with clinical nonresponse. Conclusions: We identified several risk factors for poor outcomes from RSV-ALRI among children in Botswana. These data could inform future use of RSV vaccines and therapeutics in these populations.