THE CLINICAL SPECTRUM OF RESPIRATORY SYNCYTIAL VIRUS-DISEASE IN THE GAMBIA

Background. Respiratory syncytial virus (RSV) is a well-recognized cau se of lower respiratory tract infections in early childhood in industr ialized countries, but less is known about RSV infection in developing countries. Methods. Four outbreaks of RSV infection that occurred bet ween 1993 and 1996 in The Gambia, West Africa, were studied, RSV was s ought by immunofluorescent staining of nasopharyngeal aspirate samples among young children who presented with respiratory infections at thr ee hospitals in the Western Region of the country. Results. Five hundr ed seventy-four children with RSV infection were identified. The media n ages of children seen in 1993 through 1996 were 3, 7, 8 and 5 months , respectively. Sixty-two percent of children <6 months old were boys. Thirteen children (2.4%) had conditions considered to increase the ri sk of severe RSV infection. On physical examination crepitations were heard in 80% of the children admitted to hospital, whereas wheezes wer e heard in only 39%. Eighty (16%) children received oxygen because of hypoxemia. Nine of 255 blood cultures (3.5%) were positive: 4 Streptoc occus pneumoniae; 2 Haemophilus influenzae type b; 2 Staphylococcus au reus; and 1 Enterobacter agglomerans. Thirteen children died (2.4%), D uring the 4 study years 90, 25, 75 and 95% of isolates typed were RSV Subgroup A, respectively. Conclusions. RSV is a significant cause of l ower respiratory tract infection in young children in The Gambia, caus ing epidemics of bronchiolitis. It poses a significant burden on the h ealth system, especially through the demand for supplementary oxygen. The clinical spectrum of RSV disease in The Gambia is similar to that seen in developed countries; concomitant bacterial infections are unco mmon.