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Population-based Incidence and Etiology of Community-acquired Neonatal Viral Infections in Bangladesh: A Community-based and Hospital-based Surveillance Study

Farzin, Azadeh MD*; Saha, Samir K. PhD; Baqui, Abdullah H. PhD*; Choi, Yoonjoung PhD, ASM*‡; Ahmed, Nawshad Uddin MD§¶; Simoes, Eric A.F. MD‖**††; El Arifeen, Shams DrPH‡‡; Al-Emran, Hassan M. MD‡‡; Bari, Sanwarul MB BS‡‡; Rahman, Syed M. MB BS‡‡; Mannan, Ishtiaq DrPH*‡‡; Crook, Derrick PhD§§¶¶; Seraji, Habibur Rahman MB BS‡‡; Begum, Nazma MA*; Black, Robert E. MD*; Santosham, Mathuram MD*; Darmstadt, Gary L. MD‖‖for the Bangladesh Projahnmo-2 (Mirzapur) Study Group

The Pediatric Infectious Disease Journal: July 2015 - Volume 34 - Issue 7 - p 706–711
doi: 10.1097/INF.0000000000000726
Original Studies

Background: The etiology of >90% of cases of suspected neonatal infection remains unknown. We conducted community-based surveillance in conjunction with hospital-based surveillance in a rural region in Bangladesh from June 2006 to September 2007 to assess the incidence and etiology of community-acquired viral infections among neonates.

Methods: Community health workers (CHWs) assessed neonates at home on days 0, 2, 5 and 8 after birth and referred cases of suspected illness to the hospital (CHW surveillance). Among neonates with clinically suspected upper respiratory tract infection (URTI), pneumonia, sepsis and/or meningitis, virus identification studies were conducted on nasal wash, cerebrospinal fluid and/or blood specimens. In the hospital-based surveillance, similar screening was conducted among all neonates (referred by CHWs and self-referred) who were admitted to the hospital.

Results: CHW surveillance found an incidence rate of 15.6 neonatal viral infections per 1000 live births with 30% of infections identified on the day of birth. Among neonates with suspected sepsis, a viral etiology was identified in 36% of cases, with enterovirus accounting for two-thirds of those infections. Respiratory syncytial virus was the most common etiologic agent among those with viral pneumonia (91%) and URTI (68%). There was a low incidence (1.2%) of influenza in this rural population.

Conclusion: Viral infections are commonly associated with acute newborn illness, even in the early neonatal period. The estimated incidence was 5-fold greater than reported previously for bacterial infections. Low-cost preventive measures for neonatal viral infections are urgently needed.

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From the *International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; Measure Demographic Health Surveys, United States Agency for International Development, Washington, DC; §Department of Pediatrics, Kumudini Women’s Medical College, Mirzapur, Tangail, Bangladesh; Department of Neonatology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; **Department of Epidemiology, Center for Global Health, Colorado School of Public Health, Aurora, Colorado; ††Section of Infectious Diseases, Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado; ‡‡Department of Child Health, ICDDR,B, Dhaka, Bangladesh; §§Department of Microbiology, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom; ¶¶National Institutes Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom; and ‖‖Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.

Accepted for publication December 11, 2014.

A.F. and G.L.D. wrote the first draft of the paper. All authors provided conceptual input and approved the final paper for submission.

The authors do not have a commercial or other association that might pose a conflict of interest. This study was supported by the Wellcome Trust—Burroughs Wellcome Fund Infectious Disease Initiative 2000 and the Office of Health, Infectious Diseases and Nutrition, Global Health Bureau and United States Agency for International Development through the Global Research Activity Cooperative agreement with the Johns Hopkins Bloomberg School of Public Health [award HRN-A-00-96-90006-00]. Support for data analysis and manuscript preparation was provided by the Saving Newborn Lives program through a grant by the Bill & Melinda Gates Foundation to Save the Children-US. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Address for correspondence: Gary L. Darmstadt, MD, MS, Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, 109C, Stanford, CA 94305. E-mail:

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