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Infectious Diseases - Pediatrics and Child Health - Public Health and Epidemiology - Respiratory Medicine

Incidence of Respiratory Virus-Associated Pneumonia in Urban Poor Young Children of Dhaka, Bangladesh, 2009–2011
Published: Wednesday, February 22, 2012
Author: Nusrat Homaira et al.

by Nusrat Homaira, Stephen P. Luby, William A. Petri, Raija Vainionpaa, Mustafizur Rahman, Kamal Hossain, Cynthia B. Snider, Mahmudur Rahman, A. S. M. Alamgir, Farzina Zesmin, Masud Alam, Emily S. Gurley, Rashid Uz Zaman, Tasnim Azim, Dean D. Erdman, Alicia M. Fry, Joseph Bresee, Marc-Alain Widdowson, Rashidul Haque, Eduardo Azziz-Baumgartner


Pneumonia is the leading cause of childhood death in Bangladesh. We conducted a longitudinal study to estimate the incidence of virus-associated pneumonia in children aged <2 years in a low-income urban community in Dhaka, Bangladesh.


We followed a cohort of children for two years. We collected nasal washes when children presented with respiratory symptoms. Study physicians diagnosed children with cough and age-specific tachypnea and positive lung findings as pneumonia case-patients. We tested respiratory samples for respiratory syncytial virus (RSV), rhinoviruses, human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV 1, 2, 3), and adenoviruses using real-time reverse transcription polymerase chain reaction assays.


Between April 2009–March 2011, we followed 515 children for 730 child-years. We identified a total of 378 pneumonia episodes, 77% of the episodes were associated with a respiratory viral pathogen. The overall incidence of pneumonia associated with a respiratory virus infection was 40/100 child-years. The annual incidence of pneumonia/100 child-years associated with a specific respiratory virus in children aged <2years was 12.5 for RSV, 6 for rhinoviruses, 6 for HMPV, 4 for influenza viruses, 3 for HPIV and 2 for adenoviruses.


Young children in Dhaka are at high risk of childhood pneumonia and the majority of these episodes are associated with viral pathogens. Developing effective low-cost strategies for prevention are a high priority.