Factors associated with death in patients with respiratory syncytial virus infection during a Severe Acute Respiratory Infection outbreak, January-March 2019 - Manaus, Amazonas, Brazil.

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In February 2019, during an outbreak of Severe Acute Respiratory Infection (SARI) in Amazonas State, Brazil, cases and deaths of Respiratory Syncytial Virus (RSV) were identified, mainly in the capital, Manaus Municipality. This study aimed to identify risk factors associated with RSV death.

A case-control study (1:3) was conducted using data from the SARI National Report System (Sivep gripe). Case was the resident of Manaus who had laboratory confirmation for RSV by RTq-PCR and died between January to March, 2019, being control who was cured in the same period. Controls were selected from Sivep gripe system by random selection. Medical records were reviewed and household interviews were conducted with case proxies and controls. Bivariate analysis was made to evaluate factors associated with death and those associated were taken to multivariate analysis. Odds Ratio (OR), adjusted OR (ORA), 95% confidence interval and p<0.05 were used as measures of association.

From January to March, 2019, 793 SARI cases were reported in Manaus and 147 had laboratory confirmation for RSV. All deaths (13) were included in the study and 39 cures (controls) were selected. Factors associated with death in bivariate analysis was: age (highest median for cases, p-value:<0.01), comorbidity (OR:22.7 95%CI:4.6-111.8; p-value:<0.01), cardiovascular disease (OR:11.6 95%CI:1.9-70.6; p-value:<0.01), hospital complication (OR:6.5 95%CI:1.6-32.9; p-value:0.02), invasive procedure (OR:12.4 95%CI:2.4-64.6; p-value:<0.01), days between onset symptoms and search for care (highest median for cases, p-value:0.04). Factors that remained associated after statistic regression were to have at least one comorbidity ORA 32.9 (95%CI 5.0-218.3; p-value:<0.01) and days between onset symptoms and search for care ORA 1.4 (95%CI 1.0-1.9; p-value:0.04).

Comorbidity and delay in seeking timely medical care were associated with RSV death. Appropriate clinical management for patients with pre-existing conditions and orientation to the population to seek for care in the onset of early symptoms in the SARI seasonality period are recommended.

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