Skip to main content

Characterizing the risk of respiratory syncytial virus in infants with older siblings: a population-based birth cohort study

  • P. JACOBY (a1), K. GLASS (a2) and H. C. MOORE (a1)

From a population-based birth cohort of 245 249 children born in Western Australia during 1996–2005, we used linkage of laboratory and birth record datasets to obtain data including all respiratory syncytial virus (RSV) detections during infancy from a subcohort of 87 981 singleton children born in the Perth metropolitan area from 2000 to 2004. Using log binomial regression, we found that the risk of infant RSV detection increases with the number of older siblings, with those having ⩾3 older siblings experiencing almost three times the risk (relative risk 2·83, 95% confidence interval 2·46–3·26) of firstborn children. We estimate that 45% of the RSV detections in our subcohort were attributable to infection from an older sibling. The sibling effect was significantly higher for those infants who were younger during the season of peak risk (winter) than those who were older. Although older siblings were present in our cohort, they had very few RSV detections which could be temporally linked to an infant's infection. We conclude that RSV infection in older children leads to less severe symptoms but is nevertheless an important source of infant infection. Our results lend support to a vaccination strategy which includes family members in order to provide maximum protection for newborn babies.

Corresponding author
*Author for correspondence: A/Professor P. Jacoby, Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia. (Email:
Hide All
1. Nair, H, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010; 375: 15451555.
2. Lanari, M, et al. Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort. Italian Journal of Pediatrics 2015; 41: 40.
3. Papadopoulos, NG, et al. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. American Journal of Respiratory and Critical Care Medicine 2002; 165: 12851289.
4. Moore, HC, et al. Modelling the seasonal epidemics of respiratory syncytial virus in young children. PLoS ONE 2014; 9: e100422.
5. Simoes, EA. RSV disease in the pediatric population: epidemiology, seasonal variability, and long-term outcomes. Managed Care 2008; 17: 36, discussion 18–19.
6. Falsey, AR, et al. Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness. Journal of Infectious Diseases 2014; 209: 18731881.
7. Hall, CB, Long, CE, Schnabel, KC. Respiratory syncytial virus infections in previously healthy working adults. Clinical Infectious Diseases 2001; 33: 792796.
8. Hall, CB, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics 2013; 132: e341348.
9. Bourgeois, FT, et al. Influenza and other respiratory virus-related emergency department visits among young children. Pediatrics 2006; 118: e18.
10. Mullard, A. Making way for maternal immunization. Nature Reviews Drug Discovery 2016; 15: 34.
11. Leader, S, Kohlhase, K. Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000. Journal of Pediatrics 2003; 143: S127132.
12. Law, BJ, Carbonell-Estrany, X, Simoes, EA. An update on respiratory syncytial virus epidemiology: a developed country perspective. Respiratory Medicine 2002; 96 (Suppl. B): S17.
13. Hall, CB, et al. The burden of respiratory syncytial virus infection in young children. New England Journal of Medicine 2009; 360: 588598.
14. Simoes, EA. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. Journal of Pediatrics 2003; 143: S118126.
15. Munywoki, PK, et al. The source of respiratory syncytial virus infection in infants: a household cohort study in rural Kenya. Journal of Infectious Diseases 2014; 209: 16851692.
16. Heikkinen, T, et al. Transmission of respiratory syncytial virus infection within families. Open Forum Infectious Diseases 2015; 2: ofu118.
17. Crowcroft, NS, et al. Respiratory syncytial virus infection in infants admitted to paediatric intensive care units in London, and in their families. European Journal of Pediatrics 2008; 167: 395399.
18. Murray, J, et al. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study. PLoS ONE 2014; 9: e89186.
19. Kelman, CW, Bass, AJ, Holman, CD. Research use of linked health data – a best practice protocol. Australian and New Zealand Journal of Public Health 2002; 26: 251255.
20. Bradley, JS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical Infectious Diseases 2011; 53: e2576.
21. Moore, HC, et al. A retrospective population-based cohort study identifying target areas for prevention of acute lower respiratory infections in children. BMC Public Health 2010; 10: 757.
22. Moore, HC, et al. Use of data linkage to investigate the aetiology of acute lower respiratory infection hospitalisations in children. Journal of Paediatrics and Child Health 2012; 48: 520528.
23. Rockhill, B, Newman, B, Weinberg, C. Use and misuse of population attributable fractions. American Journal of Public Health 1998; 88: 1519.
24. Lim, FJ, et al. Optimization is required when using linked hospital and laboratory data to investigate respiratory infections. Journal of Clinical Epidemiology 2016; 69: 2331.
25. Anderson, LJ, et al. Strategic priorities for respiratory syncytial virus (RSV) vaccine development. Vaccine 2013; 31 (Suppl. 2): B209215.
26. Graham, BS. Protecting the family to protect the child: vaccination strategy guided by RSV transmission dynamics. Journal of Infectious Diseases 2014; 209: 16791681.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed