Detection of human rhinovirus in Sudden Unexpected Death in Infancy (SUDI) cases at Tygerberg medico-legal mortuary, Cape Town, South Africa

Background: Infant mortality remains a major global concern. Sudden unexpected death in infancy (SUDI) is common in South Africa, but evidence on the effect of possible risk factors remains limited. Respiratory infections have repeatedly been implicated in the death of these infants, but temporality has not yet been confirmed and SUDI remains a multi-factorial phenomenon

Methods: This study investigated the relationship between risk factors and positive human rhinovirus in the trachea and lungs of infants admitted to the Tygerberg Medico-legal Mortuary in Cape Town between 2012 and 2019. This study included a total of 407 cases.

Results: The median (range) age of the infants was 9.1 (0.3 to 57.3) weeks. Infants who shared a bed with ≤1 person were significantly younger than those where bed-sharing with ≥3 people was reported (7.5 vs. 11.9 weeks, p=0.045). Cases with human rhinovirus present in the trachea and lung were significantly older (12.3 and 12.9 weeks, respectively; p<0.001) than those where no human rhinovirus was detected (8.0 and 8.7 weeks). After adjusting for possible confounders, the number of people bed-sharing and human rhinovirus detected in the trachea (standardized β [95%CI], p<0.001 and p=0.016 respectively) were independently associated with age when SUDI occurred.

Conclusion: This study correlated laboratory results with demographic data and risk factors in SUDI cases. The most prominent findings were bed-sharing and the presence of human rhinovirus in the trachea. Infection can be reduced by modifiable means, such as ventilation where possible, sleeping position and providing the infant with a separate sleeping area or bed. However, this may not be possible for many communities in South Africa due to poverty, overcrowding and other socioeconomic reasons.

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