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Introduction: Knowledge on RSV infection and disease is sparse in much of sub-Saharan Africa. Disease incidence is highest in infants, but there is little understanding on how and where they become infected. Characteristics ofRSV transmission are poorly defined. Understanding transmission ofRSV within the community is important in understanding infection and disease in infants and in defining potential effects of vaccination Methods: A prospective longitudinal surveillance ofARl in a rando1J1 selection of households in Kilifi District, coastal Kenya, was established in early 2003, and continued until 2005. Participants were under active and passive surveillance and were reviewed using a standard proforma. Nasal washings from symptomatic household members were screened for RSV antigen using IFAT. Oral-fluid for serological determination of infection was collected at enrolment and every 3 months. Results: 81 households were recruited, 25 were lost to followup. 121 infections were identified approximately half ofwhich were re-infections. The virus infected 54% ofthe households. Incidence ofRSV infection was 218 cases/lOOO cyo (95% Cl, 182- 264). The incidence ofprimary infection was 476 cases/lOOO cyo (95% Cl, 361-630) and re-infection was 147/1000 cyo (95% Cl, 115-189). Risk of disease was higher during primary infection than re-infection with the highest risk of disease in children 12-17months old. Estimated . duration ofviral shedding was short, <1 week. Age, sex, infection history and severity of infection were not found to significantly affect duration of shedding. Pre-school children with siblings in school had higher rates of infection. Index to secondary case interval was shorter for younger children and SARs were higher in smaller households. Crowding and stunting were associated with increased risk of both LRTl and RSV specific LRTI. Sanitation, type of house, and having siblings under the age of 6 years of age were associated with increased risk I ofRSV-disease. Conclusion: We have defined several aspects ofRSV transmission and demonstrated an important burden ofRSV infection and disease in a rural Kenyan community addressing a need for more information from developing countries.

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