Respiratory syncytial virus (RSV) is the most common pathogen causing viral respiratory tract infections among younger children worldwide. The influence of meteorological factors on RSV seasonal activity is well-established for temperate countries; however, in subtropical countries such as Malaysia, relatively stable temperate climates do not clearly support this trend, and the available data are contradictory. Better understanding of meteorological factors and seasonality of RSV will allow effective strategic health management relating to RSV infection, particularly immunoprophylaxis of high-risk infants with palivizumab. Retrospectively, from 2017 to 2021, we examined the association between various meteorological factors (rainfall, rainy days, temperature, and relative humidity) and the incidence of RSV in children aged less than 12 years in Kuala Lumpur, Malaysia. RSV activity peaked in two periods (July to August and October to December), which was significantly correlated with the lowest rainfall (p < 0.007) and number of rainy days (p < 0.005). RSV prevalence was also positively associated with temperature (p < 0.006) and inversely associated with relative humidity (p < 0.006). Based on our findings, we recommend that immunoprophylaxis with palivizumab be administered in children aged less than 2 years where transmission of RSV is postulated to be the highest after the end of two monsoon seasons.

Background: Laryngo-tracheo-esophageal cleft (LTEC) is a rare congenital anomaly caused by incomplete separation of the foregut. Type IV defects are exceptionally rare and typically carry high mortality and morbidity despite surgical interventions. Case presentation: We report a preterm neonate born at 34 + 1 weeks’ gestation from a monochorionic diamniotic twin pregnancy. Antenatal ultrasound detected a large microcystic congenital pulmonary airway malformation (CPAM) with mediastinal shift, absent gastric bubble, and suspected esophageal pouch. Immediately upon birth, bedside ultrasound identified the affected twin. Direct laryngoscopy and intubation revealed a common tracheoesophageal lumen; flexible bronchoscopy confirmed a Type IV LTEC with absent posterior tracheal wall extending to the carina and communicating with the oesophagus. Selective intubation of the right bronchus provided temporary ventilation. CT thorax demonstrated a wide anomalous aero-digestive tract, intrathoracic stomach, and large CPAM. Surgical repair was deemed very high risk and disproportionately burdensome due to a composite of factors: severity of the type 4 cleft, associated significant pulmonary and gastrointestinal anomalies, low birth weight, and being a high risk ECMO candidate. Following multidisciplinary counselling, care was redirected to palliation. Conclusion: This case highlights limitations of fetal imaging, the importance of early bronchoscopy for airway evaluation and stabilization, and the role of palliative care when extensive surgical correction carries risks of significant harm and may not serve in the best interest of the patient.