Healthcare-Associated Respiratory Syncytial Virus in Children’s Hospitals

Author:

Saiman Lisa1,Coffin Susan E2,Kociolek Larry K3,Zerr Danielle M4,Milstone Aaron M5,Aldrich Margaret L6,Vargas Celibell Y1,Zapata Giovanny7,Zalot Morgan A2,Reyna Megan E3,Adler Amanda4,Voskertchian Annie5,Egbert Emily R5,Alba Luis1,Gollerkeri Sonia1,Ruggieri Madelyn8,Finelli Lyn8,Choi Yoonyoung8

Affiliation:

1. Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center , New York, New York , USA

2. Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at UPenn , Philadelphia, Pennsylvania , USA

3. Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois , USA

4. Department of Pediatrics, Seattle Children’s Hospital , Seattle, Washington , USA

5. Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA

6. Department of Pediatrics, Children’s Hospital at Montefiore , Bronx, New York, New York , USA

7. Mailman School of Public Health, Columbia University Irving Medical Center , New York, New York , USA

8. Center for Observational and Real-World Evidence, Merck & Co., Inc. , Rahway, New Jersey , USA

Abstract

Abstract Background Outbreaks of healthcare-associated respiratory syncytial virus (HA-RSV) infections in children are well described, but less is known about sporadic HA-RSV infections. We assessed the epidemiology and clinical outcomes associated with sporadic HA-RSV infections. Methods We retrospectively identified hospitalized children ≤18 years old with HA-RSV infections in six children’s hospitals in the United States during the respiratory viral seasons October–April in 2016–2017, 2017–2018, and 2018–2019 and prospectively from October 2020 through November 2021. We evaluated outcomes temporally associated with HA-RSV infections including escalation of respiratory support, transfer to the pediatric intensive care unit (PICU), and in-hospital mortality. We assessed demographic characteristics and comorbid conditions associated with escalation of respiratory support. Results We identified 122 children (median age 16.0 months [IQR 6, 60 months]) with HA-RSV. The median onset of HA-RSV infections was hospital day 14 (IQR 7, 34 days). Overall, 78 (63.9%) children had two or more comorbid conditions; cardiovascular, gastrointestinal, neurologic/neuromuscular, respiratory, and premature/ neonatal comorbidities were most common. Fifty-five (45.1%) children required escalation of respiratory support and 18 (14.8%) were transferred to the PICU. Five (4.1%) died during hospitalization. In the multivariable analysis, respiratory comorbidities (aOR: 3.36 [CI95 1.41, 8.01]) were associated with increased odds of escalation of respiratory support. Conclusions HA-RSV infections cause preventable morbidity and increase healthcare resource utilization. Further study of effective mitigation strategies for HA-respiratory viral infections should be prioritized; this priority is further supported by the impact of the COVID-19 pandemic on seasonal viral infections.

Funder

Merck Sharp & Dohme LLC

Merck & Co., Inc

Spring SHEA, Colorado Springs, CO

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,General Medicine,Pediatrics, Perinatology and Child Health

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1. Severe respiratory syncytial virus disease;Journal of Intensive Medicine;2024-10

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