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REPORT: Young chronologic age, exposure to children increases risk for RSV complications among infants
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Preterm infants exposed to young children had an increased risk for hospitalization and ICU admission due to respiratory syncytial virus, according to recent study findings.Respiratory syncytial virus (RSV) is the most important viral pathogen causing acute lower respiratory illness (LRI) and community-acquired pneumonia in young children, the researchers told Infectious Diseases in Children.
“Young chronologic aged has been recognized as a major risk factor for severe RSV disease, with more than 80% of RSV hospitalizations occurring in infants younger than 12 months and the highest rates observed in the first 5 months of life,” Eric A. F. Simões, MD, professor of pediatric infectious diseases at Children’s Hospital of Colorado, and colleagues wrote. “The risk of laboratory-confirmed RSV hospitalizations among U.S. infants was estimated in a large, multi-season active surveillance study, with the highest rate of 25.9 per 1,000 infants per season observed in the second month of life.
“Additionally, significant exposure to young children through living with young siblings or daycare attendance has also been consistently associated with an increased RSV risk among preterm infants.”
The researchers analyzed data from the prospective RSV Respiratory Events Among Infants Outcomes and Risk Tracking (REPORT) study to determine the rate of incidences of medically-attended, laboratory-confirmed RSV cases and identify associated risk factors for RSV among preterm infants born at 32 to 35 weeks’ gestation in the U.S. The REPORT study included 1,642 infants enrolled from 188 clinics in 38 states observed between September and May of the 2009-2010 or 2010-2011 RSV seasons. Mean age of infants at enrollment was 2.3 months. Some 8.6% were born at 32 weeks’ gestation, 13% at 33 weeks, 25% at 34 weeks and 54% at 35 weeks’ gestation.
Further, Simões and colleagues “analyzed data from the REPORT study to evaluate the risk of RSV-related outpatient [lower respiratory tract infections (LRI)], hospitalization, and [ICU] admission as a function of chronologic age among U.S. preterm infants with and without significant exposure to young children, based on birth month and age of exposure.”
The researchers calculated event rates per 100 infant-seasons and defined a season as 5 months of analysis from November 1 to March 31.
Respiratory-related ER visits without RSV testing were considered RSV events if a positive sample was collected within 7 days of clinical visit.
Outpatient RSV LRI incidences were highest in older infants exposed to young children (22.7 per 100 infant-seasons; 95% CI, 18.6-27.7) or those born in May (20.4 per 100 infant-seasons; 95% CI, 1.8-2.9). However, RSV hospitalization occurred most often among younger infants aged less than 1 month (8.2 per 100 infant-seasons; 95% CI, 6.9-9.7) vs. older infants aged 10 months (2.3 per 100 infant-seasons; 95% CI, 1.8-2.9). Moreover, the risk for RSV ICU admission rates were highest among infants aged younger than 1 month (6.5 per 100 infant-seasons; 95% CI, 5.6-7.6) and infants born in February with exposure to young children (7.9 per 100 infant-seasons; 95% CI, 5.7-11).
These data demonstrate that higher risk for 32 to 35 wGA infants can be easily identified by age or birth month and significant exposure to other young children, and it is important these infants receive targeted efforts to prevent RSV, the researchers said in an interview.
“The results confirm that RSV is the predominant virus responsible for severe lower respiratory disease in these preterm infants, and, consistent with previous observations [in the separate SENTINEL1 and TRUVEN studies], young chronologic age and exposure to young children significantly increased the risk of severe RSV disease in preterm infants born at 32 weeks’ to 35 weeks’ gestational age,” the researchers wrote. “The current results are unique in that they provide continuous age-based risk models for outpatient and inpatient disease for infants with and without young child exposure.
“In addition, the absolute risk estimates are more accurate than those derived from administrative databases with passive case ascertainment.” – by Kate Sherrer
Disclosure: This study was supported by AstraZeneca. The researchers report no relevant financial disclosures.
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