American Indian, Alaska Native children endure high rates of RSV
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Key takeaways:
- More than half of American Indian or Alaska Native children with an acute respiratory infection tested positive for RSV.
- RSV prevention methods may be prohibitively expensive in this population.
American Indian and Alaska Native children endure high rates of respiratory syncytial virus infection, a study published in Pediatrics found.
RSV surged in the United States last fall, possibly due to waning immunity, and was part of a winter tripledemic of respiratory diseases, alongside COVID-19 and influenza.
“Historically, American Indian and Alaska Native — or AIAN — children endured high rates of RSV illness. However, they have been under-represented in current studies of the burden of RSV in U.S. children,” Laura Hammitt, MD, director of the infectious disease program at the Johns Hopkins University Center for Indigenous Health, told Healio.
“While AIAN parents might not know the term ‘RSV,’ they were very familiar with the syndrome of bronchiolitis and were concerned about the high rate of illness in their communities,” Hammitt said.
Hammitt and colleagues enrolled 324 children aged younger than 5 years in Arizona and Alaska who were hospitalized with acute respiratory infection from November 2019 to May 2020.
“Given the concerns about respiratory illness in AIAN infants, we sought and obtained community approval to begin this study in AIAN communities in Arizona and Alaska,” Hammitt said. “Children who came to a participating health care facility with respiratory illness were eligible to participate. After an informed consent process, the research team administered a questionnaire to the child’s parent or guardian and also collected a nasal swab to test for respiratory viruses. Using these data, the study team calculated the rate of RSV-associated hospitalization.”
Of the 324 children enrolled, 53% tested positive for RSV, with the rate of illness greatest among infants younger than 6 months old. However, rates of RSV-associated hospitalization were also high in 6- to 11-month-olds and children in the second year of life.
According to Hammitt, studies conducted more than a decade ago found that AIAN children “had among the highest rates of RSV hospitalization in the world, largely driven by longstanding inequities in the social determinants of health,” such as a lack of running water, household overcrowding, poor indoor air quality and other socioeconomic factors. as root causes of elevated RSV hospitalizations among AIAN children living in tribal lands.
“The persistence of this disparity is disheartening but not surprising,” Hammitt said.
“Rates among Alaska Native children in Anchorage, the only urban site, were much lower than the other sites and were more similar to rates observed for the general U.S.,” Hammitt said. “This corroborates findings from several other studies implicating social determinants of health as a root cause of the elevated RSV burden experienced by AIAN children. Disparities in RSV burden have been found in non-Native economically disadvantaged populations, as well. Improvements in the social determinants of health for AIAN children and RSV-prevention products are urgently needed to address this persistent health disparity.”
RSV prevention methods, such as maternal immunization and monoclonal antibodies, are urgently needed, the authors added.
“Two RSV prevention products — monoclonal antibodies for infants and RSV vaccine for pregnant persons — have been proven efficacious and are expected to be licensed this autumn. However, they are likely to be prohibitively expensive for marginalized populations that experience the highest rates of RSV unless they are covered by public options,” Hammitt said. “To avoid perpetuating health inequities, it’s critical that RSV prevention products are accessible to AIAN populations.”
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