RSV hospitalizations linked to ‘considerable’ health care burden in Europe
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One in 56 infants born healthy in Europe between July 2017 and April 2020 was hospitalized due to respiratory syncytial virus, or RSV, according to study results published in The Lancet Respiratory Medicine.
“The RESCEU birth cohort study is the largest multicenter prospective birth cohort that evaluated the incidence of RSV-associated hospitalizations and medically attended acute respiratory infections,” Joanne G. Wildenbeest, MD, PhD, of the department of pediatric infectious diseases and immunology at Wilhelmina Children’s Hospital, and colleagues wrote. “It was designed to provide a precise and up-to-date estimate of the total RSV incidence and health care burden in Europe.”
In the multicenter, prospective, observational birth cohort RESCEU study, Wildenbeest and colleagues evaluated 9,154 infants born at 37 weeks or more of gestation with no medical disorders between July 1, 2017, and April 1, 2020, in five different European countries to calculate the health care burden of RSV during the first year of life.
Researchers identified the first-year incidences of RSV-related hospitalizations using parental questionnaires and hospital charts. Further, in a nested group of 993 infants, they conducted active RSV surveillance to analyze the frequency of medically attended RSV infections until the infant turned 1 year old.
Researchers observed 145 (37.4%) RSV-related hospitalizations out of 388 acute respiratory infection hospitalizations, 49% of which were detected by a polymerase chain reaction test, 46.2% by point-of-care testing and seven detected by an undocumented test.
Of the total cohort, researchers found a 1.8% (95% CI, 1.6-2.1) incidence of RSV-confirmed hospitalizations, equaling a 1.6 per 1,000 infant-months incidence rate or one in every 56 infants born.
Infants born during the autumn season had more RSV-related hospitalizations (2.6 per 1,000 infant-months; 95% CI, 2-3.3) compared with those born in winter (1.1 per 1,000 infant-months; 95% CI, 0.8-1.6; P = .002) and spring (0.8 per 1,000 infant-months; 95% CI, 0.5-1.3; P = .001).
Children aged younger than 3 months accounted for 57.9% of the RSV hospitalizations.
Median hospital stay was 3 days (interquartile range, 2-5 days) for the total cohort, with no linkage between time spent in the hospital and additional measures of severity with the incidence rate of RSV-related hospitalizations.
Of the hospitalizations related to RSV, eight infants (5.5%) advanced into the pediatric ICU, with three needing mechanical ventilation. The median age at ICU admission was 1 month, with six infants in this group aged younger than 3 months.
Of the 85 infants examined for coinfections in routine care, 34 (23.4%) infants hospitalized for RSV had another infection; rhinovirus was the most common disease in these patients.
When assessing the 1,419 nasal swabs collected during episodes of acute respiratory infection in the active surveillance cohort, researchers found 262 (18.5%) cases of RSV in 249 infants.
For instances of RSV confirmed by any diagnostic assay in this cohort, RSV incidence was 26.2% (incidence rate, 23.7 per 1,000 infant-months; 95% CI, 21-26.7). For medically attended RSV cases, RSV incidence was 14.1% (incidence rate, 12.1 per 1,000 infant-months; 95% CI, 10.2-14.3).
Lastly, researchers found wheezing was linked to RSV hospitalization, medically attended RSV-associated acute respiratory infection and overall RSV-associated acute respiratory infection.
“This study provides the precise estimates of the health care burden of RSV required to decide on future RSV immunization programs,” Wildenbeest and colleagues wrote. “The health care burden of RSV among healthy infants is considerable in Europe, with one in 56 healthy term-born infants hospitalized for RSV infection annually. As the incidence of severe RSV infection is highest in the first months of life, maternal vaccination as well as passive infant immunization could have a major effect on the health of healthy term infants.”
This study by Wildenbeest and colleagues suggests more studies are needed regarding whether prevention programs will aid in combatting the burdens that come with RSV hospitalization, according to an accompanying editorial by Reinout A. Bem, MD, PhD, of the pediatric intensive care unit at Amsterdam UMC.
“As hospitalization is the primary driver for RSV-associated infant and parental distress and medical costs, it remains to be seen whether the coming prevention programs will indeed be able to offload the major health care burden associated with RSV as identified by the study of Wildenbeest and colleagues,” Bem wrote.