Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Chronic Lung Disease

Bosco Paes; Brigitte Fauroux; Josep Figueras-Aloy; Louis Bont; Paul A Checchia; Eric A F Simões; Paolo Manzoni; Xavier Carbonell-Estrany

doi:10.1007/s40121-016-0137-7

Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Chronic Lung Disease

Infect Dis Ther. 2016 Dec;5(4):453-471. doi: 10.1007/s40121-016-0137-7. Epub 2016 Nov 18.

Authors

Bosco Paes¹, Brigitte Fauroux², Josep Figueras-Aloy³, Louis Bont⁴, Paul A Checchia⁵, Eric A F Simões⁶, Paolo Manzoni⁷, Xavier Carbonell-Estrany⁸

Affiliations

¹ Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada.
² Necker University Hospital and Paris 5 University, Paris, France.
³ Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain.
⁴ University Medical Center Utrecht, Utrecht, The Netherlands.
⁵ Baylor College of Medicine, Texas Children's Hospital Houston, Houston, TX, USA.
⁶ Center for Global Health, Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, USA.
⁷ Neonatology and NICU, Sant'Anna Hospital, Turin, Italy.
⁸ Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain. carbonell@comb.cat.

Abstract

Introduction: The REGAL (RSV evidence-a geographical archive of the literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This third publication covers the risk and burden of RSV infection in infants with chronic lung disease (CLD), formerly called bronchopulmonary dysplasia (BPD).

Methods: A systematic review was undertaken of publications between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov. Studies reporting data for hospital visits/admissions for RSV infection among infants with CLD/BPD who were not prophylaxed, as well as studies reporting RSV-associated morbidity, mortality, and healthcare costs, were included. Burdens of disease data were compared with preterm infants without CLD/BPD, other high-risk groups and term infants. Study quality and strength of evidence (SOE) were graded using recognized criteria.

Results: A total of 1837 studies were identified and 39 were included. CLD/BPD is a significant independent risk factor for RSV hospitalization [RSVH (odds ratio 2.2-7.2); high SOE]. Infants and young children with CLD/BPD had high RSVH rates which were generally similar in Europe, the United States, and Canada, mostly varying between 12 and 21%. Infants with CLD also had a longer length of hospital stay than other high-risk groups and term infants (high SOE). On average, infants spent 4-11 days in hospital (moderate SOE). Once hospitalized for RSV, affected children were at risk for a more severe course of disease than children with no RSVH (moderate SOE).

Conclusion: Severe RSV infection in infants and young children with CLD/BPD poses a significant health burden in Western countries. Further studies focussing on the burden of RSV infection in this well-recognized population at high risk for severe disease are needed to help improve outcomes and plan allocation of healthcare resources.

Funding: AbbVie.

Keywords: Bronchopulmonary dysplasia; Burden; Chronic lung disease; High-risk; Hospitalization; Morbidity; Preterm; Respiratory syncytial virus.

Publication types

Review