Effects of Chronologic Age and Young Child Exposure on Respiratory Syncytial Virus Disease among US Preterm Infants Born at 32 to 35 Weeks Gestation

Eric A F Simões; Evan J Anderson; Xionghua Wu; Christopher S Ambrose

doi:10.1371/journal.pone.0166226

Effects of Chronologic Age and Young Child Exposure on Respiratory Syncytial Virus Disease among US Preterm Infants Born at 32 to 35 Weeks Gestation

PLoS One. 2016 Nov 29;11(11):e0166226. doi: 10.1371/journal.pone.0166226. eCollection 2016.

Authors

Eric A F Simões¹, Evan J Anderson², Xionghua Wu³, Christopher S Ambrose⁴

Affiliations

¹ University of Colorado School of Medicine, Colorado School of Public Health and Children's Hospital Colorado, Aurora, CO, United States of America.
² Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.
³ Department of Biostatistics, MedImmune, Gaithersburg, MD, United States of America.
⁴ AstraZeneca, Gaithersburg, MD, United States of America.

Abstract

Objective: To estimate the incidence of respiratory syncytial virus (RSV) disease as a function of chronologic age and exposure to young children in US preterm infants.

Methods: In the RSV Respiratory Events among Preterm Infants Outcomes and Risk Tracking (REPORT) study, preterm infants born at 32-35 weeks gestational age (wGA) were enrolled from 188 US clinics and followed September-May of 2009-2010 or 2010-2011. Infants with medically-attended acute respiratory illness had nasal/pharyngeal swabs collected for viral testing. Results of RSV tests conducted during routine clinical care were also collected. Event rates during November-March were modeled as a function of chronologic age and birth month using Poisson regression and adjusting for other covariates. Rates were calculated overall and for infants with and without exposure to young siblings or daycare attendance. Of 3317 infants screened, 1646 were enrolled as a consecutive sample. Infants with chronic lung disease of prematurity, hemodynamically significant congenital heart disease, life expectancy <6 months, or receiving or being considered for RSV immunoprophylaxis were excluded. 84% of patients completed the study. Demographics of the enrolled cohort were generally similar to those of US infants born at 32-35 wGA; infants 32-34 wGA, Hispanic infants, and infants of less-educated mothers were under-represented.

Results: Among 1642 evaluable infants, outpatient RSV lower respiratory illness incidence was highest at older ages, whereas RSV hospitalization and intensive care unit (ICU) admission were highest at younger ages. In all instances, young child exposure was associated with higher RSV incidence. The highest RSV hospitalization and ICU rates occurred among February-born infants with young child exposure, at 19.0 (95% CI, 13.5-27.0) and 6.5 (95% CI, 5.6-7.6) per 100 infant-seasons, respectively.

Conclusions: Preterm infants have a substantially elevated risk of RSV disease. Young age and exposure to other young children identify those at greatest risk of severe RSV disease.

Trial registration: Clinicaltrials.gov: NCT00983606.

Publication types

Clinical Trial

MeSH terms

Age Distribution
Female
Gestational Age*
Humans
Infant
Infant, Newborn
Infant, Premature*
Male
Respiratory Syncytial Virus Infections*
Respiratory Syncytial Viruses / physiology*

Associated data

ClinicalTrials.gov/NCT00983606

Grants and funding

This study was sponsored by AstraZeneca, the parent company of MedImmune. ES has received grant support through his institution from AstraZeneca and AbbVie. EA has received research funding to his institution on his behalf from AstraZeneca and is a consultant to AbbVie. XW was an employee of MedImmune when the study was conducted and is currently an independent contractor to AstraZeneca. CSA is an employee of AstraZeneca and holds stock or stock options. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.