Healthcare-Associated Respiratory Syncytial Virus in Children's Hospitals

J Pediatric Infect Dis Soc. 2023 May 31;12(5):265-272. doi: 10.1093/jpids/piad030.

Abstract

Background: Outbreaks of healthcare-associated respiratory syncytial virus (HA-RSV) infections in children are well described, but less is known about sporadic HA-RSV infections. We assessed the epidemiology and clinical outcomes associated with sporadic HA-RSV infections.

Methods: We retrospectively identified hospitalized children ≤18 years old with HA-RSV infections in six children's hospitals in the United States during the respiratory viral seasons October-April in 2016-2017, 2017-2018, and 2018-2019 and prospectively from October 2020 through November 2021. We evaluated outcomes temporally associated with HA-RSV infections including escalation of respiratory support, transfer to the pediatric intensive care unit (PICU), and in-hospital mortality. We assessed demographic characteristics and comorbid conditions associated with escalation of respiratory support.

Results: We identified 122 children (median age 16.0 months [IQR 6, 60 months]) with HA-RSV. The median onset of HA-RSV infections was hospital day 14 (IQR 7, 34 days). Overall, 78 (63.9%) children had two or more comorbid conditions; cardiovascular, gastrointestinal, neurologic/neuromuscular, respiratory, and premature/ neonatal comorbidities were most common. Fifty-five (45.1%) children required escalation of respiratory support and 18 (14.8%) were transferred to the PICU. Five (4.1%) died during hospitalization. In the multivariable analysis, respiratory comorbidities (aOR: 3.36 [CI95 1.41, 8.01]) were associated with increased odds of escalation of respiratory support.

Conclusions: HA-RSV infections cause preventable morbidity and increase healthcare resource utilization. Further study of effective mitigation strategies for HA-respiratory viral infections should be prioritized; this priority is further supported by the impact of the COVID-19 pandemic on seasonal viral infections.

Keywords: escalation of respiratory support; healthcare-associated RSV; surveillance definitions; transmission index.

MeSH terms

  • Adolescent
  • COVID-19* / epidemiology
  • Child
  • Cross Infection* / epidemiology
  • Delivery of Health Care
  • Hospitalization
  • Hospitals
  • Humans
  • Infant
  • Infant, Newborn
  • Pandemics
  • Respiratory Syncytial Virus Infections*
  • Respiratory Syncytial Virus, Human*
  • Respiratory Tract Infections*
  • Retrospective Studies
  • United States / epidemiology