Risk Factors for Severe Respiratory Syncytial Virus Infection in Hospitalized Children

Hsuan-Yin Ma; I-Fan Lin; Yun-Chung Liu; Ting-Yu Yen; Kuan-Ying A Huang; Wei-Liang Shih; Chun-Yi Lu; Luan-Yin Chang; Li-Min Huang

doi:10.1097/INF.0000000000004270

Risk Factors for Severe Respiratory Syncytial Virus Infection in Hospitalized Children

Pediatr Infect Dis J. 2024 Jan 31. doi: 10.1097/INF.0000000000004270. Online ahead of print.

Authors

Hsuan-Yin Ma^{1

2}, I-Fan Lin², Yun-Chung Liu², Ting-Yu Yen², Kuan-Ying A Huang², Wei-Liang Shih³, Chun-Yi Lu², Luan-Yin Chang², Li-Min Huang²

Affiliations

¹ From the Center for Drug Evaluation, Taipei, Taiwan.
² Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University.
³ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

PMID: 38295229
DOI: 10.1097/INF.0000000000004270

Abstract

Background: Respiratory syncytial virus (RSV) is a common cause of bronchiolitis and pneumonia in infants and young children. Starting in December 2010, RSV monoclonal antibody (RSV mAb) was endorsed by Taiwan National Health Insurance and given to children with prematurity and/or congenital heart diseases, which are considered high-risk factors for severe RSV diseases. Investigating other important contributing risk factors is warranted.

Methods: We conducted a cohort study at National Taiwan University Hospital to determine the rate of severe outcomes among children hospitalized due to RSV infection from 2008 to 2018. Adjusted for age, sex and birth cohorts born before and after RSV mAb endorsement, we identified risk factors for severe RSV infection, defined as the requirement of invasive ventilator support.

Results: There were 1985 admissions due to RSV infections. Among them, 66 patients (3.3%) had severe RSV infection. The proportion of severe RSV infections decreased significantly after RSV mAb endorsement. Multivariable analysis revealed that age <1.5 months and cardiovascular and congenital/genetic diseases were high-risk underlying conditions. In addition, bacterial coinfections, elevated creatinine levels and initial abnormal chest radiograph findings posed warning signs for severe RSV infection.

Conclusions: Children younger than 1.5 months of age with cardiovascular or congenital/genetic diseases were predisposed to severe RSV infection and might benefit from RSV mAb prophylaxis.