Abstract
ObjectiveTo estimate the incidence of respiratory syncytial virus (RSV) disease as a function of chronologic age and exposure to young children in US preterm infants.MethodsIn 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.ResultsAmong 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.ConclusionsPreterm 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 RegistrationClinicaltrials.gov: NCT00983606.
Highlights
Respiratory syncytial virus (RSV) is the most important viral pathogen causing acute lower respiratory illness (LRI) and community-acquired pneumonia in young children [1,2]
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
Young age and exposure to other young children identify those at greatest risk of severe RSV disease
Summary
Respiratory syncytial virus (RSV) is the most important viral pathogen causing acute lower respiratory illness (LRI) and community-acquired pneumonia in young children [1,2]. Subsequent to the original publication of the REPORT results, the American Academy of Pediatrics Committee on Infectious Diseases updated their guidance on the use of RSV immunoprophylaxis, recommending against use in infants born at 29 to 35 wGA without underlying comorbidity. This was based in part on the assertion that available data did not indicate a significant difference in hospitalization rates for RSV infection between preterm infants born at 29 to 36 wGA without underlying comorbidity and full-term infants [14,15]. Given the demonstration that hospitalization incidence will vary substantially based on infant age and change as infants age through the RSV season [5,16], we analyzed data from the REPORT study to evaluate the risk of RSV-related outpatient LRI, hospitalization, and intensive care unit (ICU) admission as a function of chronologic age among US preterm infants with and without significant exposure to young children, based on birth month and age of exposure
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