Abstract
ObjectiveThere is limited epidemiological data on the seasonality of respiratory syncytial virus (RSV) infection in subtropical climates, such as in Taiwan. This study aimed to assess RSV seasonality among children ≤24 months of age in Taiwan. We also assessed factors (gestational age [GA], chronologic age [CA], and bronchopulmonary dysplasia [BPD]) associated with RSV-associated hospitalization in preterm infants to confirm the appropriateness of the novel Taiwanese RSV prophylactic policy.Study DesignFrom January 2000 to August 2010, 3572 children aged ≤24-months were admitted to Taipei Mackay Memorial Hospital due to RSV infection. The monthly RSV-associated hospitalization rate among children aged ≤24 months was retrospectively reviewed. Among these children, 378 were born preterm. The associations between GA, CA, and BPD and the incidence of RSV-associated hospitalization in the preterm infants were assessed.ResultsIn children aged ≤24 months, the monthly distribution of RSV-associated hospitalization rates revealed a prolonged RSV season with a duration of 10 months. Infants with GAs ≤32 weeks and those who had BPD had the highest rates of RSV hospitalization (P<0.001). Preterm infants were most vulnerable to RSV infection within CA 9 months.ConclusionsGiven that Taiwan has a prolonged (10-month) RSV season, the American Academy of Pediatrics' recommendations for RSV prophylaxis are not directly applicable. The current Taiwanese guidelines for RSV prophylaxis, which specify palivizumab injection (a total six doses until CA 8–9 months) for preterm infants (those born before 286/7 weeks GA or before 356/7 weeks GA with BPD), are appropriate. This prophylaxis strategy may be applicable to other countries/regions with subtropical climates.
Highlights
Respiratory syncytial virus (RSV) is the major pathogen of acute lower respiratory tract infection (ALRTI) in infancy and childhood [1,2]
Preterm infants were most vulnerable to RSV infection within chronologic age (CA) 9 months
The current Taiwanese guidelines for RSV prophylaxis, which specify palivizumab injection for preterm infants, are appropriate
Summary
Respiratory syncytial virus (RSV) is the major pathogen of acute lower respiratory tract infection (ALRTI) in infancy and childhood [1,2]. As there is no effective etiopathogenetic treatment once an infant is infected by RSV, effective RSV prophylaxis is extremely important [5]. Since 1998, the American Academy of Pediatrics (AAP) has recommended the use of palivizumab for passive immunization against RSV [6]. There is limited information regarding RSV seasonality in subtropical climates [6,8]. As RSV surveillance is a globally important issue, a thorough understanding of RSV epidemiology in subtropical climates, such as that in Taiwan, is important for the optimization of global RSV prevention strategies. The current Taiwanese recommendations (published in 2010 December) for RSV prophylaxis specify six doses of palivizumab, targeting preterm infants born before 286/7 weeks gestational age (GA) or those born before 356/7 weeks GA with bronchopulmonary dysplasia (BPD), until a chronologic age (CA) of 8–9 months
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