Respiratory syncytial virus hospitalisations among young children: a data linkage study.

Namrata Prasad,Cameron C Grant,E Claire Newbern,Q Sue Huang,Adrian A Trenholme,Nayyereh Aminisani,Tim Wood,Mark G Thompson

doi:10.1017/s0950268819001377

Abstract

We aimed to provide comprehensive estimates of laboratory-confirmed respiratory syncytial virus (RSV)-associated hospitalisations. Between 2012 and 2015, active surveillance of acute respiratory infection (ARI) hospitalisations during winter seasons was used to estimate the seasonal incidence of laboratory-confirmed RSV hospitalisations in children aged <5 years in Auckland, New Zealand (NZ). Incidence rates were estimated by fine age group, ethnicity and socio-economic status (SES) strata. Additionally, RSV disease estimates determined through active surveillance were compared to rates estimated from hospital discharge codes. There were 5309 ARI hospitalisations among children during the study period, of which 3923 (73.9%) were tested for RSV and 1597 (40.7%) were RSV-positive. The seasonal incidence of RSV-associated ARI hospitalisations, once corrected for non-testing, was 6.1 (95% confidence intervals 5.8-6.4) per 1000 children <5 years old. The highest incidence was among children aged <3 months. Being of indigenous Māori or Pacific ethnicity or living in a neighbourhood with low SES independently increased the risk of an RSV-associated hospitalisation. RSV hospital discharge codes had a sensitivity of 71% for identifying laboratory-confirmed RSV cases. RSV infection is a leading cause of hospitalisation among children in NZ, with significant disparities by ethnicity and SES. Our findings highlight the need for effective RSV vaccines and therapies.

Highlights

Respiratory syncytial virus (RSV) is a common aetiological agent in acute respiratory infections (ARI) [1]; uncertainties in RSV burden estimates among children remain
RSV laboratory methods have evolved, with real-time polymerase chain reaction (PCR) having a higher sensitivity than previously used immunofluorescence and virus isolation techniques [7]. It is unclear whether varied estimates of RSV disease burden are due to hospital coding, testing, other methodological differences or reflect true geographic and seasonal variation; regardless, they highlight the value of active surveillance of RSV with real-time PCR laboratory confirmation
Specimens were tested for RSV, influenza, rhinovirus (RV), adenovirus (ADV), and human metapneumovirus using the United States Centers for Disease Control and Prevention real-time reverse-transcription (RT)-PCR protocol [14, 15] at the Institute of Environmental Science and Research or the AusDiagnostic PCR protocol and real-time RT-PCR assay at hospital laboratories [16]

Summary

Introduction

Respiratory syncytial virus (RSV) is a common aetiological agent in acute respiratory infections (ARI) [1]; uncertainties in RSV burden estimates among children remain. Some studies are based on hospital discharge records [3, 4], which rely on passive surveillance for case ascertainment and may lack laboratory confirmation, while others have used indirect statistical methods to quantify RSV attributable burdens [5, 6]. RSV laboratory methods have evolved, with real-time polymerase chain reaction (PCR) having a higher sensitivity than previously used immunofluorescence and virus isolation techniques [7]. It is unclear whether varied estimates of RSV disease burden are due to hospital coding, testing, other methodological differences or reflect true geographic and seasonal variation; regardless, they highlight the value of active surveillance of RSV with real-time PCR laboratory confirmation

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