Abstract
RSV infection is a leading cause of lower respiratory tract infection, especially in High-risk infants with a history of prematurity, bronchopulmonary dysplasia (BPD), congenital heart disease (CHD), neuromusculair impairment, immunodeficiency, and Down syndrome. Host related risk factors that have been identified to be associated with severe RSV related lower respiratory tract infection include young age below 6 months at the beginning of RSV season, multiple birth, male sex, low socioeconomic status and parental education, crowded living conditions, young siblings, maternal smoking and indoor smoke pollution, malnutrition/small for gestational age, family history of atopy or asthma, low cord serum RSV antibody titers, and living at altitude.Risk factors increasing the risk of acquisition of RSV have been identified to be birth before and/or during RSV season, day care attendance, presence of older siblings in school or day-care, and lack of breast feeding. Some of these risk factors are discussed controversially and some of them are found continuously throughout the literature.Given the high cost of RSV prophylaxis, especially for the large population of late preterm infants, algorithms and risk score systems have been published that could identify high-risk infants for treatment with palivizumab out of this gestational age group. Several models reported on an average sensitivity and specificity of 70 percent and, thus, are helpful to identify infants at high risk for severe RSV infection and need for prophylaxis with palivizumab.
Highlights
Respiratory syncytial virus (RSV) is a leading cause of viral lower respiratory tract infections (LRTI) in early childhood, causing an estimated 33 Million LRTI in children under the age of five, 3.4 million hospitalizations and between 66,000-199,000 deaths annually, globally [1]
Immunologic processes play an important role, including an immune complex reaction Type III occurring in the lung between RSV antigen and maternal acquired IgG antibodies [3] accompanied by a lack of secretory IgA antibodies, a cell mediated Type IV reaction in the lung [4] and T-cell independent mechanisms implicating macrophages and MIP 1 and other chemokines
This review aims to summarize the evidence for risk factors associated with severe RSV - LRTI
Summary
Respiratory syncytial virus (RSV) is a leading cause of viral lower respiratory tract infections (LRTI) in early childhood, causing an estimated 33 Million LRTI in children under the age of five, 3.4 million hospitalizations and between 66,000-199,000 deaths annually, globally [1]. Almost all infants are infected by 2 to 3 years or following two RSV seasons [2]. Infection rates peak in infants aged up to 3 months. Several hypotheses exist to explain the severity of RSV - LRTI during the first few months of life. Immunologic processes play an important role, including an immune complex reaction Type III occurring in the lung between RSV antigen and maternal acquired IgG antibodies [3] accompanied by a lack of secretory IgA antibodies, a cell mediated Type IV reaction in the lung [4] and T-cell independent mechanisms implicating macrophages and MIP 1 and other chemokines. The immature immune system and the small infant’s airways are important factors explaining the severity of RSV disease within the first months of life [5]. This review aims to summarize the evidence for risk factors associated with severe RSV - LRTI
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