Abstract
IntroductionSeveral vaccines for respiratory syncytial virus (RSV) are under development. Designing an effective vaccination programme for RSV requires information about the relative contribution of risk factors for severe RSV symptoms.AimTo inform preventive strategies in Europe by quantifying the contribution of key child, family and health service risk factors to the burden of RSV hospital admissions in young children.MethodsWe constructed a birth cohort study of all singleton children born in Scotland between October 2009 and September 2012 using linkage between birth registration, maternity, vaccination and hospital admission records, with follow-up until the age of 3 years. RSV-confirmed hospital admissions were defined using linkage to national laboratory surveillance data. We estimated hospital admission rates per 1,000 child years and length of stay according to each risk factor. Cox proportional hazard regression models were used to estimate adjusted hazard ratios.ResultsThere were 5,185 RSV admissions among the 169,726 children in the cohort: 48.6% of admissions occurred before the age of 6 months, and 29.6% after the age of 1 year. Children born prematurely, small for gestational age, between July and December, with chronic conditions, older siblings, mothers < 30 years old or delayed infant vaccination had a significantly increased risk of admission. Minimising the risk posed by older siblings could reduce RSV admissions by up to 34%.ConclusionFuture RSV vaccination programmes must protect children throughout early childhood. Vaccination and/or interventions to reduce transmission by older siblings could substantially reduce RSV hospital admissions.
Highlights
Several vaccines for respiratory syncytial virus (RSV) are under development
We developed a birth cohort study of all singleton children born in Scotland to Scottish resident mothers between October 2009 and September 2012, using linkage between the following national administrative health databases: birth and death registration records, maternity records, Scottish Birth Records, hospital admissions (SMR-01) and the infant vaccination registry (Scottish Immunisation Recall System, SIRS)
RSV-confirmed admissions were identified via linkage to the Electronic Communication of Surveillance in Scotland (ECOSS) database, a public health surveillance database held by Health Protection Scotland (HPS), the national infection control agency
Summary
Several vaccines for respiratory syncytial virus (RSV) are under development. Designing an effective vaccination programme for RSV requires information about the relative contribution of risk factors for severe RSV symptoms. Small for gestational age, between July and December, with chronic conditions, older siblings, mothers < 30 years old or delayed infant vaccination had a significantly increased risk of admission. Palivizumab, a humanised monoclonal RSV antibody, has been shown to reduce hospital admissions in children born preterm or with congenital heart disease [7], but is costly [8]. It is only recommended in children at high risk of serious complications, who have chronic heart or lung conditions or immunodeficiency [9]. Over 80% of infants who are admitted to hospital with bronchiolitis in the UK are born at term and otherwise healthy [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
