1406. Comparison of Clinical Presentations and Burden of Respiratory Syncytial Virus in Infants Across Three Distinct Healthcare Settings

Abstract

Background Respiratory syncytial virus (RSV) accounts for the majority of lower respiratory tract illnesses in hospitalized infants. In the U.S., RSV hospitalizations are well characterized; yet, emergency department (ED) and outpatient (OP) visits are underrecognized. We evaluated the burden of RSV across three distinct healthcare settings during one respiratory season. Methods From 12/16/19-4/30/20, we conducted a prospective RSV surveillance study among Davidson County, TN infants under one year who presented to an inpatient (IP), ED, or one of four OP clinics with either fever or any upper respiratory (i.e., cough, earache, nasal congestion, rhinorrhea, sore throat) and/or lower respiratory [i.e., wheezing, crackles, rales, diminished breath sounds, shortness of breath (SOB)] symptoms. Demographic and illness history were collected during parental/guardian interviews, followed by medical chart abstraction. Nasal swabs were collected and tested for RSV using Luminex® NxTAG RPP. Due to the COVID-19 pandemic, on 3/16/20 enrollment at three of the four OP clinics ceased. Results A total of 627 infants were screened, of whom 473 (75%) were confirmed eligible, 364 (77%) enrolled, 361 (99%) were tested for RSV of which 101 (28%) were RSV+ (IP=37, ED=18, OP=46) (Figure 1). Compared to RSV-negative subjects, RSV+ subjects were younger (6.6 vs. 4.9 months, p< 0.001), 56% were male and 48% white. By setting, infants in the OP setting were older than those seen in the IP and ED [(p=0.002), Figure 2]. Compared to infants in the OP setting, hospitalized infants were more likely to present with SOB and rhonchi/rales, but less likely to have only upper respiratory symptoms (Figure 3) and be African American (p=0.046). Infants in the IP setting had a higher proportion of clinical RSV diagnostic testing (73%) compared to the ED (39%) and OP (28%) settings (p< 0.001). Figure 1. Davidson County Infants with RSV by MMWR Week and Healthcare Setting (n=101) Figure 2. Cumulative Enrollment of Davidson County Infants with RSV by Age in Months and Healthcare Setting (n=101) Figure 3. Proportion of Davidson County Infants with RSV Showing each Clinical Symptom, by Healthcare Setting Conclusion Two-thirds of RSV+ infants sought care from either an OP or ED setting, with nearly all hospitalized infants presenting with both upper and lower respiratory symptoms. The underutilization of diagnostic testing in the OP settings may underestimate the true burden of RSV. Future studies are essential to document the true prevalence of RSV in order to assess the need and impact of new interventions (e.g., immunizations, antivirals). Disclosures Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)

Systematic literature review of the signs and symptoms of respiratory syncytial virus

“…Studies on S&S of RSV in the pediatric population (25 studies) took place in both community and clinical settings, and S&S were reported by both caregivers (six studies) 19 , 20 , 21 , 39 , 40 , 41 and clinicians (22 studies) 19 , 20 , 21 , 26 , 27 , 28 , 29 , 34 , 35 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ; we analyzed and present these two sets separately. In addition, two publications presented clinician‐reported S&S in the intensive care unit (ICU).…”

“…Four studies presented S&S reported by caregivers of children with RSV initially and primarily treated in the outpatient setting (Table S2 ). 20 , 21 , 39 , 41 All four studies were prospective and enrollment ranged from 361 to 923 children. One of these studies reported solely on wheezing.…”

“… 21 Although only reported by caregivers in one study, shortness of breath was reported in infants more frequently in the emergency department (64%) than in outpatient clinics (43%). 39 …”

“…Four publications representing three studies presented S&S reported by caregivers of children hospitalized with RSV (Figure 1 and Table S2 ) 19 , 31 , 39 , 40 ; two publications 31 , 40 reported on overlapping study populations. All three studies were prospective and ranged in enrollment from 245 to 412 children.…”

“…In the non‐hospitalized setting, eight studies captured clinician‐reported RSV S&S in children, primarily in infants. 20 , 21 , 26 , 27 , 39 , 45 , 49 , 50 Table S3 shows RSV S&S commonly reported by clinicians in the community or mixed settings. The RSV‐positive (RSV+) populations in these studies ranged in size from 11 to 311.…”