A Systematic Literature Review of the Burden of Respiratory Syncytial Virus and Health Care Utilization Among United States Infants Younger Than 1 Year

Abstract

Background The burden and health care utilization (HCU) of respiratory syncytial virus (RSV) in US infants aged <1 year across health care settings are not well characterized. Methods We systematically reviewed studies of RSV and bronchiolitis published 2000–2021 (data years, 1979–2020). Outcomes included RSV hospitalization (RSVH)/bronchiolitis hospitalization rates, emergency department (ED)/outpatient (OP) visit rates, and intensive care unit (ICU) admissions or mechanical ventilation (MV) use among RSV-/bronchiolitis-hospitalized infants. Study quality was determined using standard tools. Results We identified 141 good-/fair-quality studies. Five national studies reported annual average RSVH rates (range, 11.6 per 1000 per year among infants aged 6–11 months in 2006 to 50.1 per 1000 per year among infants aged 0–2 months in 1997). Two national studies provided RSVH rates by primary diagnosis for the entire study period (range, 22.0–22.7 per 1000 in 1997–1999 and 1997–2000, respectively). No national ED/OP data were available. Among 11 nonnational studies, RSVH rates varied due to differences in time, populations (eg, prematurity), and locations. One national study reported that RSVH infants with high-risk comorbidities had 5-times more MV use compared to non–high-risk infants in 1997-2012. Conclusions Substantial data variability was observed. Nationally representative studies are needed to elucidate RSV burden and HCU.

All Infants Are at Risk of Developing Medically Attended Respiratory Syncytial Virus Lower Respiratory Tract Infection and Deserve Protection

“…RSV LRTI is widely understood as a seasonal disease that drives infant healthcare visits across all settings. Nevertheless, a systematic literature review of the burden and healthcare utilization associated with infant RSV infections revealed an absence of national emergency department (ED) or outpatient (OP) assessments [ 16 ]. When data were available from across settings, RSV testing frequency was higher in the hospital inpatient (IP) setting than in the ED or OP settings [ 17 , 18 ] and higher among younger patients [ 19 ].…”

Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009–2019: A Study of the National (Nationwide) Inpatient Sample

“…A systematic literature review [ 3 ] of the RSV literature published between January 2000 and June 2021 recently identified 4 publications [ 4–7 ] that reported leading-cause analyses of infant hospitalizations in the US with 1 study conducted in California [ 7 ]. In these studies, RSV bronchiolitis ( International Classification of Diseases, Ninth Revision [ ICD-9 ] code 446.11) was consistently the leading cause of infant hospitalizations; however, all 4 publications [ 4–7 ] utilized data from before 2003, and only 1 study [ 5 ] provided leading-cause analyses by race/ethnicity (US general infant population and American Indian/Alaska Native [AI/AN] infants).…”

Respiratory Syncytial Virus Burden and Healthcare Utilization in United States Infants <1 Year of Age: Study of Nationally Representative Databases, 2011–2019

“…This retrospective study is based on the most recent, largest publicly available all-payer databases in the US to describe infant RSV and bronchiolitis burden, rates, and HCU in inpatient hospital and ED settings. To our knowledge, this is the first study since 2000 to provide infant RSV epidemiology data for the ED setting based on nationally representative data [ 7 ]. We found that infant RSVH rates have remained stable over time, whereas RSV ED visit rates have increased.…”

“…Palivizumab is recommended for select populations, that is, premature infants born ≤28 weeks’ gestational age (wGA), or those with chronic lung disease of prematurity (CLD) or hemodynamically significant congenital heart disease ( hs -CHD) [ 6 ]. Because palivizumab is the only available option, it is not surprising that the literature is focused on populations who are currently or formerly eligible to receive palivizumab (eg, infants born 29–34 wGA) [ 7 ]. For the broader groups of infants including late preterm to full term and those without comorbid conditions, RSV epidemiology data are limited, and there are no immunization options available [ 7 ].…”

“…Because palivizumab is the only available option, it is not surprising that the literature is focused on populations who are currently or formerly eligible to receive palivizumab (eg, infants born 29–34 wGA) [ 7 ]. For the broader groups of infants including late preterm to full term and those without comorbid conditions, RSV epidemiology data are limited, and there are no immunization options available [ 7 ].…”