Age-Specific Estimates of Respiratory Syncytial Virus-Associated Hospitalizations in 6 European Countries: A Time Series Analysis

Abstract

Background Knowledge on age-specific hospitalizations associated with RSV infection is limited due to limited testing, especially in older children and adults in whom RSV infections are not expected to be severe. Burden estimates based on RSV coding of hospital admissions are known to underestimate the burden of RSV. We aimed to provide robust and reliable age-specific burden estimates of RSV-associated hospital admissions based on data on respiratory infections from national health registers and laboratory-confirmed cases of RSV. Methods We conducted multiseason regression analysis of weekly hospitalizations with respiratory infection and weekly laboratory-confirmed cases of RSV and influenza as covariates, based on national health registers and laboratory databases across 6 European countries. The burden of RSV-associated hospitalizations was estimated by age group, clinical diagnosis, and presence of underlying medical conditions. Results Across the 6 European countries, hospitalizations of children with respiratory infections were clearly associated with RSV, with associated proportions ranging from 28% to 60% in children younger than 3 months and we found substantial proportions of admissions to hospital with respiratory infections associated with RSV in children younger than 3 years. Associated proportions were highest among hospitalizations with ICD-10 codes of “bronchitis and bronchiolitis.” In all 6 countries, annual incidence of RSV-associated hospitalizations was >40 per 1000 persons in the age group 0–2 months. In age group 1–2 years the incidence rate ranged from 1.3 to 10.5 hospitalizations per 1000. Adults older than 85 years had hospitalizations with respiratory infection associated to RSV in all 6 countries although incidence rates were low. Conclusions Our findings highlight the substantial proportion of RSV infections among hospital admissions across different ages and may help public health professionals and policy makers when planning prevention and control strategies. In addition, our findings provide valuable insights for health care professionals attending to both children and adults presenting with symptoms of viral respiratory infections.

Human Respiratory Syncytial Virus Infections among Hospitalized Children in Poland during 2010–2020: Study Based on the National Hospital Registry

“…In the present study, children aged 0–90 days accounted for approximately one-third of all hospitalized patients. It may be similar to other studies where the median age of RSV was 8.4 weeks and the highest hospitalization rate was among children aged 0–2 months [ 20 , 22 ].…”

“…However, the estimated incidence rate of hospitalizations due to RSV infection among children in Poland appears to be low compared to the data from the scientific literature. In a study based on data from six European countries, the incidence of hospitalizations in 0–2 months old children was above 4000 per 100,000, while in the group of 1–2 year-olds, it ranged from 130 to 1050 per 100,000 [ 20 ]. In an article aggregating data from 32 countries, the estimated incidence of hospitalization in 2015 in children < 5 years of age was 437 per 100,000 children, and among children < 1 year, even 1919 per 100,000 children [ 11 ].…”

Preparing for uncertainty: endemic paediatric viral illnesses after COVID-19 pandemic disruption

“…Age-related differences in disease presentations are likely to vary by pathogen. For example, the risk of severe RSV disease is higher in younger children, 16 therefore delayed exposure might reduce the disease burden in children infected at older ages, whereas young infants unprotected by maternal antibodies might be more likely to develop severe disease. It remains to be seen whether delayed exposure to enterovirus D68 during the COVID-19 pandemic could lead to the increased risk of severe paralytic disease that was observed with increased age at primary infection with poliovirus.…”

Respiratory Health Inequities among Children and Young Adults with Cerebral Palsy in Aotearoa New Zealand: A Data Linkage Study

“…In Western Australia, 16% of participants had 332 respiratory hospital admissions, an average of 4.3 per person over 5 years [ 24 ]. These data paint a picture of a high overall risk of respiratory-related hospital admissions in children and young adults with CP, a risk which is much higher than the reported risk in the general population for admissions with other respiratory illnesses such as RSV (reported to range from 1.3 to 10.5 hospitalizations per 1000 in the age group 1–2 years) [ 25 ].…”

“…In the current study, Indigenous NZ Māori children and young adults with CP experienced a higher incidence of respiratory-related hospital admissions over time when compared to non-Māori participants and were more likely to function at GMFCS levels IV or V. Individuals with CP and GMFCS levels IV or V often have associated co-morbidities, such as oropharyngeal motor dysfunction and recurrent seizures [ 26 , 27 ]. Overall, oropharyngeal motor dysfunction is common in people with CP [ 25 ] and results in sequential direct aspiration leading to aspiration pneumonia, acute respiratory infections, and chronic airway inflammation [ 28 ]. Similarly, seizures can lead to temporary altered muscle tone and reduced consciousness, which may increase the risk of aspiration, leading to aspiration pneumonia.…”