Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Chronic Lung Disease

Abstract

IntroductionThe REGAL (RSV evidence—a geographical archive of the literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This third publication covers the risk and burden of RSV infection in infants with chronic lung disease (CLD), formerly called bronchopulmonary dysplasia (BPD).MethodsA systematic review was undertaken of publications between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov. Studies reporting data for hospital visits/admissions for RSV infection among infants with CLD/BPD who were not prophylaxed, as well as studies reporting RSV-associated morbidity, mortality, and healthcare costs, were included. Burdens of disease data were compared with preterm infants without CLD/BPD, other high-risk groups and term infants. Study quality and strength of evidence (SOE) were graded using recognized criteria.ResultsA total of 1837 studies were identified and 39 were included. CLD/BPD is a significant independent risk factor for RSV hospitalization [RSVH (odds ratio 2.2–7.2); high SOE]. Infants and young children with CLD/BPD had high RSVH rates which were generally similar in Europe, the United States, and Canada, mostly varying between 12 and 21%. Infants with CLD also had a longer length of hospital stay than other high-risk groups and term infants (high SOE). On average, infants spent 4–11 days in hospital (moderate SOE). Once hospitalized for RSV, affected children were at risk for a more severe course of disease than children with no RSVH (moderate SOE).ConclusionSevere RSV infection in infants and young children with CLD/BPD poses a significant health burden in Western countries. Further studies focussing on the burden of RSV infection in this well-recognized population at high risk for severe disease are needed to help improve outcomes and plan allocation of healthcare resources.FundingAbbVie.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-016-0137-7) contains supplementary material, which is available to authorized users.

Seasonality and clinical impact of human parainfluenza viruses

“…In children, increased severity of illness was associated with respiratory conditions, cardiovascular conditions and HPIV‐4 while in adults, increased severity of illness was associated with age ≥65 years and cardiovascular conditions. The association of comorbid conditions and severe illness in those with HPIV is consistent with other respiratory viruses, most notably RSV and influenza, which both can exacerbate underlying cardiac and pulmonary conditions . This may also explain why 21% of hospitalized patients had a nonrespiratory primary diagnosis.…”

Factors predicting length of stay in bronchiolitis

“…In those born prematurely, there was a negative correlation between gestational age and disease severity [30]. Infants with chronic lung disease had a higher risk of hospitalization (OR 2.2-7.2) and a longer LOS [31]. Similarly, children with CHD had a higher risk of hospitalization and a more severe course, with 53% requiring PICU [32].…”

Risk factors for bronchiolitis hospitalization in infants: A French nationwide retrospective cohort study over four consecutive seasons (2009-2013)

“…Respiratory syncytial virus (RSV) represents the most common cause of bronchiolitis, followed by other viruses, such as rhinovirus, influenza, or metapneumovirus [1,3,4]. It is well-established that premature infants and those with bronchopulmonary dysplasia (BPD) or congenital heart disease (CHD) are at high-risk for severe bronchiolitis requiring hospital admission during epidemic season [5][6][7]. Recently, D. Verhoeven notes that although some of the morbidity associated with RSV in neonates is due to immunological maturation, the rapid development of the immune system right after birth suggests that each age group of infants may respond to the virus in different ways [8].…”