Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Abstract

One thousand five hundred sixty-eight RSV infections were documented prospectively in 1,541 pediatric patients. Of these, 20 (1.3%) had acquired the RSV infection while treated by mechanical ventilation for reasons other than the actual RSV infection (group ventilated mechanically). The clinical characteristics of children who were infected with respiratory syncytial virus (RSV) infection while ventilated mechanically for other reasons are described and compared with a matched control group. Sixty percent of the group ventilated mechanically had at least one additional risk factor for a severe course of infection (prematurity 50%, chronic lung disease 20%, congenital heart disease 35%, immunodeficiency 20%). The median age at diagnosis in the group ventilated mechanically was 4.2 months. The matched pairs analysis (group ventilated mechanically vs. control group) revealed a higher proportion of patients with hypoxemia and apnoea in the group ventilated mechanically; more patients in the control group showed symptoms of airway obstruction (wheezing). At least one chest radiography was performed in 95% of the patients (n ¼ 19) in the group ventilated mechanically versus 45% (n ¼ 9) in the control group (P ¼ 0.001). The frequency of pneumonia was 40% in the group ventilated mechanically and 20% in the control group. Despite existing consensus recommendations, only two patients (10%) of the group ventilated mechanically had received palivizumab previously. Significantly more patients in the group ventilated mechanically received antibiotic treatment (85% vs. 45%, P ¼ 0.008), and attributable mortality was higher in the group ventilated mechanically (15% [n ¼ 3] vs. 0% in the control group, P ¼ 0.231). Children treated by long term mechanical ventilation may acquire RSV infection by transmission by droplets or caregivers and face an increased risk of a severe course of RSV infection. The low rate of immunoprophylaxis in this particular risk group should be improved.

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

“…Nosocomial outbreaks of RSV infection in ICUs also represent an important cause of morbidity in this specific, high-risk population [53, 54]. Children on long-term mechanical ventilation may acquire RSV infection by transmission through droplets or caregivers and face an increased risk of a severe course of RSV infection [53].…”

“…Children on long-term mechanical ventilation may acquire RSV infection by transmission through droplets or caregivers and face an increased risk of a severe course of RSV infection [53]. A German study prospectively documented 1568 RSV infections in 1541 pediatric patients of whom 20 (1.3%) had acquired the RSV infection while being treated by mechanical intervention for other reasons.…”

“…A German study prospectively documented 1568 RSV infections in 1541 pediatric patients of whom 20 (1.3%) had acquired the RSV infection while being treated by mechanical intervention for other reasons. Thirty-five percent of the children (median age 4.2 months, range 0.5–97 months) who acquired the RSV infection whilst mechanically ventilated had CHD [53]. In a UK study reporting on a RSV outbreak in a PICU, 27.8% (15/54) of the children acquired the RSV infection whilst in the PICU [54].…”

Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities

“…In addition to the usual bacterial pathogens common in hospitals, children in pLTCFs have frequent viral infections including vaccine preventable infections, such as varicella, rubella, hepatitis A, influenza, and rotavirus, as well as respiratory viral pathogens such as respiratory syncytial virus, adenovirus, rhinovirus, human metapneumovirus, and parainfluenza and gastrointestinal viruses such as noroviruses (James et al, 2007; von Renesse et al, 2009). For example, in one of these facilities between January 2009 and September 2013, 471 acute respiratory infections were diagnosed in 183 residents (Jackson, Murray, Hutcheon, Saiman, & Neu, 2014).…”

Emerging Viral Infections

“…However, recent investigations have demonstrated clearly that RSV infection is underestimated in the elderly and in patients with other malignancies, where it may cause severe to fatal pneumonia [174,182,184,185,196,197,215,222]. This increasing incidence in some patient groups may define the RSV as a reemerging pathogen, although it is ascribable to the use, for the first time, of molecular RSV diagnostic methods in vulnerable patient groups.…”