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Hospitalizations Associated with Respiratory Syncytial Virus and Influenza in Children, Including Children Diagnosed with Asthma

Goldstein, Edwarda; Finelli, Lynb; O’Halloran, Alissac; Liu, Patrickd; Karaca, Zeynale; Steiner, Claudia A.e,†; Viboud, Cecilef; Lipsitch, Marca,g

doi: 10.1097/EDE.0000000000001092
Infectious Diseases

Background: There is uncertainty about the burden of hospitalization associated with respiratory syncytial virus (RSV) and influenza in children, including those with underlying medical conditions.

Methods: We applied previously developed methodology to Health Care Cost and Utilization Project hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003 and 2010.

Results: The estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460–519) present anywhere in the discharge diagnosis were 2,381 (95% CI(2252,2515)) in children <1 year of age; 710.6 (609.1, 809.2) (1 y old); 395 (327.7, 462.4) (2 y old); 211.3 (154.6, 266.8) (3 y old); 111.1 (62.4, 160.1) (4 y old); 72.3 (29.3, 116.4) (5–6 y of age); 35.6 (9.9,62.2) (7–11 y of age); and 39 (17.5, 60.6) (12–17 y of age). The corresponding rates of influenza-associated hospitalization were lower, ranging from 181 (142.5, 220.3) in <1 year old to 17.9 (11.7, 24.2) in 12–17 years of age. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups <5 y ranged between 3.1 (2.1, 4.7) (<1 y old) and 6.7 (4.2, 11.8) (2 y old; the corresponding risks for influenza-related hospitalization ranged from 2.8 (2.1, 4) (<1y old) to 4.9 (3.8, 6.4) (3 y old).

Conclusion: RSV-associated hospitalization rates in young children are high and decline rapidly with age. There are additional risks for both RSV and influenza hospitalization associated with a prior diagnosis of asthma, with the rates of RSV-related hospitalization in the youngest children diagnosed with asthma being particularly high.

From the aDepartment of Epidemiology, Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health, Boston, MA

bVaccines Division, Merck & Co., Inc., Kenilworth, NJ

cInfluenza Division, National Center for Immunization and Respiratory Diseases, US CDC, Atlanta, GA

dYale School of Medicine, New Haven, CT

eDivision of International Epidemiology and Population Studies, Agency for Healthcare Research and Quality, United States Department of Health and Human Services, Rockville, MD

fDivision of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD

gDepartment of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA.

Submitted January 11, 2019; accepted July 29, 2019.

† Current address for Dr Steiner: Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231.

This work was supported by Award Number U54GM088558 from the National Institute of General Medical Sciences (M.L., E.G.), and by the in-house research program of the Division of International Epidemiology and Population Studies, The Fogarty International Center, US National Institutes of Health, funded in part by the Office of Pandemics and Emerging Threats at the United States Department of Health and Human Services (C.V.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

M.L. reports grants from NIH/NIGMS, during the conduct of the study; personal fees from Affinivax, personal fees from Merck, grants and personal fees from Pfizer, grants from PATH Vaccine Solutions, outside the submitted work. The other authors report no conflicts of interests.

Hospitalization data used in this article can be requested from Dr. Zeynal Karaca of the Agency for HealthCare Research and Quality, U.S. Department of Health & Human Services, The corresponding author (E.G.) would be happy to share the computing code used for the inference in this article, and suggest modifications of thereof for related inference.

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Correspondence: Edward Goldstein, Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health, 677 Huntington Ave, Kresge Room 506, Boston MA 02115. E-mail:

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