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Severe Respiratory Syncytial Virus Infection in Hospitalized Children Less Than 3 Years of Age in a Temperate and Tropical Climate

Butler, Jessica, MBBS*; Gunnarsson, Ronny, MD, PhD; Traves, Aileen, MBBS, DCH, FRACGP, MPHTM; Marshall, Helen, MBBS, MD, MPH, DCH§

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 6–11
doi: 10.1097/INF.0000000000002026
Original Studies

Background: Respiratory syncytial virus (RSV) infection is a frequent cause of hospitalization in infants younger than 3 years of age. We aimed to determine the factors associated with severe RSV disease.

Methods: Retrospective medical review of children up to 3 years of age admitted for laboratory-proven RSV infection between January 1, 2013, and December 31, 2014, was conducted at the Women’s and Children’s Hospital, Adelaide, South Australia, and the Paediatric Department at Cairns Hospital, Cairns, North Queensland. Severity of infection was determined using the validated Brisbane RSV Infection Severity Score.

Results: Four-hundred ninety-six children (383 at Women’s and Children’s Hospital and 113 at Cairns Hospital) were included in the study, with 76, 323 and 97 patients identified as having mild, moderate or severe disease, respectively. Decreasing age [odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90–0.99, P = 0.020), and being Indigenous, increased (OR = 2.6; 95% CI = 1.4–4.9, P = 0.002) the risk of severe RSV infection in hospitalized children. Underlying respiratory (P = 0.029, OR = 2.5; 95% CI = 1.1–5.8) or cardiac (OR = 2.7; 95% CI = 1.1–6.4, P = 0.024) conditions, as well as the presence of tachypnoea on admission (OR = 2.2; 95% CI = 1.2–4.1, P = 0.009), were also independent predictors of severe RSV infection. Seasonal variation in hospitalization was observed between temperate and tropical climates but was not associated with disease severity.

Conclusions: Young infants, Indigenous patients and children with underlying respiratory and cardiac disease should be observed closely for signs of deterioration. Infants with tachypnoea on admission should be continuously monitored.

From the *James Cook University, Cairns, Queensland, Australia

General Practice and Rural Medicine, Cairns Hospital, Queensland, Australia

Cairns Hospital, Queensland, Australia

§Vaccinology and Immunology Research Trials Unit (VIRTU), Women’s and Children’s Hospital, Women’s and Children’s Health Network, Discipline of Paediatrics, Adelaide Medical School, and Robinson Research Institute, University of Adelaide.

Accepted for publication February 2, 2018.

H.M. is an investigator on a maternal RSV vaccine study sponsored by Novavax. Hellen Marshall is an investigator on other vaccine trials sponsored by Industry. Hellen Marshall does not receive any personal payments from Industry. Her institution receives funding from Industry for investigator led studies.

Address for correspondence: Helen Marshall, MBBS, MD, MPH, DCH, 72 King William Rd, North Adelaide, South Australia. E-mail:

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