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Publications

Journal Article Observational Study Research Support, Non-U.S. Gov't Epublish 28 citations

PubMed: 40214990 DOI: 10.1001/jamanetworkopen.2025.4666

Risk Factors for Severe Disease Among Children Hospitalized With Respiratory Syncytial Virus.

JAMA Netw Open 8(4):e254666

Authors: Nardin Kirolos, Haifa Mtaweh, Rohini R Datta, Daniel S Farrar, Claire Seaton, Jeffrey N Bone, Fiona Muttalib, Caitlyn L Kaziev, Jonathan Fortini, Sanjay Mahant, Aaron Campigotto, Gabrielle Freire, Rae S M Yeung, Jonathan H Rayment, Connie Yang, Jocelyn A Srigley, Manish Sadarangani, Francine Buchanan, Shaun K Morris, Peter J Gill

Affiliations

  • Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
  • Interdepartmental Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
  • Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Division of Pediatric Hospital Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.
  • Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
  • BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
  • Biostatistics Clinical Research Support Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
  • Division of Pediatric Critical Care Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.
  • Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Division of Microbiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
  • Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Cell Biology, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
  • Department of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
  • Division of Respiratory Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada.
  • Division of Paediatric Infectious Disease, BC Children's Hospital, Vancouver, British Columbia, Canada.
  • Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  • Vaccine Evaluation Center, BC Children's Hospital, Vancouver, British Columbia, Canada.
  • Centre for Innovation and Excellence in Child and Family-Centred Care, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  • Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Abstract

Importance

A resurgence of respiratory syncytial virus (RSV)-associated acute respiratory tract infection (ARI) was observed in 2022 and 2023 after the COVID-19 pandemic. Changes in the demographic characteristics, disease severity, and outcomes of patients were observed, which could impact the identification of risk groups for interventions aimed at reducing the severity of RSV disease.

Objectives

To identify factors associated with severe clinical outcomes among children hospitalized with RSV-associated ARIs in 2022 and 2023.

Design, Setting, and Participants

This observational cohort study, conducted at 2 large, Canadian, tertiary-level pediatric hospitals, comprised all 709 cases of RSV-associated ARI among children younger than 18 years who were admitted to the hospital or intensive care unit (ICU) from July 1, 2022, to June 30, 2023.

Exposure

Diagnosis of RSV-associated ARI.

Main Outcomes and Measures

The primary outcome of severe disease was defined as requiring noninvasive or invasive ventilation or death. Risk factors for severe disease and ICU admission (secondary outcome) were assessed using multivariable Poisson regression, and results were reported as adjusted risk ratios (ARRs) with 95% CIs, with age-stratified models (<2 years and ≥2 years).

Results

A total of 709 cases (median age, 13.1 months [IQR, 2.0-36.6 months]; 442 boys [62.3%]) were admitted with RSV-associated ARI; 452 (63.8%) were younger than 2 years, and 257 (36.2%) were aged 2 years or older. Severe disease was documented for 204 cases (28.8%). Patients with severe disease were younger than those with nonsevere disease (median age, 2.6 months [IQR, 1.3-16.0 months] vs 18.6 months [IQR, 4.5-39.1 months]; P < .001). Pulmonary disease and use of home oxygen (ARR, 2.47 [95% CI, 1.30-4.68]) and neurologic, neuromuscular, and developmental conditions (ARR, 1.89 [95% CI, 1.03-3.49]) were associated with severe disease among children aged 2 years or older. Among children younger than 2 years, age younger than 3 months (ARR, 2.34 [95% CI, 1.43-3.84]), age 3 to less than 6 months (ARR, 2.79 [95% CI, 1.65-4.70]), and prematurity (ARR, 1.40 [95% CI, 1.03-1.89]) were associated with severe disease.

Conclusions and Relevance

In this cohort study of children hospitalized with RSV in 2022 and 2023, severe RSV disease was more likely among those aged 2 years or older with pulmonary and neurologic, neuromuscular, or developmental conditions. For children younger than 2 years, age younger than 6 months and prematurity were the main risk factors. These findings support prevention strategies for all younger children, including premature infants, with potential benefit for children aged 2 years or older in specific high-risk groups.

MeSH

Respiratory Syncytial Viruses, Cohort Studies, Child, Hospitalized, Aged, Clinical Medicine, Viruses, Risk Factors, Intensive Care Units, Child

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