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ABSTRACT. Objective. To determine the burden of respiratory syncytial virus (RSV) disease among American Indian (AI) and Alaska Native (AN) infants, by examining RSV-associated hospitalizations.Methods. Infant hospitalizations from 1997 through 2001 with RSV listed as a diagnosis were selected by using Indian Health Service/tribal hospital discharge data for AIs/ANs and National Hospital Discharge Survey data for the general US population.Results. In 2000 -2001, RSV disease was listed as a diagnosis for 14.4% of all AI/AN infant hospitalizations, with bronchiolitis attributable to RSV infection (12.2%) being among the top 5 listed diagnoses. The rate of RSV-specific hospitalizations was 34.4 hospitalizations per 1000 infants for AI/AN infants and 27.4 hospitalizations per 1000 births for the general US infant population. The hospitalization rates for AI/AN infants living in the Alaska and Southwest regions (70.9 and 48.2 hospitalizations per 1000 infants, respectively) were much higher than the overall rate for US infants. R espiratory syncytial virus (RSV) infection remains a major cause of lower respiratory tract disease among infants and children. 1,2 Most RSV-related childhood hospitalizations occur among infants Ͻ6 months of age, and almost all children are infected with RSV by 2 years of age. 2,3 One study estimated that between 73 000 and 126 000 RSVassociated hospitalizations per year occurred among US infants in 1994 -1996. 1 Another study, using the newly introduced, RSV-specific diagnostic codes, estimated that ϳ96 000 RSV hospitalizations occurred annually in 1997-2000. 4 That study also noted that bronchiolitis attributable to RSV was the leading cause of hospitalization among the general population of infants in the United States. Conclusions. RSV infection is one of the leading causes of hospitalization among all infants in the UnitedThe availability of effective prophylaxis for some infants and young children and the promise of future vaccines make the identification of at-risk populations and the quantification of risk levels important for developing RSV prevention strategies. The risk of severe RSV-associated disease varies with age and is increased by the presence of comorbidities, such as underlying lung, cardiac, and immune-compromising conditions. 2,5,6 Infants born prematurely are also at increased risk for RSV disease. In addition, previous studies suggested that American Indian (AI) and Alaska Native (AN) children and infants have higher rates of hospitalization associated with respiratory infections, compared with the general US population, with RSV being considered an important cause of these infections. [7][8][9][10][11][12][13][14] One study reported that almost 75% of all infectious disease hospitalizations among AI/AN infants were associated with lower respiratory tract infections. 13 It is estimated that 50% to 80% of infant hospitalizations for treatment of bronchiolitis and one-third of hospitalizations for treatment of pneumonia are RSV-related. 1,6 RSV-specific International...

LRTIs continue to be an important cause of morbidity in children, especially among AI/AN infants in the Alaska and Southwest regions. Strategies to reduce LRTI hospitalizations and outpatient visits are warranted for all infants, but the greatest potential impact would be among AI/AN infants.

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