Clinical and epidemiological impact of respiratory syncytial virus and identification of risk factors for severe disease in children hospitalized due to acute respiratory tract infection

Abstract

Introduction: Severe acute respiratory tract infection (ARTI) is a very common cause of hospitalization in pediatrics; respiratory syncytial virus (RSV) is the major etiologic agent. Accurately defining the burden of RSV life-threatening disease (LTD) and its risk factors is a challenge. Objectives: To know the impact of RSV in children hospitalized due to ARTI and describe the risk factors for LTD. Materials and methods: Prospective study in children < 2 years old hospitalized due to ARTI during 2012-2013 at Hospital de Niños "R. Gutiérrez." LTD was defined as requiring non-invasive ventilation and/or mechanical ventilation. Results: 622 studied children, 372 were RSV(+) (59.8 %). Annual rate of hospitalization due to RSV in infants < 1 year old: 956 (95 % CI: 858-1062)/10 000 hospitalizations. RSV caused 56/78 (71.8 %) cases of LTD; 42 (75 %) were previously healthy subjects; 32 (76.2 %) were < 6 months old. In the multivariate analysis, RSV was a risk factor for LTD (adjusted odds ratio [aOR]: 2.04; 95 % CI: 1.15-3.63; p = 0.014). A differential effect by sex was identified in RSV(+) patients: overcrowding was a risk factor for LTD in males (aOR: 2.36; 95 % CI: 1.07-5.21; p = 0.033); breastfeeding was a significant protective factor in females (aOR: 0.342; 95 % CI: 0.13-0.91; p = 0.032). Conclusions: RSV caused more than half of ARTI cases and mostly affected previously healthy patients < 1 year old. Males living in overcrowding conditions and females who were not breastfed were at the greatest risk for LTD.

Risk Factors for Poor Outcomes in Children Hospitalized With Virus-associated Acute Lower Respiratory Infections: A Systematic Review and Meta-analysis

“… 41 Family history of atopy was reported in 3 studies based on univariable analysis with ORs 0.61–1.22. 27 , 28 , 46 …”

“… 28 , 46 Additionally, 1 study identified a significant association between over-crowding and poor outcomes in male children with OR 2.36 in multivariable analysis; however, for female children the OR was not significant. 27 Precarious home, defined as no sewage system at home or household use of wood as a cooking fuel, was identified as a significant risk factor in 2 studies based on multivariable analyses with ORs 1.66–1.72. 28 , 39 Vulnerable mother, living far from hospital and indigenous ethnicity were each reported in 1 study, but were not significant risk factors.…”

Enfermedad por virus sincitial respiratorio en pediatría más allá del compromiso respiratorio

“…La adecuada evaluación clínica inicial, el monitoreo estricto y el conocimiento de otras posibles etiologías infecciosas, pueden facilitar el inicio temprano de una terapia dirigida, en especial en pacientes de alto riesgo como prematuros, con patología atópica moderada a severa, trisomía 21, tabaquismo pasivo o en inmunodeficiencia congénita o adquirida. 37,38 La infección por VSR sigue siendo una de las más comunes en la población general que afecta a niños menores de 5 años, generando alta de morbimortalidad en aquellos con factores de riesgo o en menores de 1 año. Hasta 1% de los pacientes infectados por este agente pueden desarrollar alteraciones neurológicas, ya sea por infección directa del sistema nervioso central o por los cambios secundarios a las adaptaciones neuroendocrinas ante la injuria pulmonar y la hipoxemia, que incluyen apnea central y convulsiones.…”

Clinical overview for pediatric population with SARS-CoV-2 and care: review

“…Gastrointestinal symptoms were also identified in other studies (4,11) . Such symptoms should be further investigated, as they are common in other viral infections of the respiratory tract such as respiratory syncytial virus (44) .…”