Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

Holman, Robert C.; Curns, Aaron T.; Cheek, James E.; Bresee, Joseph S.; Singleton, Rosalyn; Carver, Karen; Anderson, Larry J.

doi:10.1542/peds.2004-0049

Cited by 112 publications

(110 citation statements)

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“…Although recent studies, most of which were retrospective assessments, have consistently shown RSV hospitalizations to be the highest in the first year of life, very few have dissected the exact age of RSV-specific hospitalizations more precisely. [4][5][6][13][14][15][16][17][18][19][20] For example, a retrospective, population-based study from Spain found that among children ,24 months old hospitalized with laboratory-identified RSV, 9% were ,1 month of age, similar to our findings; however, their rate of RSV hospitalizations among infants ,1 month of age was more than twice ours (31 per 1000 vs 13.5 per 1000, respectively). 19 Another study estimated a notably high annual rate of RSV-associated hospitalizations among infants #3 months old, 48.9 per 1000 children, which is more than twice the rate we found.…”

Section: Discussionsupporting

confidence: 85%

“…[1][2][3][4][5][6] Accurate assessment of the burden of RSV hospitalizations, therefore, is essential in determining priorities for the use of existing RSV prophylaxis and future vaccines. However, estimates of the burden of RSV hospitalizations in the United States have varied.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6] However, substantially lower rates, approximately one-half lower, are reported by the few available prospective, population-based studies of laboratory-confirmed cases. 7,8 Our goal, therefore, was to more accurately define and characterize RSV hospitalizations among children ,24 months old, the group at greatest risk of severe RSV illness.…”

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confidence: 99%

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Respiratory Syncytial Virus–Associated Hospitalizations Among Children Less Than 24 Months of Age

Hall

Weinberg²,

Blumkin³

et al. 2013

Pediatrics

510

430

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WHAT'S KNOWN ON THIS SUBJECT: Respiratory syncytial virus (RSV) infection is a leading cause of hospitalization among infants. Most estimates of RSV hospitalization rates are imprecise, having been calculated by using retrospective discharge diagnosis data and stratified age groups no narrower than 6 to 12 months.WHAT THIS STUDY ADDS: Prospective, population-based surveillance data for infants hospitalized with laboratoryconfirmed RSV infection were combined with birth certificate information to yield more precise age-specific hospitalization rates. These data should help determine priorities for the use of existing and future RSV prophylaxis strategies. abstract BACKGROUND: Respiratory syncytial virus (RSV) infection is a leading cause of hospitalization among infants. However, estimates of the RSV hospitalization burden have varied, and precision has been limited by the use of age strata grouped in blocks of 6 to $12 months. METHODS:We analyzed data from a 5-year, prospective, population-based surveillance for young children who were hospitalized with laboratoryconfirmed (reverse-transcriptase polymerase chain reaction) RSV acute respiratory illness (ARI) during October through March 2000-2005. The total population at risk was stratified by month of age by birth certificate information to yield hospitalization rates.RESULTS: There were 559 (26%) RSV-infected children among the 2149 enrolled children hospitalized with ARI (85% of all eligible children with ARI). The average RSV hospitalization rate was 5.2 per 1000 children ,24 months old. The highest age-specific rate was in infants 1 month old (25.9 per 1000 children). Infants #2 months of age, who comprised 44% of RSV-hospitalized children, had a hospitalization rate of 17.9 per 1000 children. Most children (79%) were previously healthy. Very preterm infants (,30 weeks' gestation) accounted for only 3% of RSV cases but had RSV hospitalization rates 3 times that of term infants.CONCLUSIONS: Young infants, especially those who were 1 month old, were at greatest risk of RSV hospitalization. Four-fifths of RSVhospitalized infants were previously healthy. To substantially reduce the burden of RSV hospitalizations, effective general preventive strategies will be required for all young infants, not just those with risk factors. Pediatrics 2013;132:e341-e348 AUTHORS:

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

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Respiratory Syncytial Virus–Associated Hospitalizations Among Children Less Than 24 Months of Age

Hall

Weinberg²,

Blumkin³

et al. 2013

Pediatrics

510

430

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“…Anemia of chronic disease (also known as anemia of inflammation) is caused by chronic or acute immune activation and is the second most common cause of anemia after iron deficiency. 38,39 Alaska Natives experience a disproportionately high incidence of several infectious diseases and other inflammatory conditions compared with the US population overall, including respiratory syncytial virus bronchiolitis, 40 chronic lung disease, 41 otitis media, 42 and invasive bacterial infections, 43 which may contribute to anemia in some children in this region. Inflammatory processes can also cause elevated serum ferritin levels, which may have led to underestimation of the proportion of anemic children with iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

Endemic Iron Deficiency Associated With Helicobacter pylori Infection Among School-Aged Children in Alaska

et al. 2006

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OBJECTIVES. Rural Alaska Natives have a high prevalence of iron deficiency and Helicobacter pylori infection. The objective of this study was to estimate the prevalence of iron deficiency, iron-deficiency anemia, and active H pylori infection among school-aged children in rural Alaska.METHODS. We enrolled 68% (688) of the 7-to 11-year-old children from 10 predominantly Alaska Native villages in southwestern Alaska. We collected venous blood samples to assess iron deficiency and anemia. Each child was tested for active H pylori infection by 13 C-urea breath test (UBT). Evaluated risk factors included age, gender, village of residence, number of household members, number of household members who were younger than 5 years, recent antibiotic use, and household water source.RESULTS. Of 688 enrolled children, iron deficiency was present in 38%, iron-deficiency anemia was present in 7.8%, and H pylori infection by UBT was present in 86%. Iron deficiency was independently associated with living in a household with Ͼ6 people and village of residence. H pylori infection by UBT was independently associated with child's age Ն10 years and village of residence. Ninety-one percent of children with iron deficiency had H pylori infection by UBT, and children with active H pylori infection were more likely to be iron deficient than uninfected children. Children with H pylori infection by UBT were also more likely to have iron-deficiency anemia than uninfected children.CONCLUSIONS. In this study of nearly 700 children in 10 different villages in Alaska, we confirmed that the high prevalence of iron deficiency persists among schoolaged children. We found that active H pylori infection was independently associated with iron deficiency and iron-deficiency anemia among children in this region. H pylori infection may account for a portion of the iron deficiency and iron-deficiency anemia in rural Alaska and other areas with high prevalences of both conditions. Innovative approaches are critically needed to address the iron deficiency in high prevalence areas such as rural Alaska and most of the developing world. Dr Baggett assisted with study design, was the primary person responsible for study implementation during the first study year, conducted all data analysis, and was the primary manuscript author. Dr Gessner was the study primary investigator, wrote the study protocol, was the primary person responsible for study implementation during the second study year, and assisted with data analysis and preparing the manuscript. Dr Parkinson was responsible for all components of laboratory analysis, assisted with study design, and provided critical input into the final manuscript. Ms Muth assisted with study design and writing the study protocol, was the primary person responsible for administrative project management, and reviewed the final manuscript. Dr Gold contributed to the study design, data analysis, and interpretation and provided critical input into the final manuscript. 2 The prevalence of iron deficiency among children...

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“…This estimation method was necessary because there were no specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for RSV-related disease, other than RSV pneumonia (ICD-9-CM 480.1), until October 1996. 13 Using the NHDS database for the 2-year period from January 2000 through December 2001 to identify hospital stays with the specific ICD-9-CM codes for RSV (466.11 for RSV bronchiolitis, 480.1 for RSV pneumonia, and 079.6 for RSV infection), Holman During the 17-year period from 1980 to 1996 studied by Shay et al, 57% of the estimated 1.65 million hospitalizations for bronchiolitis were accounted for by children younger than 6 months and 81% by children younger than 1 year. Among children younger than 1 year, annual bronchiolitis hospitalization rates increased more than 2-fold, from 1.29% in 1980 to 3.12% in 1996.…”

Section: What Is the True Incidence Of Rsv-related Hospitalizations Amentioning

confidence: 99%

Utilization Management Opportunities for Palivizumab for Prophylaxis of Respiratory Syncytial Virus Complications in Infants

Curtiss¹,

Fairman²

2010

JMCP

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A survey conducted in December 2008 of 69 health plans representing over 83 million commercial, Medicare, and managed Medicaid members found that 81% of the health plans required prior authorization (PA) for coverage of palivizumab (Synagis).1 Palivizumab is commonly covered under the medical benefit (73%) rather than the pharmacy benefit, and is ranked among the therapeutic areas with the highest priority for utilization management (UM). Health plans cite as the primary motivation for targeting palivizumab for UM intervention "to prevent inappropriate use," the same motivation attributed to UM interventions for growth hormones, blood cell stimulants, and omalizumab for asthma. Indications and Recommendations for Appropriate Use of PalivizumabPalivizumab was approved by the U.S. Food and Drug Administration (FDA) in June 1998 for "prophylaxis of serious lower respiratory tract disease, caused by respiratory syncytial virus, in pediatric patients at high risk of RSV disease."4 The initial product label included the indication "for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients at high risk of RSV disease. Safety and efficacy were established in infants with bronchopulmonary dysplasia (BPD) and infants with a history of prematurity (= 35 weeks gestational age)." 5 AAP guidelines initially (1998) recommended that the appropriate use of palivizumab should be based on the age of the infant at the start of the RSV season: (a) children less than 2 years old with chronic lung disease (CLD) who required medical therapy within the 6 months prior to the RSV season, (b) infants less than 1 year old born up to 28 weeks gestation, and (c) infants less than 6 months old born between 29 and 32 weeks gestation. 6 For infants with a gestational age of 32 to 35 weeks, the AAP guidelines suggested that palivizumab "should be reserved for those infants with additional risk factors" that "predispose to respiratory complications," including neurologic disease, young siblings, child care attendance, "exposure to tobacco smoke in the home, anticipated cardiac surgery, and distance to and availability of hospital care for severe respiratory illness." 6 The initial AAP guidelines in 1998 further suggested that many infants should not receive palivizumab despite "qualifying for the approved indications" because the "risk of rehospitalization for serious respiratory illness will be low, and the cost and logistical difficulties associated with prophylaxis may outweigh the potential benefits." 6 The efficacy of palivizumab in prophylaxis of RSV-related hospitalization has been studied in 2 randomized controlled trials (RCTs). Palivizumab was initially approved by the FDA based on the IMpact-RSV trial (1998), which was conducted during a single RSV season (1996)(1997) and randomized 1,502 children who at the start of the RSV season were either (a) aged 24 months or younger with bronchopulmonary dysplasia (BPD, now known as CLD) or (b) aged 6 months or younger with a...

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Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population

Cited by 112 publications

References 34 publications

Respiratory Syncytial Virus–Associated Hospitalizations Among Children Less Than 24 Months of Age

Respiratory Syncytial Virus–Associated Hospitalizations Among Children Less Than 24 Months of Age

Endemic Iron Deficiency Associated With Helicobacter pylori Infection Among School-Aged Children in Alaska

Utilization Management Opportunities for Palivizumab for Prophylaxis of Respiratory Syncytial Virus Complications in Infants

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