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Bronchiolitis-associated hospitalizations among American Indian and Alaska Native children
S A Lowther1, D K Shay, R C Holman
1Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. SGL6@cdc.gov
Insights
American Indian and Alaska Native infants have significantly higher hospitalization rates for bronchiolitis, a common respiratory syncytial virus (RSV) manifestation, compared to other US infants. Targeted prevention programs are crucial for this vulnerable population.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a primary cause of lower respiratory tract illness in young children.
- Respiratory illnesses lead to significant hospitalizations in American Indian and Alaska Native (AI/AN) children.
- Prior to this study, aggregate RSV-associated hospitalization data for AI/AN children were unavailable.
Purpose of the Study:
- To estimate the burden of bronchiolitis-associated hospitalizations among AI/AN children.
- To compare these rates with national estimates for all US infants.
- To inform the development of targeted public health interventions.
Main Methods:
- Utilized Indian Health Service hospitalization data from 1990-1995.
- Focused on AI/AN children under 5 years old.
- Analyzed hospitalizations for bronchiolitis, a key indicator of RSV infection.
Main Results:
- AI/AN infants (<1 year) had a bronchiolitis hospitalization rate of 61.8 per 1,000, substantially higher than the 1995 US infant rate of 34.2 per 1,000.
- Male infants experienced higher rates (72.2/1,000) than females (51.1/1,000).
- The Navajo Area showed the highest infant hospitalization rate (96.3/1,000), with annual peaks in January/February.
Conclusions:
- Bronchiolitis hospitalization rates are disproportionately high among AI/AN infants.
- This disparity may indicate increased RSV disease severity or lower hospitalization thresholds in this population.
- AI/AN children would benefit from enhanced lower respiratory tract illness prevention, including future RSV vaccines.
Background:
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract illness among infants and young children. Respiratory system diseases account for a large proportion of hospitalizations in American Indian and Alaska Native (AI/AN) children; however, aggregate estimates of RSV-associated hospitalizations among AI/AN children have not been made.
Methods:
We used Indian Health Service hospitalization data from 1990 through 1995 to describe hospitalizations associated with bronchiolitis, the most characteristic clinical manifestation of RSV infection, among AI/AN children <5 years old.
Results:
The overall bronchiolitis-associated hospitalization rate among AI/AN infants < 1 year old was considerably higher (61.8 per 1,000) than the 1995 estimated bronchiolitis hospitalization rate among all US infants (34.2 per 1,000). Hospitalization rates were higher among male infants (72.2 per 1,000) than among females infants (51.1 per 1,000). The highest infant hospitalization rate was noted in the Navajo Area (96.3 per 1,000). Hospitalizations peaked annually in January or February, consistent with national peaks for RSV detection. Bronchiolitis hospitalizations accounted for an increasing proportion of hospitalizations for lower respiratory tract illnesses.
Conclusions:
Bronchiolitis-associated hospitalization rates are substantially greater for AI/AN infants than those for all US infants. This difference may reflect an increased likelihood of severe RSV-associated disease or a decreased threshold for hospitalization among AI/AN infants with bronchiolitis compared with all US infants. AI/AN children would receive considerable benefit from lower respiratory tract illness prevention programs, including an RSV vaccine, if and when one becomes available.