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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis
Kam Lun Hon1, Ting Fan Leung, Wing Yee Cheng
1Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China. ehon@hotmail.com
Insights
Young infants with chronic lung disease, heart conditions, or neurodevelopmental issues face higher risks of pediatric intensive care unit (PICU) admission due to respiratory syncytial virus (RSV). RSV infections show no winter seasonality in Hong Kong.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Viral Infections
- Critical Care Medicine
Background:
- Respiratory syncytial virus (RSV) is a common cause of respiratory illness in children.
- Understanding factors leading to severe disease and pediatric intensive care unit (PICU) admission is crucial for resource allocation and patient management.
Purpose of the Study:
- To identify factors associated with morbidity and PICU admission in children with RSV infection.
- To explore the seasonality of RSV and the implications for prophylaxis strategies.
Main Methods:
- Retrospective study of laboratory-confirmed RSV infections in children between 2006 and 2008.
- Analysis of demographic, clinical, and historical data to determine risk factors for PICU admission.
Main Results:
- Six hundred seventy RSV admissions were identified, with 1.5% requiring PICU admission.
- Younger age, chronic lung disease, acyanotic heart disease, and neurodevelopmental conditions were significantly associated with PICU admission.
- Bacterial coinfections increased the odds of PICU admission; no significant predilection for sex, prematurity, or other comorbidities was observed.
Conclusions:
- Most infants experience mild RSV disease, but those with specific comorbidities are at higher risk for PICU support.
- RSV disease in Hong Kong lacks distinct winter seasonality, necessitating year-round prophylaxis considerations for at-risk populations.
- PICU admissions for RSV were brief, but overall hospital stays were longer for PICU patients.
Objectives:
We investigated factors associated with morbidity and pediatric intensive care unit (PICU) admission in children with respiratory syncytial virus (RSV) infection and explored seasonality and implication of prophylaxis.
Methods:
A retrospective study between 2006 and 2008 of every child with a laboratory-confirmed RSV infection was included.
Results:
Six hundred seventy RSV admissions were identified. Ten (1.5%) required PICU admissions. Children admitted to PICU were younger than non-PICU admissions (median [interquartile range] age, 0.3 [0.11-0.48] vs 1.18 [0.46-2.49] years; P = .001). Odds associated with PICU admissions included history of chronic lung disease (odds ratio [95% confidence interval], 18.08 [2.29-114.95]; P = .010), history of acyanotic heart disease (7.61 [1.04-42.59], P = .043), and neurodevelopmental conditions (mental retardation, cerebral palsy, or neuromuscular disease; 8.41 [1.63-38.57], P = .012). Odds of bacterial coinfections was 13.50 (1.77-81.29), P = .017. There appeared no significant PICU predilection in terms of sex, history of prematurity, cyanotic heart disease, seizure disorders, chromosomal disorders, or malignancy. Admissions associated with proven RSV infections accounted for 2.4% of PICU annual admissions. The duration of PICU stay was generally brief (median, 3 days). However, median length of hospital stay was significantly longer in the PICU category (8.5 vs 3 days, P < .001). There was no death in the study period. Only 5 (0.75%) of 665 patients were readmitted to the pediatric infectious disease isolation ward in consecutive years, and none required PICU support. Twenty (3%) of admissions involved neonates younger than 30 days. There was no definite seasonality, but incidence was lowest between October and January.
Conclusions:
Most infants have mild disease and do not require PICU support. Young infants with history of chronic lung disease, congenital heart disease, and neurodevelopmental conditions appear to be at significantly increased risk for PICU support. There is no winter seasonality for RSV disease in Hong Kong. Therefore, any prophylaxis for at-risk population should provide adequate coverage for the warmer months in subtropical regions.
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