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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
Children with Down syndrome are high-risk for severe respiratory syncytial virus disease
David R Stagliano1, Cade M Nylund2, Matilda B Eide2
1Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
Insights
Children with Down syndrome face a significantly higher risk of respiratory syncytial virus (RSV) hospitalization and more severe illness. This increased risk persists beyond 24 months of age.
Area of Science:
- Pediatric Infectious Diseases
- Genetics and Developmental Disorders
Background:
- Respiratory syncytial virus (RSV) is a common cause of respiratory illness in young children.
- Down syndrome is a genetic disorder associated with various health complications, potentially increasing vulnerability to infections.
Purpose of the Study:
- To determine if Down syndrome is an independent risk factor for RSV hospitalization in children under three years old.
- To evaluate the severity of RSV illness in children with and without Down syndrome.
Main Methods:
- Retrospective cohort study utilizing military health system data.
- Cox proportional hazards model to assess RSV hospitalization risk, controlling for other factors.
- Disease severity assessed by hospitalization length, respiratory support needs, and age at admission.
Main Results:
- Children with Down syndrome had a 9.6% RSV hospitalization rate compared to 2.8% in others.
- Down syndrome conferred a significantly higher adjusted hazard ratio (3.46) for RSV hospitalization.
- Patients with Down syndrome experienced longer hospital stays (median 4 vs 2 days) and greater need for respiratory support (RR 5.5).
Conclusions:
- Down syndrome is an independent risk factor for increased RSV hospitalization.
- Children with Down syndrome exhibit more severe RSV illness and are older at hospitalization.
- The elevated risk of RSV hospitalization associated with Down syndrome extends beyond 24 months of age.
Objective:
To assess Down syndrome as an independent risk factor for respiratory syncytial virus (RSV) hospitalization in children younger than 3 years of age and to evaluate illness severity.
Study Design:
A retrospective cohort study of children enrolled in the military health system database was conducted. The effect of Down syndrome on RSV hospitalization was assessed by Cox proportional hazards model, while we controlled for risk factors. Disease severity was assessed by length of hospital stay, need for respiratory support, and age at hospitalization.
Results:
The study included 633 200 children and 3 209 378 person-years. Children with Down syndrome had a hospitalization rate of 9.6% vs 2.8% in children without Down syndrome. Down syndrome had a greater adjusted hazard ratio (HR) for RSV hospitalization than most risk factors, 3.46 (95% CI 2.75-4.37). A sensitivity analysis demonstrated HR 3.21 (95% CI 2.51-4.10) for patients with Down syndrome ages 0-23 months and HR 5.07 (95% CI 2.21-11.59) ages 24-36 months. The median (IQR) length of stay of children with and without Down syndrome was 4 days (2-7) and 2 days (1-4) (P < .001). Patients with Down syndrome had a greater risk of requiring respiratory support (relative risk 5.5; 95% CI, 2.5-12.3). The median (IQR) ages at admission for children with and without Down syndrome were 9.8 months (5.5-17.7) and 3.5 months (1.7-8.7) (P < .001).
Conclusions:
Down syndrome is independently associated with an increased risk for RSV hospitalization. Children with Down syndrome are older at time of RSV hospitalization and have more severe RSV illness than children without Down syndrome. This increased risk for hospitalization continues beyond 24 months.
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