Related Experiment Video
Updated: Dec 7, 2025
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
Calibration of Chronic Lung Disease Severity as a Risk Factor for Respiratory Syncytial Virus Hospitalization
Yoonyoung Choi1, H Cody Meissner2, Christian Hampp1,3
1Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Insights
The 180-day guideline for respiratory syncytial virus (RSV) season risk in children with chronic lung disease (CLD) can be shortened. This study identifies shorter treatment intervals for RSV immunoprophylaxis in infants with CLD.
Area of Science:
- Pediatrics
- Pulmonology
- Epidemiology
Background:
- Current guidelines consider children with chronic lung disease (CLD) requiring medical support within 6 months of the second respiratory syncytial virus (RSV) season at high risk for severe disease.
- This study aimed to determine the specific number of days since last treatment (DSL) at which RSV hospitalization risk for CLD infants equals that of infants not eligible for immunoprophylaxis.
Purpose of the Study:
- To refine risk assessment for RSV hospitalization in infants with CLD.
- To establish evidence-based thresholds for RSV immunoprophylaxis eligibility in CLD infants based on time since last treatment.
Main Methods:
- A cohort of 858,830 healthy term and 5,562 preterm infants with CLD was assembled using linked Medicaid and birth certificate records (1999-2010).
- Discrete time logistic regression models within a survival analysis framework were used to compare RSV hospitalization risks.
- Models were adjusted for immunoprophylaxis use and analyzed hospitalization risk at four age points for CLD infants compared to 1-month-old term infants.
Main Results:
- The average RSV hospitalization risk for 1-month-old term infants was 14.8 per 1000 patient season-months.
- For preterm infants with CLD, the risk threshold equivalent to term infants was reached at DSL values of 76, 52, 35, and 12 days at ages 12, 15, 17.2, and 21 months, respectively.
- Confidence intervals for DSL thresholds varied, indicating a range of potential risk equivalency.
Conclusions:
- The established 180-day threshold for CLD severity at the start of the RSV season can be shortened.
- Specifically, the threshold can be reduced to 120 days for 15-month-olds, 90 days for 17.2-month-olds, and 60 days for 21-month-olds with CLD.
Background:
Guidelines assume children with chronic lung disease (CLD) who require medical support within 6 months before the second respiratory syncytial virus (RSV) season remains at high risk of severe RSV disease. We determined the number of days since the last treatment (DSL) when the risk of RSV hospitalization among children with CLD becomes equivalent to the risk for those not qualified for immunoprophylaxis.
Methods:
The study cohort was assembled using Medicaid billing records from 1999 to 2010 linked to Florida and Texas birth certificate records. We developed DSL-trend discrete time logistic regression models within a survival analysis framework, adjusting for use of immunoprophylaxis, to compare the hospitalization risk of CLD infants at 4 age points to that of term infants at 1 month of age with siblings.
Results:
The study cohort included 858 830 healthy term and 5562 preterm infants with CLD. Among 1-month-old term infants, the RSV hospitalization risk averaged across all covariate strata was 14.8 (95% confidence interval [CI], 13.5-16.1) per 1000 patient season-months. Risk for preterm CLD children reached the threshold derived from term infants when DSL was 76 (95% CI, 22-198.5), 52 (95% CI, 6.5-123), 35 (95% CI, 0-93.5), and 12 (95% CI, 0-61.5) at the respective ages of 12, 15, 17.2, and 21 months.
Conclusions:
The 180-day threshold used to define CLD severity at season start can be shortened to 120 days, 90 days, and 60 days for children with CLD at age 15, 17.2, and 21 months, respectively.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:31Common Respiratory Disorders
Upper respiratory disorders impact the airways above the vocal cords, encompassing areas like the nose, sinuses, and throat. Various conditions fall under this category, including the common cold and allergic rhinitis. These disorders can stem from several causes,...