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Using Multiple Methods to Estimate Respiratory Syncytial Virus (RSV)-associated Hospitalization Rates in Children
Elizabeth J Harker1, Ryan Wiegand1, Erica Billig Rose1,2
1National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Estimating respiratory syncytial virus (RSV) hospitalizations in children is crucial for new vaccine implementation. Capture-recapture analysis, when adjusted, offers a valuable method for accurate RSV burden estimation.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Respiratory syncytial virus (RSV) is a primary cause of severe respiratory infections in children under five globally.
- RSV is the leading cause of infant hospitalizations in the United States.
- Accurate burden estimates are vital for implementing new RSV immunizations and assessing their impact.
Purpose of the Study:
- To estimate the hospitalization rates associated with RSV in young children.
- To compare the effectiveness of different estimation methods for RSV burden.
Main Methods:
- Utilized five distinct methods to estimate RSV-associated hospitalizations over an 8-year period at a major US pediatric medical center.
- Employed active and passive surveillance systems, crude and stratified capture-recapture analyses, and discharge diagnosis codes.
- Conducted stratified analysis to ensure independence and equal probability of capture, key assumptions for capture-recapture methodology.
Main Results:
- Estimated RSV-associated hospitalization rates varied by method: active surveillance (4.0/1000), passive surveillance (1.7/1000), crude capture-recapture (7.9/1000), stratified capture-recapture (5.0/1000), and discharge diagnosis codes (4.4/1000).
- The stratified capture-recapture analysis yielded an adjusted rate of 5.0 (3.8, 7.2) per 1000 children.
Conclusions:
- All methods for estimating RSV burden have inherent limitations and biases.
- Capture-recapture analysis is a potentially valuable tool for estimating RSV burden.
- Adjustments to capture-recapture methods are necessary to address assumption violations and ensure accurate disease burden approximation, preventing overestimation.
Background:
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in children less than 5 years of age worldwide. In the United States, RSV commonly causes hospitalization in young children and is the leading cause of hospitalizations in infants. As new RSV immunizations become available, burden estimates are critical to guide the implementation of recommendations and quantify impact.
Methods:
We estimated RSV-associated hospitalization rates at a large US pediatric medical center during an 8-year period using five approaches, namely, estimation directly from active and passive surveillance systems, both a crude and stratified capture-recapture analysis of data from both systems, and estimation based on discharge diagnosis codes. The stratified analysis was performed to ensure adherence with the capture-recapture methodology assumption that samples are independent and participants have an equal probability of being observed within each system.
Results:
Overall, estimated RSV-associated hospitalization rates per 1000 children were 4.0 (2.5, 6.1) based on adjusted estimates from active surveillance, 1.7 (2.1, 4.4) from passive surveillance, 7.9 (5.7, 13.0) from crude capture-recapture analysis, 5.0 (3.8, 7.2) from the stratified capture-recapture, and 4.4 (4.0, 4.9) from discharge diagnosis codes.
Conclusions:
Each method has limitations and inherent biases that may impact the estimation of the burden of RSV. Capture-recapture analysis may be a useful tool to estimate the burden of RSV, but needs to be adjusted to account for possible violation of the assumptions of independence and equal probability of capture to ensure accurate approximation of disease burden and avoid over estimation.
