Burden of laboratory-confirmed RSV hospitalization in children <5 years-of-age; 2019-2022

Respiratory Syncytial Virus (RSV) is one of the leading causes of acute lower respiratory tract infection (LRTI) in children. We sought to measure the clinical and economic burden of hospitalized RSV LRTI in children.

We conducted a prospective study of Salt Lake County resident children < 5 years hospitalized with laboratory-confirmed RSV LRTI (hospitalized > 24 h) from 2019 to 2022 at Primary Children's and Riverton Hospitals, Salt Lake City, Utah. Demographic, clinical, and hospital cost data were abstracted from the electronic medical records and financial transaction database.

Overall, 637 children were hospitalized with laboratory-confirmed RSV infection; 43% <6 months, 36% 6-<24 months, and 21% 24-<60 months years of age. Median hospital LOS was 2.2 days (IQR: 1.6-3.7days) with median and mean hospital cost of $6126 (IQR: $3577-$13436) and $13,941 (SD $26,235) respectively. Admissions to ICU and intubation decreased with age (p < 0.01), while antibiotic, steroid, and bronchodilator use increased with age (p < 0.01). Hospitalization rates were 24.1, 16.4, 11.1 and 5.5 per 1,000 person-years among children < 6 months, < 1 year, < 2 years and 5 years respectively. Extrapolating to all US children, RSV is estimated to cause ∼101,000 annual hospitalizations nationwide, 63% in otherwise healthy children, with an average total hospital cost of $1.4 billion (95% CI, $683 million-$1.9 billion).

Hospitalized RSV continues to be associated with substantial clinical and cost burden. This underscores the urgent need for widespread implementation of RSV immunoprophylaxis strategies to reduce hospitalization rates.