Local variability in respiratory syncytial virus disease severity

Area of Science:

• Pediatrics
• Infectious Diseases
• Epidemiology

Background:

• Respiratory syncytial virus (RSV) lower respiratory tract infections present with varying clinical severity across different healthcare settings.
• Differences in RSV disease severity have been noted between centers like Sophia Children's Hospital in Rotterdam and Geneva Children's Hospital in Switzerland.

Purpose of the Study:

• To prospectively and retrospectively assess and compare the clinical severity of RSV infections in infants admitted to hospitals in Rotterdam and Geneva.
• To identify potential factors contributing to the observed differences in RSV morbidity between the two study sites.

Main Methods:

• A combined prospective (1994-5) and retrospective (1993-4) study of 151 infants with confirmed RSV infection.
• Data collection included parameters of morbidity such as apnea, intensive care unit admission, mechanical ventilation, length of hospital stay, respiratory rate, wheezing, and retractions.
• Multivariate analyses were performed to account for variables like infant age and feeding method.

Main Results:

• Infants in Rotterdam experienced more severe RSV outcomes, including higher rates of apnea (23.9% vs 1.8%), ICU admission (28.1% vs 3.6%), and mechanical ventilation (7.3% vs 0%).
• Rotterdam also showed a longer average hospital stay (9.1 vs 6.8 days).
• Geneva reported higher respiratory rates (59.2 vs 51.2), more wheezing (65.5% vs 28.8%), and more retractions (81.8% vs 63.3%).

Conclusions:

• Significant differences in RSV infection severity exist between Rotterdam and Geneva, even after adjusting for infant age and feeding practices.
• Unidentified local factors likely influence the clinical presentation and severity of RSV infections.
• These localized variations may impact the generalizability and outcomes of multicenter prophylactic and therapeutic studies for RSV.