Respiratory syncytial virus disease in preterm infants in the U.S. born at 32-35 weeks gestation not receiving immunoprophylaxis

Christopher S Ambrose, Evan J Anderson, Eric A F Simões, Xionghua Wu, Hanaa Elhefni, C Lucy Park, Frangiscos Sifakis, Jessie R Groothuis, Christopher S Ambrose, Evan J Anderson, Eric A F Simões, Xionghua Wu, Hanaa Elhefni, C Lucy Park, Frangiscos Sifakis, Jessie R Groothuis

Abstract

Background: The Respiratory Syncytial Virus (RSV) Respiratory Events Among Preterm Infants Outcomes and Risk Tracking (REPORT) study evaluated RSV disease burden in U.S. preterm infants 32-35 weeks gestational age (wGA) not receiving RSV prophylaxis.

Methods: Preterm infants <6 months of age as of November 1st were followed prospectively at 188 clinics from September to May 2009-2010 or 2010-2011. Nasal and pharyngeal swabs were collected for medically attended acute respiratory illnesses (MAARI) and tested for RSV by qRT-polymerase chain reaction. Risk factors were assessed using multivariate Cox proportional hazard model adjusted for seasonality.

Results: Of 1642 evaluable infants, 287 experienced RSV MAARI. Rates of RSV-related MAARI, outpatient lower respiratory tract illness, emergency department visits and hospitalization (RSVH) during November to March were 25.4, 13.7, 5.9 and 4.9 per 100 infant-seasons, respectively. Preschool-aged, nonmultiple-birth siblings and daycare attendance were consistently associated with increased risk of RSV. RSVH rates were highest in infants 32-34 and 35 wGA who were <6 months of age during November to March with daycare attendance or nonmultiple-birth, preschool-aged siblings (8.9 and 9.3 per 100 infant-seasons, respectively, versus 3.5 for all other infants, P<0.001). Chronologic age <3 months was associated with a higher RSVH rate for infants 35 wGA but not for infants 32-34 wGA.

Conclusions: In US preterm infants who were 32-35 wGA, <6 months on November 1st and not receiving RSV prophylaxis, the burden of RSV MAARI was 25 per 100 infant-seasons. The highest RSVH rates occurred among those with daycare attendance or nonmultiple-birth, preschool-aged siblings while they were <6 months of age during the RSV season.

Trial registration: ClinicalTrials.gov NCT00983606.

Figures

FIGURE 1.
FIGURE 1.
Study subject disposition and care patterns among infants with RSV-related MAARI. *Of the 32 patients with an ED and hospital visit, 9 were discharged home but hospitalized 0–8 days later, and 23 were admitted immediately to the hospital. No RSV hospitalization was recorded for 2 subjects with RSV whose ED discharge disposition was hospital admission (1 with ICU admission), because hospitalization records could not be obtained.
FIGURE 2.
FIGURE 2.
Multivariate risk factor analysis. HR, hazard ratio; wGA, weeks gestational age. Variables that were not statistically significant predictors for the specific outcome evaluated and thus were not retained in the multivariate model were not presented.
FIGURE 3.
FIGURE 3.
Risk of RSV disease during November to March by GA, chronologic age on November 1st, chronologic age during November to March and 2012 AAP environmental risk factors (A) RSV-related MAARI; (B) RSV Hospitalizations. GA, gestational age. Rates are per 100 infant-seasons. For chronologic age during November to March, subjects contributed events and exposure time only while they were within specific age ranges. Overall incidence rates are for November to March regardless of chronologic age during November to March. The plus (+) and minus (−) symbols represent the presence or absence of 2012 AAP environmental risk factors, respectively. AAP risk factors were associated with increased rates of RSV-related events (P < 0.02 for all event types). Older chronologic age was associated with an increased risk of RSV-related MAARI (P < 0.01 for both <3 vs. ≥3 months and <6 vs. ≥6 months). There was no evidence of a decrease in RSV hospitalization rates in infants 32–34 wGA at 3 to <6 months versus <3 months of age (P = 0.9).

References

    1. Simoes EA. Respiratory syncytial virus infection. Lancet. 1999;354:847–852.
    1. Mutuc JD, Langley GE. Respiratory syncytial virus--United States, July 2007-June 2011. MMWR Morb Mortal Wkly Rep. 2011;60:1203–1206.
    1. Zachariah P, Shah S, Gao D, et al. Predictors of the duration of the respiratory syncytial virus season. Pediatr Infect Dis J. 2009;28:772–776.
    1. Panozzo CA, Fowlkes AL, Anderson LJ. Variation in timing of respiratory syncytial virus outbreaks: lessons from national surveillance. Pediatr Infect Dis J. 2007;26(11 suppl):S41–S45.
    1. Boyce TG, Mellen BG, Mitchel EF, Jr, et al. Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr. 2000;137:865–870.
    1. Moler FW, Khan AS, Meliones JN, et al. Respiratory syncytial virus morbidity and mortality estimates in congenital heart disease patients: a recent experience. Crit Care Med. 1992;20:1406–1413.
    1. Horn SD, Smout RJ. Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes. J Pediatr. 2003;143(5 suppl):S133–S141.
    1. Langley GF, Anderson LJ. Epidemiology and prevention of respiratory syncytial virus infections among infants and young children. Pediatr Infect Dis J. 2011;30:510–517.
    1. Centers for Disease Control and Prevention. User guide to the 2010 Natality public use file. Available at: . Accessed January 21, 2014.
    1. Qin C, Hsia J, Berg CJ. Variation between last-menstrual-period and clinical estimates of gestational age in vital records. Am J Epidemiol. 2008;167:646–652.
    1. Centers for Disease Control and Prevention. CDC WONDER On-line Database. Linked Birth/Infant Death Records, 2007–2008. Available at: . Accessed January 21, 2014.
    1. MedImmune, LLC, Gaithersburg, MD: 2013. Synagis® (palivizumab).Full Prescribing Information.
    1. American Academy of Pediatrics. Respiratory syncytial virus. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. pp. 609–617.
    1. Committee on Infectious Diseases. From the American Academy of Pediatrics: Policy statements--modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics. 2009;124:1694–1701.
    1. American Academy of Pediatrics. Respiratory syncytial virus. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. pp. 560–569.
    1. Blanken MO, Koffijberg H, Nibbelke EE, et al. Dutch RSV Neonatal Network. Prospective validation of a prognostic model for respiratory syncytial virus bronchiolitis in late preterm infants: a multicenter birth cohort study. PLoS One. 2013;8:e59161.
    1. Figueras-Aloy J, Carbonell-Estrany X, Quero J IRIS Study Group. Case-control study of the risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born at a gestational age of 33-35 weeks in Spain. Pediatr Infect Dis J. 2004;23:815–820.
    1. Figueras-Aloy J, Carbonell-Estrany X, Quero-Jiménez J, et al. IRIS Study Group. FLIP-2 Study: risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born in Spain at a gestational age of 32 to 35 weeks. Pediatr Infect Dis J. 2008;27:788–793.
    1. Law BJ, Langley JM, Allen U, et al. The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J. 2004;23:806–814.
    1. Fryzek JP, Martone WJ, Groothuis JR. Trends in chronologic age and infant respiratory syncytial virus hospitalization: an 8-year cohort study. Adv Ther. 2011;28:195–201.
    1. Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132:e341–e348.
    1. Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360:588–598.
    1. Holman RC, Curns AT, Cheek JE, et al. Respiratory syncytial virus hospitalizations among American Indian and Alaska Native infants and the general United States infant population. Pediatrics. 2004;114:e437–e444.
    1. Paramore LC, Ciuryla V, Ciesla G, et al. Economic impact of respiratory syncytial virus-related illness in the US: an analysis of national databases. Pharmacoeconomics. 2004;22:275–284.
    1. Stockman LJ, Curns AT, Anderson LJ, et al. Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997-2006. Pediatr Infect Dis J. 2012;31:5–9.
    1. Legoff J, Kara R, Moulin F, et al. Evaluation of the one-step multiplex real-time reverse transcription-PCR ProFlu-1 assay for detection of influenza A and influenza B viruses and respiratory syncytial viruses in children. J Clin Microbiol. 2008;46:789–791.
    1. The IMpact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics. 1998;102:531–537.
    1. Heikkinen T, Valkonen H, Lehtonen L, et al. Hospital admission of high risk infants for respiratory syncytial virus infection: implications for palivizumab prophylaxis. Arch Dis Child Fetal Neonatal Ed. 2005;90:F64–F68.
    1. Forbes ML, Hall CB, Jackson A, et al. Comparative costs of hospitalisation among infants at high risk for respiratory syncytial virus lower respiratory tract infection during the first year of life. J Med Econ. 2010;13:136–141.
    1. Carbonell-Estrany X, Quero J IRIS Study Group. Hospitalization rates for respiratory syncytial virus infection in premature infants born during two consecutive seasons. Pediatr Infect Dis J. 2001;20:874–879.
    1. McEvoy C, Venigalla S, Schilling D, et al. Respiratory function in healthy late preterm infants delivered at 33-36 weeks of gestation. J Pediatr. 2013;162:464–469.
    1. Hoo AF, Dezateux C, Henschen M, et al. Development of airway function in infancy after preterm delivery. J Pediatr. 2002;141:652–658.
    1. Friedrich L, Pitrez PM, Stein RT, et al. Growth rate of lung function in healthy preterm infants. Am J Respir Crit Care Med. 2007;176:1269–1273.
    1. Colin AA, McEvoy C, Castile RG. Respiratory morbidity and lung function in preterm infants of 32 to 36 weeks’ gestational age. Pediatrics. 2010;126:115–128.
    1. Yeung CY, Hobbs JR. Serum-gamma-G-globulin levels in normal premature, post-mature, and “small-for-dates” newborn babies. Lancet. 1968;1:1167–1170.
    1. Simoes EA. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr. 2003;143(5 suppl):S118–S126.
    1. Lacaze-Masmonteil T, Truffert P, Pinquier D, et al. Lower respiratory tract illness and RSV prophylaxis in very premature infants. Arch Dis Child. 2004;89:562–567.
    1. Simoes EA, King SJ, Lehr MV, et al. Preterm twins and triplets. A high-risk group for severe respiratory syncytial virus infection. Am J Dis Child. 1993;147:303–306.
    1. Resch B, Pasnocht A, Gusenleitner W, et al. Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age. J Infect. 2005;50:397–403.
    1. Park HW, Lee BS, Kim AR, et al. Epidemiology of respiratory syncytial virus infection in infants born at less than thirty-five weeks of gestational age. Pediatr Infect Dis J. 2012;31:e99–e104.
    1. Liese JG, Grill E, Fischer B, et al. Munich RSV Study Group. Incidence and risk factors of respiratory syncytial virus-related hospitalizations in premature infants in Germany. Eur J Pediatr. 2003;162:230–236.
    1. Law B, Macdonald N, Langley J, et al. Severe respiratory syncytial virus infection among otherwise healthy prematurely born infants: What are we trying to prevent? Paediatr Child Health. 1998;3:402–404.
    1. Winterstein AG, Knox CA, Kubilis P, et al. Appropriateness of age thresholds for respiratory syncytial virus immunoprophylaxis in moderate-preterm infants: a cohort study. JAMA Pediatr. 2013;167:1118-1124
    1. Carbonell X, Fullarton JR, Gooch KL, et al. The evolution of risk factors for respiratory syncytial virus-related hospitalisation in infants born at 32–35 weeks’ gestational age: time-based analysis using data from the FLIP-2 study. J Perinat Med. 2012;40:685–691.
    1. Olsen IE, Lawson ML, Meinzen-Derr J, et al. Use of a body proportionality index for growth assessment of preterm infants. J Pediatr. 2009;154:486–491.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner