Pediatric Disease Burden Attributable to Respiratory Syncytial Virus (RSV): an application of temporal models and a modified birth-cohort analysis.

摘要

More than half of serious respiratory infections in infants are caused by Respiratory Syncytial Virus (RSV). While current surveillance systems are useful in describing RSV seasonality and strains in circulation, active and laboratory-based surveillance systems for RSV at a national level may underestimate the burden of RSV infections.;This dissertation utilized the State Inpatient Databases (SID) of the Hospital Cost Utilization Project (HCUP) to evaluate temporal trends and sociodemographic characteristics associated with excess hospitalizations due to RSV in infants using cyclical regression models. To further investigate the effect of these sociodemographic variables on RSV hospitalization and on inpatient mortality associated with RSV, we conduct a case-control analysis matching on age, state of admitting hospital, and respiratory season. To examine the role of birth month on RSV hospitalizations we perform a modified birth cohort analysis.;We found that 5% of children <1 year were hospitalized annually due to RSV (direct and indirectly attributed); this is higher than previous estimates from laboratory confirmed studies. RSV-related hospitalizations were highest among infants 0-11 months residing in ZIP codes where >30% of the residents lived under the poverty level (average, 15.5%) compared with infants residing in ZIP codes with 0-9% living under the poverty level (average, 4.0%). Among infants 0-23 months, the odds of hospitalization were 16% higher in White non-Hispanics than Black non-Hispanics (Adjusted Odds Ratio (AOR), 95% Confidence Interval: 1.16 [1.1, 1.2]); however the odds of inpatient mortality with RSV diagnosis were 50% lower in White non-Hispanics compared with Black non-Hispanics (AOR: 0.52 [0.33, 0.81]). One-month olds born in January were ~10 times more at risk for RSV-related hospitalization than 1-month olds born in October (Risk Ratio: 9.8, [7.8, 12.4]). Across the first year of life, infants born in December and January had a 2- and 3-fold higher risk, respectively, of an RSV-related hospitalization event than infants born in July.;Consistent with the Healthy People 2020 goal to promote quality of life, healthy development and behaviors across all life stages, findings from this dissertation can be used to provide an estimate of the potential impact of an RSV vaccine.