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Patients with congenital heart disease (CHD) have been reported by many authors to have high rates of hospitalisation, morbidity, and mortality associated with respiratory syncytial virus (RSV) lower respiratory tract illness.1–3 However, in a recent paper in Archives of Disease in Childhood, Duppenthaler et al reported a substantially lower incidence of RSV hospitalisation in patients with “haemodynamically significant” CHD.4
They suggest that the rate of hospitalisation in their population of patients from the Canton of Bern, Switzerland was as much as four times lower than rates previously reported in the United States. Based on these results they concluded that the unrestricted use of palivizumab to prevent RSV hospitalisation was not justified.
There are several possible methodological reasons for the disparity in RSV hospitalisation rates in the calculations of both the numerator and denominator. With respect to the numerator, Duppenthaler’s methods would miss all of the nosocomial RSV disease. Furthermore, ascertaining the true incidence of RSV hospitalisation would require that all CHD patients admitted to the hospital undergo RSV screening, as was done in the international multicentre trial, not just those with symptoms judged typical of RSV.5
Finally, in a previous paper by the same authors in the first four years of the study (1997/98–2000/01),6 12 of 497 patients studied aged <5 years were identified with CHD compared to 6 of 449 aged <2 years in this study. Since the previous study encompassed children under the age of 5, the difference of six patients between the first study and this one would imply that children who were hospitalised were between the ages of 2 and 5 (making a strong case for palivizumab prophylaxis in that age group), or they were deemed to have haemodynamically insignificant heart disease (making a case for prophylaxis in this group …
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