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Factors associated with severe respiratory syncytial virus disease in hospitalised children: a retrospective analysis
  1. Jeremy Anderson1,2,
  2. Michelle Oeum1,
  3. Eva Verkolf3,
  4. Paul V Licciardi1,2,
  5. Kim Mulholland1,4,
  6. Cattram Nguyen5,
  7. Kim Chow2,
  8. Gregory Waller6,
  9. Anna-Maria Costa6,
  10. Andrew Daley7,
  11. Nigel W Crawford8,
  12. Franz E Babl9,
  13. Trevor Duke10,
  14. Lien Anh Ha Do1,2,
  15. Danielle Wurzel1,11,12
  1. 1Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  2. 2Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
  3. 3Erasmus University Rotterdam, Rotterdam, The Netherlands
  4. 4London School of Hygiene & Tropical Medicine, London, UK
  5. 5The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
  6. 6The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  7. 7Microbiology and Infection Control, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  8. 8General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  9. 9Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  10. 10Intensive Care Unit and Department of Paediatrics, The Royal Children's Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
  11. 11Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  12. 12Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Jeremy Anderson, Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; jeremy.anderson{at}mcri.edu.au

Abstract

Background Early recognition of children at risk of severe respiratory syncytial virus (RSV) lower respiratory tract infection is important as it informs management decisions. We aimed to evaluate factors associated with severe disease among young children hospitalised with RSV infection.

Methods We conducted a retrospective cohort study of all children <2 years of age hospitalised for RSV lower respiratory tract infection at a single tertiary paediatric hospital over three RSV seasons (January 2017–December 2019). We classified children as having ‘moderate’ or ‘severe’ disease based on the level of respiratory intervention and used univariable and multivariable regression models to determine factors associated with severe disease.

Results Of 970 hospitalised children, 386 (40%) were classified as having ‘severe’ and 584 (60%) as having ‘moderate’ RSV disease. On multivariable analyses, age <2 months (OR: 2.3, 95% CI 1.6 to 3.3, p<0.0001), prematurity (OR: 1.6, 95% CI 1.1 to 2.4, p=0.02) and RSV–parainfluenza virus type 3 (PIV3) codetection (OR: 2.6, 95% CI 1.05 to 6.5, p=0.04) were independently associated with severe disease.

Conclusion Younger age, prematurity and PIV3 codetection were associated with severe RSV disease in children <2 years of age hospitalised with RSV infection. The association between PIV3 and severe RSV disease is a novel finding and warrants further investigation.

  • child health
  • infectious disease medicine
  • paediatrics
  • virology

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Contributors JA wrote the manuscript, performed the analyses and aided in the conception of the study. DW conceived the study and study protocol, and provided major input into manuscript revision, analysis and drafting. LAHD performed genotyping experiments and reviewed the laboratory data. MO collected patient data used for the analyses and critically revised the manuscript. LAHD, PVL, KM, KC, GW, A-MC, AD, FEB, NWC and TD contributed to interpretation of the data and critically revised the manuscript. CN contributed to data analysis and interpretation and critically revised the manuscript. LAHD and DW are equally contributed as last authors.

  • Funding This work was funded by the Murdoch Children’s Research Institute Theme Research Grant. JA is supported by an Australian Postgraduate Award Scholarship. PVL is a recipient of an Australian National Health and Medical Research Council Career Development Fellowship (GNT1146198). We also thank Victorian Government’s Operational Infrastructure Support Program. FEB is a recipient of a National Health and Medical Research Council Practitioner Fellowship and a grant from The Royal Children’s Hospital Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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