Children and adolescents who are not eligible for respiratory syncytial virus (RSV) immunization represent a significant percentage of RSV-related intensive care unit (ICU) admissions and fatalities in recent years, according to a cohort study conducted in the U.S.
Between 2017 and 2023, children aged 2 years and older comprised 46.9% of pediatric RSV-related ICU cases and 65.9% of the RSV-related deaths, based on a multicenter analysis led by Dr. Taylor Olson from Children’s National Hospital in Washington, D.C.
The children who succumbed to the virus were notably older than those who survived, with a median age of 9.1 years compared to 6.5 years. The majority of these fatalities (93.8%) in children aged 2 and older had at least one complex chronic condition, as outlined in a publication in JAMA Network Open.
Dr. Olson noted, “Our study demonstrated that older children and adolescents with medical complexities account for a disproportionate share of RSV-associated critical illness. These children represent an important population for the development of prevention strategies.”
Notably, children with one or more complex chronic conditions were nearly 13 times more likely to die (odds ratio [OR] 12.76, 95% confidence interval [CI] 8.79-18.53), while those with three or more such conditions were 22 times more likely to succumb (OR 22.56, 95% CI 15.44-32.97) compared to those without complex medical conditions.
RSV is responsible for approximately 10% of all infant hospitalizations in the U.S., leading to nearly 80,000 admissions annually. However, immunizations targeting this annual virus, which were introduced in 2023, are not recommended for children aged 2 years and older.
For older children, especially those with underlying medical conditions, current practices emphasize general infection control measures and the optimization of existing medical issues, as explained by Dr. Olson.
In the study, complex conditions associated with higher mortality included malignant neoplasms (adjusted odds ratio [aOR] 4.27, 95% CI 3.16-5.77), neurological or neuromuscular disorders (aOR 2.66, 95% CI 2.08-3.39), and respiratory conditions (aOR 2.36, 95% CI 1.83-3.03), with organ transplants also correlating with increased mortality (aOR 2.18, 95% CI 1.47-3.23). Other conditions such as congenital disorders, metabolic disorders, cardiovascular diseases, and technology dependence were similarly linked to increased risk of RSV-related mortality.
The American Academy of Pediatrics advocates for infants to receive protection before their first RSV season, either through maternal vaccination or with approved monoclonal antibodies, such as nirsevimab (Beyfortus) or clesrovimab (Enflonsia). Nirsevimab is also authorized for high-risk children under 2 years entering their second RSV season.
Recent federal recommendations have generally aligned with these guidelines until this year, when new policies were suggested that restricted RSV immunization guidance to only high-risk infants. A federal judge has intervened to block some major changes to U.S. vaccine policy.
Olson emphasized that further research is crucial to ascertain whether broader preventive measures for older children would enhance outcomes.
Utilizing the Oracle Electronic Health Record Real-World Data database, which encompasses over 100 U.S. health systems, researchers documented 13,732 pediatric ICU admissions connected to RSV between January 2017 and June 2023, resulting in 735 deaths.
Among these cases, 6,430 involved children aged 2 years and older. The median age of these patients was 6.6 years, 54% were boys, and more than half (57.2%) had at least one complex chronic condition, with roughly a quarter harboring three or more. Of the 484 deaths in this demographic, 30.8% were among 2- to 4-year-olds, 39.5% among those aged 5 to 12, and 29.8% within the 13 to 17-year bracket.
While children with complex chronic conditions accounted for most RSV-related deaths, the researchers noted that severe cases and ICU admissions were not entirely restricted to those with medical complexities.
For instance, 53.8% of children aged 2 to 5 in this study had no identifiable complex chronic condition. This statistic highlights that previously healthy children remain at risk for severe RSV disease beyond infancy, even though their risk of death is relatively lower.
The study’s limitations were acknowledged, including variability in diagnostic coding which impeded the researchers’ ability to accurately assess the extent to which RSV contributed to critical illnesses. Furthermore, the analysis focused solely on ICU admissions, thereby limiting the generalizability of findings to children experiencing less severe RSV conditions. Therefore, the authors caution that their results should not be interpreted as evidence that complex chronic conditions are solely responsible for the risk of developing severe RSV disease at the population level.
Disclaimer: This content is for informational purposes only and should not be considered medical advice. Please consult a healthcare professional for any health-related inquiries.
Fuente: https://www.medpagetoday.com/infectiousdisease/rsv/123052
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