1
|
Clopper BR, Zhou Y, Tannis A, Staat MA, Rice M, Boom JA, Sahni LC, Selvarangan R, Harrison CJ, Halasa NB, Stewart LS, Weinberg GA, Szilagyi PG, Klein EJ, Englund JA, Rha B, Lively JY, Ortega-Sanchez IR, McMorrow ML, Moline HL. Medical Costs of Respiratory Syncytial Virus-Associated Hospitalizations and Emergency Department Visits in Children Aged Younger Than 5 Years: Observational Findings from the New Vaccine Surveillance Network, 2016-2019. J Pediatr 2024; 271:114045. [PMID: 38561048 DOI: 10.1016/j.jpeds.2024.114045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To assess medical costs of hospitalizations and emergency department (ED) care associated with respiratory syncytial virus (RSV) disease in children enrolled in the New Vaccine Surveillance Network. STUDY DESIGN We used accounting and prospective surveillance data from 6 pediatric health systems to assess direct medical costs from laboratory-confirmed RSV-associated hospitalizations (n = 2007) and ED visits (n = 1267) from 2016 through 2019 among children aged <5 years. We grouped costs into categories relevant to clinical care and administrative billing practices. We examined RSV-associated medical costs by care setting using descriptive and bivariate analyses. We assessed associations between known RSV risk factors and hospitalization costs and length of stay using χ2 tests of association. RESULTS The median cost was $7100 (IQR $4006-$13 355) per hospitalized child and $503 (IQR $387-$930) per ED visit. Eighty percent (n = 2628) of our final sample were children aged younger than 2 years. Fewer weeks' gestational age was associated with greater median costs in hospitalized children (P < .001, ≥37 weeks of gestational age: $6840 [$3905-$12 450]; 29-36 weeks of gestational age: $7721 [$4362-$15 274]; <29 weeks of gestational age: $9131 [$4518-$19 924]). Infants born full term accounted for 70% of the total expenditures in our sample. Almost three quarters of the health care dollars spent originated in children younger than 12 months of age, the primary age group targeted by recommended RSV prophylactics. CONCLUSIONS Reducing the cost burden for RSV-associated medical care in young children will require prevention of RSV in all young children, not just high-risk infants. Newly available maternal vaccine and immunoprophylaxis products could substantially reduce RSV-associated medical costs.
Collapse
Affiliation(s)
- Benjamin R Clopper
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA.
| | - Yingtao Zhou
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Ayzsa Tannis
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary Allen Staat
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Marilyn Rice
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julie A Boom
- Immunization Project, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Leila C Sahni
- Immunization Project, Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Christopher J Harrison
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO; Department of Infectious Diseases, UMKC, Kansas City, MO
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Peter G Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Eileen J Klein
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Janet A Englund
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Joana Y Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Ismael R Ortega-Sanchez
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service, Rockville, MD
| | - Heidi L Moline
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service, Rockville, MD
| |
Collapse
|
2
|
Tran P, Nduaguba S, Wang Y, Diaby V, Finelli L, Choi Y, Winterstein A. Economic Burden of Medically Attended Respiratory Syncytial Virus Infections Among Privately Insured Children Under 5 Years of Age in the USA. Influenza Other Respir Viruses 2024; 18:e13347. [PMID: 38951044 PMCID: PMC11216811 DOI: 10.1111/irv.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The cost of medically attended RSV LRI (lower respiratory infection) is critical in determining the economic value of new RSV immunoprophylaxes. However, most studies have focused on intermittent RSV encounters, not the episode of care that captures the entirety of RSV illness. METHODS We created age- and condition-specific cohorts of children under 5 years of age using MarketScan® data (2015-2019). We contrasted aggregating healthcare costs over RSV-LRTI episodes to ascertaining costs based on RSV-specific encounters only. Economic burden was estimated by multiplying costs per encounter or per episode by their respective incidence rates. RESULTS Average cost was higher per episode than per encounter regardless of settings (inpatient: $28,586 vs. $18,056 and outpatient/ED: $2099 vs. $407 for infants). Across ages, the economic burden was highest for infants and RSV-LRTI requiring inpatient care, but the burden in outpatient/ED settings was disproportionately higher than costs due to higher incidence rates (for inpatient vs. outpatient episodes: $226,403 vs. $101,269; for inpatient vs. outpatient encounters: $151,878 vs. $38,819 per 1000 infant-years). For high-risk children, cost and burden were up to 3-10 times higher, respectively. CONCLUSIONS With a comprehensive stratification by settings and risk condition, the encounter- versus episode-based estimates provide a robust range for policymakers' economic appraisal of new RSV immunoprophylaxes.
Collapse
Affiliation(s)
- Phuong T. Tran
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- Faculty of PharmacyHUTECH UniversityHo Chi Minh CityVietnam
| | - Sabina O. Nduaguba
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- Department of Pharmaceutical Systems and PolicySchool of PharmacyMorgantownWest VirginiaUSA
- West Virginia University Cancer InstituteWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Yanning Wang
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
- Department of Health Outcomes and Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
- Global Value and Real‐World EvidenceOtsuka America Pharmaceutical, Inc.PrincetonNew JerseyUSA
| | - Lynn Finelli
- Center for Observational and Real‐World EvidenceMerck & Co., IncRahwayNew JerseyUSA
| | - Yoonyoung Choi
- Center for Observational and Real‐World EvidenceMerck & Co., IncRahwayNew JerseyUSA
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
- Center for Drug Evaluation and SafetyUniversity of FloridaGainesvilleFloridaUSA
- Department of Epidemiology, College of Medicine and College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| |
Collapse
|
3
|
Cui C, Timbrook TT, Polacek C, Heins Z, Rosenthal NA. Disease burden and high-risk populations for complications in patients with acute respiratory infections: a scoping review. Front Med (Lausanne) 2024; 11:1325236. [PMID: 38818396 PMCID: PMC11138209 DOI: 10.3389/fmed.2024.1325236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/24/2024] [Indexed: 06/01/2024] Open
Abstract
Background Acute respiratory infections (ARIs) represent a significant public health concern in the U.S. This study aimed to describe the disease burden of ARIs and identify U.S. populations at high risk of developing complications. Methods This scoping review searched PubMed and EBSCO databases to analyze U.S. studies from 2013 to 2022, focusing on disease burden, complications, and high-risk populations associated with ARIs. Results The study included 60 studies and showed that ARI is associated with a significant disease burden and healthcare resource utilization (HRU). In 2019, respiratory infection and tuberculosis caused 339,703 cases per 100,000 people, with most cases being upper respiratory infections and most deaths being lower respiratory infections. ARI is responsible for millions of outpatient visits, especially for influenza and pneumococcal pneumonia, and indirect costs of billions of dollars. ARI is caused by multiple pathogens and poses a significant burden on hospitalizations and outpatient visits. Risk factors for HRU associated with ARI include age, chronic conditions, and socioeconomic factors. Conclusion The review underscores the substantial disease burden of ARIs and the influence of age, chronic conditions, and socioeconomic status on developing complications. It highlights the necessity for targeted strategies for high-risk populations and effective pathogen detection to prevent severe complications and reduce HRU.
Collapse
Affiliation(s)
- Chendi Cui
- PINC, AI Applied Sciences, Premier Inc., Charlotte, NC, United States
| | - Tristan T. Timbrook
- Global Medical Affairs, bioMérieux, Inc., Salt Lake City, UT, United States
- University of Utah College of Pharmacy, Salt Lake City, UT, United States
| | - Cate Polacek
- PINC, AI Applied Sciences, Premier Inc., Charlotte, NC, United States
| | - Zoe Heins
- Global Medical Affairs, bioMérieux, Inc., Salt Lake City, UT, United States
| | - Ning A. Rosenthal
- PINC, AI Applied Sciences, Premier Inc., Charlotte, NC, United States
| |
Collapse
|
4
|
Simões EAF, Botteman M, Chirikov V. Epidemiology of Medically Attended Respiratory Syncytial Virus Lower Respiratory Tract Infection in Japanese Children, 2011-2017. J Infect Dis 2024; 229:1112-1122. [PMID: 37625899 DOI: 10.1093/infdis/jiad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The objective was to report critical respiratory syncytial virus (RSV)-related epidemiological and healthcare resource utilization measures among Japanese children stratified by gestational and chronological age groups. METHODS The JMDC (formerly the Japan Medical Data Center) was used to retrospectively identify infants with or without RSV infection (beginning between 1 February 2011 and 31 January 2016, with follow-up through 31 December 2017). The incidence of RSV medically attended lower respiratory tract infection (MALRI) was captured by flagging hospitalizations, outpatient, and emergency department/urgent care visits with an RSV diagnosis code during the season. RESULTS Of 113 529 infants and children identified, 17 022 (15%) had an RSV MALRI (14 590 during the season). The RSV MALRI and hospitalization rates in the first 5 months were 14.3/100 child-years (CY) and 6.0/100 CY, respectively (13.4/100 and 5.8/100 CY for full-term infants and 20/100 and 6.8/100 CY for late preterm infants, respectively). Among those with ≥1 type of MALRI event during the RSV season, >80% of children had it by 24 months of chronological age, although this observation differed by prematurity status. Sixty percent of healthcare resource utilization measures started in the outpatient setting. CONCLUSIONS This study emphasizes the RSV burden in young children and critically highlights the data needed to make decisions about new preventive strategies.
Collapse
Affiliation(s)
- Eric A F Simões
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
- Samshoma Medical Research
| | | | | |
Collapse
|
5
|
Suh M, Movva N, Jiang X, Reichert H, Pastula ST, Sacks NC, Frankenfeld C, Fryzek JP, Simões EAF. Healthcare Utilization Among Infants Covered by Medicaid and Newly Diagnosed With Respiratory Syncytial Virus. Open Forum Infect Dis 2024; 11:ofae174. [PMID: 38595954 PMCID: PMC11002947 DOI: 10.1093/ofid/ofae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Infants covered by Medicaid have higher respiratory syncytial virus (RSV) hospitalization rates than those with commercial insurance, but findings are limited to the inpatient setting. This birth cohort study describes healthcare encounters for RSV across all settings among infants covered by Medicaid and the Children's Health Insurance Program. Methods Medicaid claims for infants born and residing in Arizona (AZ), California (CA), Florida (FL), Michigan (MI), North Carolina (NC), New York (NY), and Texas (TX) were analyzed for first diagnosis of RSV in 2016-2018 using International Classification of Diseases, Tenth Revision codes. Encounters on the day of first diagnosis were examined by setting in 7 states and by setting and race in CA, FL, and NC. Results A total of 80 945 infants were diagnosed with RSV in 7 states in 2016-2018. The highest encounter rates for first RSV diagnosis were in the emergency department (ED) in 5 states (11.0-33.4 per 1000 in AZ, CA, FL, MI, and NY) and outpatient setting in 2 states (54.8 and 68.5 per 1000 in TX and NC). Significantly higher outpatient encounter rates were found in CA and NC for White infants compared to non-White infants. In NC, ED encounter rates were significantly higher for non-White infants than White infants, whereas in CA, the rates were comparable. In these 2 states, hospitalization rates were similar across groups. In FL, compared with White infants, non-White infants had significantly higher encounter rates in each setting on the day of first RSV diagnosis. Conclusions This is the first study to describe the burden of RSV by setting and race. Medicaid infants who are newly diagnosed with RSV have the highest burden in ED and outpatient settings.
Collapse
Affiliation(s)
- Mina Suh
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Xiaohui Jiang
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Heidi Reichert
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Susan T Pastula
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Naomi C Sacks
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Cara Frankenfeld
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Eric A F Simões
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| |
Collapse
|
6
|
Abrams EM, Doyon-Plourde P, Davis P, Brousseau N, Irwin A, Siu W, Killikelly A. Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2024; 50:1-15. [PMID: 38511049 PMCID: PMC10949905 DOI: 10.14745/ccdr.v50i12a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Passive immunization products for infants and pregnant women and people have sparked interest in understanding Canada's respiratory syncytial virus (RSV) burden. This rapid review examines RSV burden of disease in infants, young children and pregnant women and people. Methods Electronic databases were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit admissions, deaths and preterm labour associated with RSV. We also contacted Canadian respiratory virus surveillance experts for additional data. Results Overall, 17 studies on infants and young children and 10 studies on pregnant women and people were included, in addition to primary surveillance data from one Canadian territory (Yukon). There were higher rates of medical utilization for infants than older children. Hospitalization rates were highest in infants under six months (more than 1% annually), with 5% needing intensive care unit admission, but mortality was low. Severe outcomes often occurred in healthy full-term infants and burden was higher than influenza. Respiratory syncytial virus attack rate was 10%-13% among pregnant women and people. Only one study found a higher hospitalization rate in pregnant women and people compared to non-pregnant women and people. Limited evidence was found on intensive care unit admission, death and preterm birth for pregnant women and people. Conclusion While risk of severe outcomes is larger in high-risk infants and children, healthcare burden is greatest in healthy term infants. The RSV severity for pregnant women and people appears to be similar to that for non-pregnant women and people.
Collapse
Affiliation(s)
- Elissa M Abrams
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Manitoba, Department of Pediatrics, Section of Allergy and Clinical Immunology, Winnipeg, MB
- University of British Columbia, Department of Pediatrics, Division of Allergy and Immunology, Vancouver, BC
| | | | - Phaedra Davis
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | | | - Andrea Irwin
- Yukon Communicable Disease Control, Health and Social Services, Government of Yukon, Whitehorse, YT
| | - Winnie Siu
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, ON
| | - April Killikelly
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON
| |
Collapse
|
7
|
Yang C, Gao J, Glass L, Cross A, Sun J. Multi-faceted analysis and prediction for the outbreak of pediatric respiratory syncytial virus. J Am Med Inform Assoc 2023; 31:198-208. [PMID: 37934728 PMCID: PMC10746302 DOI: 10.1093/jamia/ocad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is a significant cause of pediatric hospitalizations. This article aims to utilize multisource data and leverage the tensor methods to uncover distinct RSV geographic clusters and develop an accurate RSV prediction model for future seasons. MATERIALS AND METHODS This study utilizes 5-year RSV data from sources, including medical claims, CDC surveillance data, and Google search trends. We conduct spatiotemporal tensor analysis and prediction for pediatric RSV in the United States by designing (i) a nonnegative tensor factorization model for pediatric RSV diseases and location clustering; (ii) and a recurrent neural network tensor regression model for county-level trend prediction using the disease and location features. RESULTS We identify a clustering hierarchy of pediatric diseases: Three common geographic clusters of RSV outbreaks were identified from independent sources, showing an annual RSV trend shifting across different US regions, from the South and Southeast regions to the Central and Northeast regions and then to the West and Northwest regions, while precipitation and temperature were found as correlative factors with the coefficient of determination R2≈0.5, respectively. Our regression model accurately predicted the 2022-2023 RSV season at the county level, achieving R2≈0.3 mean absolute error MAE < 0.4 and a Pearson correlation greater than 0.75, which significantly outperforms the baselines with P-values <.05. CONCLUSION Our proposed framework provides a thorough analysis of RSV disease in the United States, which enables healthcare providers to better prepare for potential outbreaks, anticipate increased demand for services and supplies, and save more lives with timely interventions.
Collapse
Affiliation(s)
- Chaoqi Yang
- Computer Science Department, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| | - Junyi Gao
- University of Edinburgh, Edinburgh, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Lucas Glass
- IQVIA, Plymouth Meeting, PA 19462, United States
| | - Adam Cross
- Department of Pediatrics, University of Illinois College of Medicine Peoria, Peoria, IL 61605, United States
| | - Jimeng Sun
- Computer Science Department, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61801, United States
| |
Collapse
|
8
|
Hodges EN, White M, Nelson CB. All Infants Are at Risk of Developing Medically Attended Respiratory Syncytial Virus Lower Respiratory Tract Infection and Deserve Protection. J Infect Dis 2022; 226:S148-S153. [PMID: 35968870 PMCID: PMC9377026 DOI: 10.1093/infdis/jiac244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Movva N, Suh M, Bylsma LC, Fryzek JP, Nelson CB. Systematic Literature Review of Respiratory Syncytial Virus Laboratory Testing Practices and Incidence in United States Infants and Children <5 Years of Age. J Infect Dis 2022; 226:S213-S224. [PMID: 35968874 PMCID: PMC9377029 DOI: 10.1093/infdis/jiac203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause serious illness in those aged <5 years in the United States, but uncertainty remains around which populations receive RSV testing. We conducted a systematic literature review of RSV testing patterns in studies published from 2000 to 2021. Methods Studies of RSV, medically attended RSV lower respiratory tract infections (LRTIs), and bronchiolitis were identified using standard methodology. Outcomes were clinical decisions to test for RSV, testing frequency, and testing incidence proportions in inpatient (IP), emergency department (ED), outpatient (OP), and urgent care settings. Results Eighty good-/fair-quality studies, which reported data from the period 1988–2020, were identified. Twenty-seven described the clinical decision to test, which varied across and within settings. Two studies reported RSV testing frequency for multiple settings, with higher testing proportions in IP (n = 2, range: 83%–85%, 1996–2009) compared with ED (n = 1, 25%, 2006–2009) and OP (n = 2, 15%–25%, 1996–2009). Higher RSV testing incidence proportions were observed among LRTI infant populations in the ED (n = 1, 74%, 2007–2008) and OP (n = 2, 54%–69%, 1995–2008). Incidence proportions in LRTI populations were not consistently higher in the IP setting (n = 13). Across studies and time, there was heterogeneity in RSV testing patterns, which may reflect varying detection methods, populations, locations, time periods, and healthcare settings. Conclusions Not all infants and children with LRTI are tested for RSV, highlighting underestimation of RSV burden across all settings.
Collapse
Affiliation(s)
- Naimisha Movva
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | - Mina Suh
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | | |
Collapse
|
10
|
Simões EAF. The Burden of Respiratory Syncytial Virus Lower Respiratory Tract Disease in Infants in the United States: A Synthesis. J Infect Dis 2022; 226:S143-S147. [PMID: 35968867 PMCID: PMC9377025 DOI: 10.1093/infdis/jiac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eric A F Simões
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| |
Collapse
|
11
|
Suh M, Movva N, Jiang X, Reichert H, Bylsma LC, Fryzek JP, Nelson CB. OUP accepted manuscript. J Infect Dis 2022; 226:S184-S194. [PMID: 35968879 PMCID: PMC9377028 DOI: 10.1093/infdis/jiac155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is the leading cause of hospitalizations in United States infants aged <1 year, but research has focused on select populations. Methods National (Nationwide) Inpatient Sample and National Emergency Department (ED) Sample data (2011–2019) were used to report RSV hospitalization (RSVH), bronchiolitis hospitalization (BH), and ED visit counts, percentage of total hospitalizations/visits, and rates per 1000 live births along with inpatient mortality, mechanical ventilation (MV), and total charges (2020 US dollars). Results Average annual RSVH and RSV ED visits were 56 927 (range, 43 845–66 155) and 131 999 (range, 89 809–177 680), respectively. RSVH rates remained constant over time (P = .5), whereas ED visit rates increased (P = .004). From 2011 through 2019, Medicaid infants had the highest average rates (RSVH: 22.3 [95% confidence interval {CI}, 21.5–23.1] per 1000; ED visits: 55.9 [95% CI, 52.4–59.4] per 1000) compared to infants with private or other/unknown insurance (RSVH: P < .0001; ED visits: P < .0001). From 2011 through 2019, for all races and ethnicities, Medicaid infants had higher average RSVH rates (up to 7 times) compared to infants with private or other/unknown insurance. RSVH mortality remained constant over time (P = .8), whereas MV use (2019: 13% of RSVH, P < .0001) and mean charge during hospitalization (2019: $21 513, P < .0001) increased. Bronchiolitis patterns were similar. Conclusions This study highlights the importance of ensuring access to RSV preventive measures for all infants.
Collapse
Affiliation(s)
- Mina Suh
- Correspondence: Mina Suh, MPH, EpidStrategies, a Division of ToxStrategies, 27001 La Paz Road, Suite 260 Mission Viejo, CA 92691, USA ()
| | | | - Xiaohui Jiang
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | - Heidi Reichert
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, a Division of ToxStrategies, Rockville, Maryland, USA
| | | |
Collapse
|
12
|
Suh M, Movva N, Jiang X, Bylsma LC, Reichert H, Fryzek JP, Nelson CB. OUP accepted manuscript. J Infect Dis 2022; 226:S154-S163. [PMID: 35968878 PMCID: PMC9377046 DOI: 10.1093/infdis/jiac120] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study describes leading causes of hospitalization, including respiratory syncytial virus (RSV), in United States infants (<1 year) from 2009 through 2019. Methods Within the National (Nationwide) Inpatient Sample (NIS) data, hospitalizations were determined by primary diagnosis using International Classification of Diseases, Ninth or Tenth Revision codes. RSV was defined as 079.6, 466.11, 480.1, B97.4, J12.1, J20.5, or J21.0. Bronchiolitis was defined as 466.19, J21.8, or J21.9. Leading causes overall and by sociodemographic variables were identified. The Kids’ Inpatient Database (KID) was used for confirmatory analyses. Results Acute bronchiolitis due to RSV (code 466.11 or J21.0) was the leading primary diagnosis, accounting for 9.6% (95% confidence interval [CI], 9.4%–9.9%) and 9.3% (95% CI, 9.0%–9.6%) of total infant hospitalizations from January 2009 through September 2015 and October 2015 through December 2019, respectively; it was the leading primary diagnosis in every year accounting for >10% of total infant hospitalizations from December through March, reaching >15% in January–February. From 2009 through 2011, acute bronchiolitis due to RSV was the leading primary diagnosis in every birth month. Acute bronchiolitis due to RSV was the leading cause among all races/ethnicities, except Asian/Pacific Islanders, and all insurance payer groups. KID analyses confirmed these results. Conclusions Acute bronchiolitis due to RSV is the leading cause of US infant hospitalizations.
Collapse
Affiliation(s)
- Mina Suh
- Correspondence: Mina Suh, MPH, EpidStrategies, A Division of ToxStrategies, Inc., 27001 La Paz Road, Suite 260, Mission Viejo, CA 92691, USA ()
| | - Naimisha Movva
- EpidStrategies, a division of ToxStrategies, Rockville, Maryland, USA
| | - Xiaohui Jiang
- EpidStrategies, a division of ToxStrategies, Rockville, Maryland, USA
| | - Lauren C Bylsma
- EpidStrategies, a division of ToxStrategies, Rockville, Maryland, USA
| | - Heidi Reichert
- EpidStrategies, a division of ToxStrategies, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, a division of ToxStrategies, Rockville, Maryland, USA
| | | |
Collapse
|