Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan
May
Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan
Hsin Chi 0 1 2
Ching-Hu Chung 0 2
Yuh-Jyh Lin 2
Chyi-Her Lin 2
0 Department of Medicine, Mackay Medical College , New Taipei City, Taiwan , 3 Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University , Tainan , Taiwan
1 Department of Pediatrics, Mackay Memorial Hospital and Mackay Children's Hospital , Taipei , Taiwan
2 Editor: Chih-Jung Chen, Chang Gung Memorial Hospital , TAIWAN
-
Data Availability Statement: The ownership of the
data underlying this study belong to the National
Health Insurance Research Database (NHIRD) of
Taiwan and cannot be made publicly available due
to legal restrictions. However, the data are available
through formal application to the Health and
Welfare Data Science Center at Ministry of Health
and Welfare, Taiwan (https://dep.mohw.gov.tw/
DOS/np-2500-113.html) and require a signed
affirmation regarding data confidentiality. The
authors have no special privilege of access to the
database.
Objectives
To assess the nationwide seasonal peaks, risk factors, and utilization of medical resources
of respiratory syncytial virus-associated hospitalization (RSVH) in preterm infants in
Taiwan.
Study design
A Taiwan nationwide birth cohort was extracted from the Birth Certificate Application
Database during 2007±2009 and prospectively linked to the National Health Insurance database.
We evaluated the seasonal peaks and risk factors (gestational age [GA], chronologic age
[CA], and bronchopulmonary dysplasia [BPD]) associated with the RSVH of preterm infants.
The length of hospital stays (LOS), care in intensive care unit (ICU), and use of mechanical
ventilation (MV) were also analyzed.
Results
There is a total duration of 9 months of RSVH season in Taiwan, three seasonal peaks and
two seasonal peaks of RSVH in preterm infants with BPD and without BPD, respectively.
Preterm infants had significantly higher RSVH rate than term infants (2.6% vs 0.9%,
p<0.0001). Preterm infants born at 29±35 weeks of gestational age (wGA) with BPD had
significantly higher RSVH rate than those without BPD (p<0.0001). Preterm infants without
BPD born at < 32 wGA had higher RSVH rate than those born at 33±35 wGA (p<0.0001).
Overall, 56.4% of RSVH occurred within 9 months of CA. Preterm infants with BPD had
significantly higher ICU admission rate within 18 months of CA (p<0.0001), MV usage within 12
months of CA (p<0.0001) and LOS within 18 months of CA (p<0.001) than those without
BPD. RSVH occurred within 6 months of CA was significantly associated with higher ICU
admission rate (p<0.0001), MV usage (p = 0.0002) and longer LOS (p<0.001) in preterm
infants without BPD.
Funding: The author(s) received no specific
funding for this work.
Competing interests: The authors have declared
that no competing interests exist.
Conclusions
There is a total duration of 9 months of RSVH season in Taiwan. Preterm < 32 wGA, BPD,
and CA within 6 months were risk factors of RSVH which also contribute to higher utilization
of medical resources.
Introduction
Respiratory syncytial virus (RSV) is an important virus for lower respiratory tract infections
among infants and young children [
1,2
]. Nearly all children have been infected at least once by
2 years of age, with 1±2% requiring hospitalization [
3,4
]. Populations at risk for
RSV-associated hospitalization (RSVH) include infants who are born before 35 weeks of gestational age
(wGA), with bronchopulmonary dysplasia (BPD), and who have hemodynamically significant
congenital heart disease (HS-CHD) [
5
]. Chronologic age (CA) is one of the most important
risk factor for RSVH and most of pediatric RSVH occur in the first 5 months after birth [
5,6
].
Since 1998, the American Academy of Pediatrics (AAP) has recommended palivizumab
prophylaxis guidelines against RSV according to their BPD status, gestational age(GA) and CA at
the beginning of the RSV season to prevent the respiratory complication [7]. Because of the
high costs of RSV prophylaxis [
8
] and additional data regarding seasonality of RSV infection,
AAP revised its policy and restricted the palivizumab prophylaxis to preterm infants who were
born before 32 wGA and infants born at 32 to 35 wGA with certain risks in 2009 [
9
]. In 2014,
the AAP further evolved palivizumab prophylaxis to preterm infants born before 29 wGA,
born at <32 weeks with BPD of prematurity, and infants with HS-CHD [
10
].
Prevention of RSV is complicated by considerable variation in RSV seasonality across
geographic locations [
11
]. The current AAP guideline recommends a series of 5 monthly
injections which simply reflects the average length of the RSV season across the United States,
Canada, and the United Kingdom without considering the variation in regional seasonality
[
12
]. The RSV infection has been reported to be ongoing t (...truncated)