Risk factors associated with severe disease in respiratory syncytial virus infected children under 5 years of age

Lise Beier Havdal; Håkon Bøås; Terese Bekkevold; Anne-Marte Bakken Kran; Astrid Elisabeth Rojahn; Ketil Størdal; Sara Debes; Henrik Døllner; Svein Arne Nordbø; Bjørn Barstad; Elisebet Haarr; Liliana Vázquez Fernández; Britt Nakstad; Christopher Inchley; Elmira Flem

doi:10.3389/fped.2022.1004739

Risk factors associated with severe disease in respiratory syncytial virus infected children under 5 years of age

Front Pediatr. 2022 Aug 30:10:1004739. doi: 10.3389/fped.2022.1004739. eCollection 2022.

Authors

Lise Beier Havdal^{1

2}, Håkon Bøås², Terese Bekkevold², Anne-Marte Bakken Kran^{2

3}, Astrid Elisabeth Rojahn⁴, Ketil Størdal^{5

6}, Sara Debes⁷, Henrik Døllner^{8

9}, Svein Arne Nordbø^{9

10}, Bjørn Barstad¹¹, Elisebet Haarr¹², Liliana Vázquez Fernández², Britt Nakstad^{1

6}, Christopher Inchley¹, Elmira Flem²

Affiliations

¹ Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
² Norwegian Institute of Public Health, Oslo, Norway.
³ Department of Microbiology, Oslo University Hospital, Oslo, Norway.
⁴ Division of Paediatric and Adolescent Medicine, Oslo University Hospital Ullevål, Oslo, Norway.
⁵ Department of Paediatrics, Østfold Hospital Kalnes, Grålum, Norway.
⁶ Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Medical Microbiology, Østfold Hospital Kalnes, Grålum, Norway.
⁸ Department of Paediatrics, St. Olavs University Hospital, Trondheim, Norway.
⁹ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁰ Department of Medical Microbiology, St. Olavs University Hospital, Trondheim, Norway.
¹¹ Department of Paediatric and Adolescent Medicine, Stavanger University Hospital, Stavanger, Norway.
¹² Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway.

Abstract

Objective: To evaluate risk factors for severe disease in children under 59 months of age hospitalized with respiratory syncytial virus (RSV) infection.

Study design: We prospectively enrolled 1,096 cases of laboratory confirmed RSV infection during three consecutive RSV seasons in 2015-2018. Potential risk factors for severe disease were retrieved through patient questionnaires and linkage to national health registries. Need for respiratory support (invasive ventilation, bi-level positive airway pressure, or continuous positive airway pressure), and length of stay exceeding 72 h were used as measures of disease severity. Associations were investigated using multivariable logistic regression analyses. Multiple imputation was used to avoid bias and inference induced by missing data.

Results: Risk factors associated with a need for respiratory support included age younger than 3 months of age [aOR: 6.73 (95% CI 2.71-16.7)], having siblings [aOR: 1.65 (95% CI 1.05-2.59)] and comorbidity [aOR: 2.40 (95% CI 1.35-4.24)]. The length of hospital stay >72 h was significantly associated with being younger than 3 months of age [aOR: 3.52 (95% CI 1.65-7.54)], having siblings [aOR: 1.45 (95% CI 1.01-2.08)], and comorbidity [aOR: 2.18 (95% CI 1.31-3.61)]. Sub-group analysis of children younger than 6 months of age confirmed the association between both young age and having siblings and the need for respiratory support.

Conclusion: In a large cohort of children <59 months hospitalized with RSV infection, young age, comorbidity, and having siblings were associated with more severe disease.

Keywords: disease severity analysis; pediatric infection; respiratory infection; respiratory syncytial virus (RSV); risk factor (RF).