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BACKGROUND: Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infections in children and causes >150,000 hospitalizations in US children <5 years annually. However, surveillance for severe acute respiratory illness (SARI), including RSV, is not well established.
METHODS: From April 2013 through October 2014, surveillance for SARI (acute-onset of severe respiratory symptoms requiring hospitalization) was implemented at Children’s Hospitals and Clinics of Minnesota. Residual respiratory specimens from routine diagnostic testing were submitted to the MDH–Public Health Laboratory and tested for 22 viral and bacterial pathogens, including RSV, by real-time PCR. Medical records were reviewed to obtain clinical and demographic data on Minnesota residents.
RESULTS: RSV was detected in 592 of 2,553 (23%) submitted specimens and was the most frequently detected pathogen in patients <1 year (362, 61%). Median age of RSV cases was 0.6 years (range 0-16y), compared to median age of 1.3 years among cases with another pathogen detected (range 0-25y) and 1.8 years (range 0-25y) with no pathogen detected. Admitting symptoms for RSV cases included cough (81%), fever (69%), respiratory distress (62%), and shortness of breath (17%). Compared to cases with another pathogen or with no pathogen detected, RSV cases ≤6mo had greater odds of presenting with respiratory distress (OR 2.8 (95% CI: 2.0-3.9) and OR 3.5 (95% CI: 2.5-5.1) respectively, p<0.001 for each). Co-morbidities were identified in 230 (39%) RSV cases, including prematurity (14%), asthma (11%), neurologic disorders (10%), cardiovascular disease (6%), and chronic lung disease (4%). ICU admission occurred in 79 (13%) RSV cases; 39 (49%) were previously healthy and 17 (21%) received mechanical ventilation. Median length of stay (LOS) was 3 days (range 1-51) for non-ICU stay and 4 days (range 1-34) for stay in ICU. Co-detection of RSV and another pathogen(s) was identified in 207 (35%) cases, including rhinovirus (41%), adenovirus (37%), and coronavirus (30%). No differences in ICU admission, LOS, or presence of co-morbidities were found between RSV-positive cases and cases with co-detections or cases positive for a different pathogen.
CONCLUSIONS: RSV was the most frequently detected pathogen in infants with SARI. Children with RSV were more likely to present with respiratory distress than other SARI cases. The majority of children hospitalized with RSV were previously healthy, including half who required ICU care. Co-detections, although common, did not result in increased severity. Development of an effective RSV vaccine would be a useful tool for reducing the burden of SARI.