Implementation and Preliminary Results of Reporting for Severe Respiratory Syncytial Virus (RSV) in Children <5 Years in Los Angeles County

BACKGROUND:   Respiratory syncytial virus (RSV) causes significant morbidity in the pediatric population resulting in severe lower respiratory illness and contributing to a large burden of secondary infections affecting young children and infants. A study looking at RSV coded hospital discharge information estimated that 132,000-172,000 children < 5 years of age were hospitalized annually in the United States from 1997-2006. In July 2014, the American Academy of Pediatrics updated guidelines for prophylaxis use in children and infants at high risk for hospitalization attributable to RSV infection. In light of these new guidelines, the Centers for Disease Control and Prevention plans to assess implementation of the recommendations by collecting data on severe cases. Consequently, the Los Angeles County Department of Public Health (LACDPH) made severe RSV in children < 5 years old reportable starting December 1, 2014, to identify missed opportunities for prevention and their consequences. 

METHODS:   Severe pediatric RSV is defined as a child < 5 years old who died or was admitted to the ICU as a direct or indirect consequence of infection with RSV. Cases must have a positive laboratory test indicating infection with RSV. Data being collected for each case include: demographic information, medical history (including premature birth, underlying illness, RSV prophylaxis, and influenza and pneumococcal vaccine history), present illness information, diagnostic tests, chest x-ray results, , antiviral usage, and treatment. If the case was fatal, additional clinical information is collected.

RESULTS:   As of January 5, 2014, 55 cases of severe RSV in children < 5 years old have been reported to LACDPH from 14 hospitals of 39 hospitals with a neonatal or pediatric ICU. Of these, 10 (18%) did not meet the case definition, 10 (18%) have been confirmed, and 35 (64%) remain under investigation. All confirmed cases are < 1 year of age and 9 (90%) were < 6 months old at the time of onset. The ratio of male to female cases is 1:1. Four of the 10 confirmed cases (40%) were premature at birth (<37 weeks gestational age); 1 case was < 32 weeks gestational age. Preliminary data regarding prophylaxis with palivizumab, antiviral usage and frequency of co-morbidities is being analyzed.  

CONCLUSIONS:   LACDPH made severe RSV in children <5 years reportable beginning December 1, 2014. Preliminary data show that many hospitals have complied with the new reporting requirement. Data collection is on-going and results from the current respiratory season will be presented.