BACKGROUND: Respiratory syncytial virus (RSV) is a common virus which typically causes upper respiratory tract infections, though in immunocompromised individuals, the very young, and the elderly, it may lead to lower respiratory tract infections and severe illness requiring hospitalization, and which may be fatal. Palivizumab is an immunoprophylactic therapy available for children who are considered high risk for a severe infection, though it is administered according to national RSV seasonality rather than Florida’s RSV seasonality. The purpose of this review was to pilot the RSV-associated pediatric mortality case report form and to describe Florida cases medically and demographically in order to determine high risk populations and immunoprophylaxis uptake among cases.
METHODS: Cases of RSV-associated pediatric mortalities in the state of Florida were identified by querying initial literal causes of death on death certificates accessible via Florida’s Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL). After these cases were identified, death certificates were obtained for those individuals through the Florida Department of Health (FDOH). County health department staff and infection control practitioners were asked to obtain cases’ medical records, after which the investigator abstracted data from those records using a case report form (CRF) created by merging Centers for Disease Control and Prevention (CDC) and FDOH CRFs.
RESULTS: Nearly half of identified cases were under one year of age, and minorities were disproportionately represented. Most cases expired in the months October through March, with the Central Region experiencing the most overall RSV-associated pediatric mortalities. All cases with medical history reported at least one pre-existing medical condition. None of the cases’ medical records indicated that they had received palivizumab immunoprophylaxis prior to presenting at the hospital.
CONCLUSIONS: The case report form piloted in this review captured all relevant information, though the age field had to be refined throughout the abstraction process. Consistent with previous studies, most cases were under one year of age and most had pre-existing conditions which likely contributed to the severity of their illness. Many of those cases would have met the criteria to receive palivizumab prophylaxis and, had it been administered according to RSV seasonality in Florida, it is possible that these cases would not have experienced mortality as a final outcome. It is important to ensure that pediatricians in communities and hospitals are aware of the benefits of administering palivizumab quickly and consistently for high risk patients, especially during RSV season.