| Pediatric and adult populations at higher risk of developing complications from acute respiratory infections |
Pediatric population
Complications that have been assessed include neurologic complications, pulmonary complications (including pneumonia severity, respiratory failure), multisystem inflammatory syndrome, healthcare resource utilization (HRU) including readmission, intensive care unit (ICU) admission, and length of stay (LOS), and mortality Younger age, male and racial and ethnic minorities (including Asian, Pacific Islander, American Indian, multiracial, and unspecified race/ethnicities) and chronic neurologic conditions were associated with increased risk of neurologic complications Age (older children or infant), comorbidities and chronic conditions (including asthma, congenital respiratory anomalies, congenital musculoskeletal anomalies, chromosomal anomalies, 3+ comorbidities, and complex chronic medical conditions) were associated with increased risk of pulmonary complications Non-Hispanic Black and low social vulnerability index were associated with increased risk of multisystem inflammatory syndrome Age younger than 6 months and chronic conditions (including complex chronic complex conditions, lung disease, cardiovascular disease, and neurologic and neuromuscular disorder) were associated with increased HRU Asthma, comorbidities (including congenital respiratory anomalies, congenital musculoskeletal anomalies, and chromosomal anomalies), and heart and/or lung transplant were associated with increased risk of mortality
Adult population
Complications that have been assessed include intracerebral hemorrhage (ICH), renal complications (including acute kidney injury [AKI] and renal replacement therapy), respiratory complications (including acute respiratory failure, acute respiratory distress syndrome (ARDS), and the use of mechanical ventilation), HRU (including ICU admission, hospitalization, and LOS), and mortality Races other than Caucasian and the use of anticoagulation agents were associated with increased risk of ICH Higher BMI and heart failure were associated with increased risk of renal complications Asthma, higher BMI, heart failure, and malnutrition were associated with increased risk of respiratory complications Older age (≥75 years) and comorbidities including hematological malignancies, chronic kidney disease, chronic heart failure, stroke, previous evidence of pneumonia, and asthma were associated with increased HRU Older age (>65 years), male, alcohol use disorder and alcohol-related complications, higher BMI, malnutrition, heart failure, malignancy with chemotherapy administered and a higher SOFA score were associated with increased risk of mortality
Combined population
One study assessed the association between patient characteristics and ICU admission among patients with influenza A (H1N1) and seasonal influenza Asthma, pregnancy, male, and non-Hispanic were associated with increased risk of ICU admission Individuals younger than 18 years were more likely to have a influenza A (pH1N1)-related ICU stay than those aged 45–64 years Risk for influenza-like illness (ILI)-related ICU stay was greater for individuals aged 5–12 years than for those aged 45–64 years
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| The disease burden of acute respiratory infections |
Pediatric population
Increases in severe respiratory illness among children and adolescents resulting from enterovirus D68 (EV-D68) infections occurred biennially in the US in 2014, 2016, and 2018, primarily in late summer and fall. EV-D68 levels were lower in 2020, possibly due to COVID-19 mitigation measures (e.g., face masks, hand hygiene, physical distancing) (21) Human metapneumovirus (HMPV) infection is associated with a substantial burden of hospitalizations and outpatient visits among children through the first 5 years of life, especially in the first year (17) RSV is a frequent cause of hospitalization, especially among children aged <2 months (15). In the US population, an estimated 49,509–59,867 community-onset RSV-associated hospitalizations among children aged <2 years occurred during the 2014–2015 season. Among US infants <1 year of age, annual rates of RSV-associated hospitalization ranged from 8.4 to 40.8 per 1000 (22) SARS-CoV-2 affects children of marginalized populations at higher rates than children who come from racial/ethnic majority groups and higher socioeconomic status (20). In one study, Hispanic children represented 46.4% of cases, and Non-Hispanic, Black children represented 30.0%
Adult population
Elderly age is associated with 3–9 times the odds of hospitalization and select comorbidities were associated with 2–7 times the odds of hospitalization Co-morbidities include congestive heart failure, COPD, coronary artery disease, and late-stage chronic kidney disease (46) The increasing elderly population will account for an estimated growth of 45 million people by 2040. If age-specific incidence rates of pneumococcal pneumonia remain stable, outpatient pneumococcal pneumonia visits will likely increase by 43%, and hospitalizations due to pneumococcal pneumonia will increase by close to 100% between 2004 and 2040, with most of the increase occurring in the elderly (53) About 2.2 million outpatient visits for otitis media related to influenza occur annually, of which 86% are in children <18 years (45) Pneumonia as a complication of influenza increases risk of mortality and leads to greater HRU and direct medical costs among patients hospitalized with influenza. These effects are seen early during the index hospitalization and within the first 30 days after diagnosis, but their impact continues throughout a year of follow-up (26) Almost one in five patients who are hospitalized with community-acquired pneumonia (CAP) requires intensive care. Nearly one-half of patients with CAP in the ICU will die within 1 year (28). CAP episodes are also associated with a notable increase in cost during a 90-day CAP episode period, including expenditures related to hospitalization and other inpatient services (39)
Combined population
For all age groups with RSV compared to those without, particularly in the elderly age groups, there are 1.9–3 days length of stay, 0.4–0.5 more ED/urgent care visits, 0.7–2.7 more ambulatory visits, 12.1–18.6 more outpatient visits, and 9.5–14.6 more prescriptions Adjusted mean annual costs between RSV and non-RSV controls is higher in the elderly (≥65; $12,030–$23,194) than in those aged <65 years ($2251–$5391) Among children, adjusted costs attributable to RSV are higher in children aged 5–17 years ($3192), than those 1–4 years ($2251–$2521)
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