Table 2.
RSV hospitalization, healthcare resource utilization and case fatality rate in immunocompromised infants and children
| Study | Country | Design/study population | Incidence RSV (per 1000) | Incidence RSVH (per 1000) | LOS, median days (range) | Admitted to ICU/PICU (%) | Supplemental oxygen (%) | Intubation and/or mechanical ventilation (%) | Case fatality rate (%) |
|---|---|---|---|---|---|---|---|---|---|
| Studies of children ≤2 years | |||||||||
| Murray 2014 [7] | UK | Retrospective multicenter study (2007–2008) of 7189 children aged <12 months admitted to hospital with bronchiolitis [7 (0.1%) were immunocompromised]. No information on RSV immunoprophylaxis | NA | 117 | 8 (1–58) | NR | NR | NR | NR |
| Kristensen 2012 [10] | Denmark | Register-based cohort study of 452 205 children aged <2 years of whom 12 498 (2.8%) were hospitalized for RSV from 1997 to 2003. 7/83 RSVHs for children with cancer. During the study period, 118 of total population received RSV immunoprophylaxis | NR | 187 | 1.1 (0.4–2.9)a | NRb | NRb | NRb | NRb |
| Simon 2008 [48, 49] | Germany | Prospective, multicenter study of 39 hospitalized infants (<1 year) with cancer who had an RSV infection between 1999 and 2005; no information on RSV immunoprophylaxis | NA (study population) | NA (study population) | 7 (2–35) | 13 | 44 | 3 | 0 |
| Wang 1995 [42] | US | Multicenter, prospective cohort study of 689 children aged <2 years hospitalized with an RSV infection in 1993 (21 immunocompromised childrenc); no information on RSV immunoprophylaxis | NA (study population) | NA (study population) | 10d | 19.1d | NRd | 14.3d | 4.8d |
| Studies of children ≤18 years | |||||||||
| Feldman 2015 [35] | US | Retrospective cohort study of 2554 children aged <18 years who had a liver transplant between 2004 and 2013; no information on RSV immunoprophylaxis | 72 | 40e | NR | 20.9 | NR | 9.3 | 4.9e |
| Hutspardol 2015 [9] | Canada | Retrospective study of 844 children [median age 7.5 years (range 1 month–17.8 years)] who underwent HSCT (allogeneic 491, autologous 353) between 2000 and 2012; 1 child (0.1%) received RSV immunoprophylaxis | 18 | NR | NR | NR | NR | 0.2 | 6.7 |
| Robinson 2015 [8] | Canada | Surveillance study of 24 inpatients and outpatients aged <17 years who had received HSCT or SOT and had an RSV infection within 2 years post-transplant (2010–2013); 2 children (8.3%) had/possibly received RSV immunoprophylaxis | NA (study population) | NAf | NR | 29 | NR | 21 | 8.3 |
| Chemaly 2014 [37] | US | Retrospective study of 59 children aged <18 years with cancer (solid tumor 15%; hematologic malignancy 53%; HSCT 32%) with RSV between 1998 and 2009; no information on RSV immunoprophylaxis | NA (study population) | NAg (study population) | 6 (2–9) | 10 | NR | 5 | 5 |
| Lo 2013 [39] | US | Retrospective study of 2375 children who received HSCT or SOT or had cancer at a tertiary center (1993–2006); median age 6.1 and 4.3 years, respectively; no information on RSV immunoprophylaxis | 37h | NRi | NRi | NRi | NRi | NRi | NRi |
| Asner 2013 [47] | Canada | Single-center observational study of 117 immunocompromised children aged <18 years (HSCT 13.7%; SOT 16.2%; solid tumors 16.2%; leukemia/lymphoma 28.2%; immunosuppression for chronic condition 1.7%) with positive RSV infection from 2006 to 2011; 15 (12.8%) children received RSV immunoprophylaxis | NA (study population) | NAj (study population) | 9 (5–24.5) | 23.9 | NR | 17.1 | 4.3 |
| Tran 2013 [38] | US | Retrospective study of 30 children aged ≤18 years who received an abdominal organ transplant, hospitalized with a positive respiratory illness in 2008–2011; 5 patients (16.7%) with RSV; children <24 months old received immunoprophylaxis | NA (study population) | NA (study population) | NR | NR | NRi | NR | 40 |
| Anak 2010 [50] | Turkey | Retrospective survey of two RSV outbreaks (2006; 2009) among 30 pediatric patients hospitalized for hemato-oncological diseases treated with or without HSCT; no information on RSV immunoprophylaxis | 200 | NA | NR | NR | NRi | 0 | 0 |
| Sung 2008 [40] | US | Retrospective review of 3 Children’s Oncology Group AML trials (2003–2005); 2078 children with de novo AML (median age 8.7 years); no information on RSV immunoprophylaxis | 0–22k | NR | NR | NR | NR | NR | 0.2 |
| Mendoza Sánchez 2006 [17] | Spain | Retrospective study of 347 children aged ≤14 years diagnosed with cancer and receiving anticancer therapy (n = 218) or HIV infection (n = 129) (1989–2003) | 101 (HIV); 46 (cancer) | NRi | NRi | NRi | NRi | NRi | 0 (HIV); 20.0 (cancer) |
| Small 2002 [45] | US | Single center, retrospective study of 548 allogenic HSCT (including 154 children <19 years) and 394 autologous HSCT recipients from 1994 to 1999; no information on RSV immunoprophylaxis | 175l | NR | NR | NR | NR | NR | 12m |
| Miller 1996 [41] | US | Retrospective study of 173 pediatric recipients of renal transplantation between 1985 and 1993; no information on RSV immunoprophylaxis | 30 | NR | NR | NR | NR | 0 | 0 |
| Studies of mixed populations of children and adults | |||||||||
| Chu 2016 [33] | US | Single-center retrospective cohort study of 15 children and young adults aged <21 years with HSCT, SOT or hematologic malignancy with RSV diagnosed as an outpatient between 2008 and 2013; no patient received RSV immunoprophylaxis | NA (study population) | NAn | NR | 2 | 6 | 0 | 0 |
| Campbell 2015 [34] | US | Prospective study of 458 patients (52 children aged <18 years) who underwent allogeneic HSCT between 2005 and 2010; no information on RSV immunoprophylaxis | 19o | NA | NR | NR | NR | NR | 0o |
| El-Bietar 2015 [36] | US | Prospective study of 349 consecutive patients aged 6 months–25 years who underwent BMT between 2008 and 2013; no information on RSV immunoprophylaxis | 52p | NR | NR | NR | NR | NR | 0 |
| Liu 2009 [44] | US and Europeq | Multicenter, retrospective study of 576 lung transplant recipients (≤21 years) from 1988 to 2005; no information on RSV immunoprophylaxis | 36e,h | NR | NR | NR | NR | NR | NR |
| El Saleeby 2008 [20] | US | Retrospective study of 58 cases of RSV in immunocompromised pediatric patients aged <21 years (40% ALL, 19% solid tumors, 41% HSCT recipients, AML, or SCID) between 1997 and 2005; no information on RSV immunoprophylaxis | NA (study population) | NA (study population)p,r | 7 (3–51)p | NR | 22p | 9p | 8.6p,s |
| Luján-Zilbermann 2001 [43] | US | Single center, retrospective review of 281 HSCT recipients (including hematological malignancies, solid tumors, sickle cell disease, metabolic disorders, primary immunodeficiencies) from 1994 to 1997; mean age 9.28 (0.2–22) years; no information on RSV immunoprophylaxis | 17e | 11 | NR | NR | NR | NR | 0 |
| McCarthy 1999 [51] | UK | Single-center retrospective study of 336 patients [median age 10.6 years (range 0.5–31.1)] who received BMT between 1993 and 1998; no information on RSV immunoprophylaxis | 63t | NA | NR | NR | NR | NR | 19.2 |
| Outcome | Number of studies | Number of countries | Population age and timeframe of studiesu | Value |
|---|---|---|---|---|
| Summary | ||||
| Incidence of RSV infection | 13 | 7 | ≤31 years; 1985–2013 | 0–200 per 1000 population |
| Incidence of RSVH | 4 | 3 | ≤22 years; 1994–2013 | 11–187 per 1000 population |
| LOS, median | 6 | 4 | <21 years; 1993–2011 | 6–10 days |
| Admission to ICU/PICU | 7 | 3 | <21 years; 1993–2013 | 2–29% |
| Supplemental oxygen | 4 | 2 | <21 years; 1993–2013 | 6–44% |
| Intubation and/or mechanical ventilation | 10 | 4 | <21 years; 1993–2013 | 0–21% |
| Case fatality rate | 17 | 6 | ≤31 years; 1985–2013 | 0–40% |
ALL acute lymphoblastic leukemia, AML acute myeloid leukemia; HIV human immunodeficiency syndrome, HSCT hematopoietic stem cell transplantation, ICU intensive care unit, LOS length of stay, LRTI lower respiratory tract infection, NA not applicable, NR not recorded, PICU pediatric intensive care unit, RSV respiratory syncytial virus, RSVH respiratory syncytial virus hospitalization, SCID severe combined immunodeficiency syndrome, SOT solid organ transplant, URTI upper respiratory tract infection
aGeometric mean ratio (95% confidence interval) for presence of cancer vs. non-presence of condition; P = 0.814
bNo specific data for children with cancer
cIncludes immunodeficiency, immunosuppressant therapy and use of corticosteroids
dData for immunocompromised cohort
eRSV rate during first year post-transplant
f11 of 24 (45.8%) children with RSV hospitalized
g34 of 59 (57.6%) children with RSV infection were hospitalized
hRate based on number of episodes
iNo specific data for infants/children with RSV infection
j64.1% patients admitted due to RSV; 35.9% nosocomial acquisition of RSV
kPrevalence based on children in induction and consolidation for AML
lData for pediatric population aged <19 years who underwent allogenic HSCT
mMortality in patients with LRTI from pooled allogenic and autologous group including children and adults
n15 of 54 (27.8%) children with RSV infection were hospitalized
oData for pediatric population aged <18 years
pData for pediatric and young adult patients
qEuropean counties include UK, Germany and Austria
r36% of children with RSV infection were hospitalized
sOverall mortality rate
tRSV identified during 5-year study period
uIncludes studies whose populations contain patients up to 21 years old [44], 22 years old [43], 25 years old [36], and 31 years old (median age 10.6 years) [51]