Respiratory syncytial virus (RSV) accounted for 53% of hospitalizations for non-COVID-19-related lower respiratory tract infections (LRTI) and 79% of patients needing respiratory support at a tertiary pediatric hospital in Barcelona, Spain, between 2012 and 2020, according to study findings published in Influenza and Other Respiratory Viruses.
Investigators sought to characterize pediatric hospitalizations due to viral LRTIs unrelated to COVID-19 at Vall d’Hebron University Hospital, a tertiary pediatric hospital in Barcelona, Spain, from October 2012 to December 2020, examining clinical, epidemiological, virological, and economic factors. The researchers conducted an observational, retrospective, single-center study of all consecutive hospitalized pediatric patients (<16 years of age) with laboratory-confirmed viral LRTIs (other than SARS-CoV-2).
The researchers found that 3325 children (43% girls; <10% with a history of chronic disease) accounted for 4056 hospitalizations, and that a third of these hospitalization involved children who were 12 months of age or younger. Of those children, 54% were admitted with asthma/wheezing, 38% with bronchiolitis, and 8% with pneumonia. Almost 4% were immunocompromised.
Among the 4056 hospitalizations, investigators found 4753 viruses, with 2 or more viruses isolated in 565 patients. Respiratory syncytial virus (RSV) was the most common (53%) virus and was associated with bronchiolitis (odds ratio [OR], 6.62). RSV was also the most frequent reason for respiratory support (79%) and the most frequent reason for pediatric intensive care unit (PICU) admission (11%). The next most common (30%) virus was rhinovirus (RV).
Notably, the time period between October and May accounted for 91% of all hospitalizations for LRTIs, and seasonal viral LRTIs, typically occurring during that time period, accounted for more than 12% of overall hospital bed days.
[I]t is essential to increase the limited number of antivirals available for influenza and RSV by developing new prophylaxis measures and drugs to treat viral LRTI. This will improve the health of the paediatric population, and reduce the consumption of hospital resources and associated costs.
Among all patients admitted with LRTIs, 9% required PICU admission and 4 patients died. Factors that significantly increased the odds for PICU admission were chronic conditions, bronchiolitis, male sex, and 12 months of age or younger. Influenza A was associated with pneumonia (OR, 7.75) causing longer mean (SD) hospitalizations (7  days).
The total cost of hospitalization during the study period exceeded 16.6 million euros, based on 2021 costs of 615 euros (about $665) per day in the pediatric ward and 2,350 euros per day in the PICU.
Significant study limitations include the retrospective design, the single-center design, unaccounted-for viral-bacterial and viral-viral co-detections, varying sensitivities of diagnostic techniques, the use of rapid tests targeting only RSV or influenza viruses, coding errors in electronic records, and unaccounted-for changing costs during the study period.
Study authors concluded that “Viral LRTIs are an important cause of morbidity, hospitalization and PICU admission in children. The clinical burden is associated with significant bed occupancy and health-care costs, especially during seasonal periods.” The investigators further added that “[I]t is essential to increase the limited number of antivirals available for influenza and RSV by developing new prophylaxis measures and drugs to treat viral LRTI. This will improve the health of the paediatric population, and reduce the consumption of hospital resources and associated costs.”