Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy.
Department of Medical and Surgical Sciences, Department of Hygiene, University of Foggia, Policlinico Riuniti University Hospital of Foggia, Ospedale "Colonnello D'Avanzo" Viale degli Aviatori, 2, 71122, Foggia, Italy.
Ital J Pediatr. 2024 Mar 7;50(1):45. doi: 10.1186/s13052-024-01617-w.
Respiratory syncytial virus (RSV), a single-stranded RNA virus, is a leading cause of hospitalization in infants, especially ≤ 2 months of life. In the light new immunization strategies adoption, we described epidemiological and clinical characteristics of RSV-associated hospitalizations in pediatric and neonatal intensive care units of the Policlinico Foggia Hospital, Apulia Region, Italy.
Hospitalized children with a laboratory-confirmed RSV infection from 2011 to 2023 were retrospectively evaluated. Clinical information was collected from Hospital Discharge Registry in the period 2011-2020. The proportion of the hospitalization for acute respiratory infections (ARIs) associated to RSV was calculated and the hospitalization cost was analyzed by using the diagnosis-related group reimbursement rate. The anticipated impact of immunization either with monoclonal antibodies or maternal immunization on the number of hospitalizations was estimated. All analyses and quality assessment were performed using STATA/SE15.0.
A total of 1,005 RSV-cases were included in the study, of which 86.3% occurred between December-March. In the period 2011-2020, 832 RSV-cases were matched with the corresponding hospital admissions; 75.2% were aged < 1 year (49.6% 0-2 months). Bronchiolitis was the most frequent admission diagnosis occurring in 63.3% of patients; 25% of children were affected by a very severe RSV-disease. Younger age ≤ 2 months (OR:14.8, 95%CI:8.30-26.31, p = 0.000), higher length-of-hospital-stay (OR:1.01, 95%CI:1.0-1.02, p = 0.030) and history of prematurity (OR:4.4, 95%CI:1.57-12.11, p = 0.005) were associated with a higher disease severity. RSV caused 48.9% of ARIs among children < 1 year. The mean cost of an RSV-associated hospitalization was 3,036 euros/year, with the higher cost in the 0-2 months age group (4,225 euros/year). Immunization programs with nirsevimab could prevent 51.4 RSV hospitalizations/year and 18.1 very severe RSV disease/year in infants < 1 year of age. RSV vaccine could prevent 46.1 of hospitalizations/year caused by RSV within 180 days after birth.
Our study contributes to outlining the baseline profile of RSV-associated hospitalizations among Italian children by providing epidemiological/clinical/economic estimates. While awaiting new recommendations on immunization, healthcare-workers should persist in implementing public health measures and appropriate case management to control RSV seasonal epidemics. Strengthened laboratory RSV surveillance is needed to inform the implementation of the new immunization strategies.
呼吸道合胞病毒（RSV）是一种单链 RNA 病毒，是导致婴儿住院的主要原因，尤其是在 2 个月以下的婴儿。鉴于新的免疫接种策略的采用，我们描述了意大利福贾医院儿科和新生儿重症监护病房的与 RSV 相关的住院患者的流行病学和临床特征。
对 2011 年至 2023 年实验室确诊 RSV 感染的住院儿童进行回顾性评估。2011-2020 年期间从住院记录中收集临床信息。计算与 RSV 相关的急性呼吸道感染（ARI）的住院比例，并使用诊断相关组报销率分析住院费用。估计免疫接种（单克隆抗体或母亲免疫）对住院人数的预期影响。所有分析和质量评估均使用 STATA/SE15.0 进行。
本研究共纳入 1005 例 RSV 病例，其中 86.3%发生在 12 月至 3 月之间。在 2011-2020 年期间，832 例 RSV 病例与相应的住院病例相匹配；75.2%的患者年龄<1 岁（49.6%为 0-2 个月）。细支气管炎是最常见的入院诊断，发生在 63.3%的患者中；25%的儿童患有严重的 RSV 疾病。年龄较小（≤2 个月）（OR：14.8，95%CI：8.30-26.31，p=0.000）、住院时间较长（OR：1.01，95%CI：1.0-1.02，p=0.030）和早产史（OR：4.4，95%CI：1.57-12.11，p=0.005）与疾病严重程度增加相关。RSV 导致<1 岁儿童 ARI 的 48.9%。与 RSV 相关的住院费用平均为每年 3036 欧元，0-2 个月年龄组的费用较高（每年 4225 欧元）。nirsevimab 免疫接种计划可预防<1 岁婴儿每年 51.4 例 RSV 住院治疗和 18.1 例严重 RSV 疾病。RSV 疫苗可预防出生后 180 天内 RSV 引起的 46.1 例住院治疗。
我们的研究通过提供流行病学/临床/经济估计，有助于概述意大利儿童与 RSV 相关的住院治疗的基线特征。在等待新的免疫接种建议的同时，医疗保健工作者应继续实施公共卫生措施和适当的病例管理，以控制 RSV 季节性流行。需要加强 RSV 的实验室监测，以为实施新的免疫接种策略提供信息。
