Rupp Naomi, Schöbi Nina, Duppenthaler Andrea, Casaulta Carmen, Kopp Matthias V, Agyeman Philipp Ka, Aebi Christoph
Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, CH-3010, Switzerland.
Division of Pediatric Respiratory Medicine, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
BMC Pediatr. 2025 Jul 12;25(1):550. doi: 10.1186/s12887-025-05887-z.
Long-acting monoclonal antibodies against Respiratory Syncytial Virus (RSV) have recently become available for prevention of severe disease including RSV hospitalization in children below two years of age. Data on the risk of rehospitalization among children, who had suffered from severe first RSV episode, remain important to inform the need for secondary prevention using a (additonal) dose of such an antibody. We studied the risk of RSV rehospitalization in a large cohort of patients with a particular focus on same-season rehospitalizations.
Retrospective single-center study of all RSV rehospitalizations occurring in 13 RSV seasons between 2009 and 2023 based on an ongoing RSV surveillance program. We calculated the overall and same-season rates of rehospitalizations for patients of any age and for the first 5 years of life, respectively, and provide a clinical description of of rehospitalization cases.
In a cohort of 3'143 patients having had a primary RSV hospitalization, the overall risk of rehospitalization (69 cases) and same-season risk of rehospitalization (2 cases) for a second RSV infection were 2.2% (95% confidence interval (CI), 1.73-2.79) and 0.06% (95% CI 0.02-0.23), respectively. The figures for the RSV rehospitalization rates from birth until age 5 years of age were 2.3% (95% CI 1.76-3.07) for all rehospitalizations and 0.04% (95% CI 0.01-0.25) for same-season rehospitalizations. The median length of stay (LoS) of rehospitalizations (4.0 days, interquartile range (IQR) 3.0-6.0) was significantly shorter than the LoS of first hospitalizations (6.0 days, IQR 4.0-9.0, p < 0.0001). Children with a pre-existing condition (68%) and those born prematurely (40%) predominated among rehospitalized patients.
Same-season RSV rehospitalizations were exquisitely rare. Routine administration of a dose of a monoclonal antibody for protection against a same-season rehospitalization does not appear to be generally warranted. The majority of patients with subsequent season readmission would be covered by the current recommendations in Switzerland as they had pre-existing conditions making them eligible for second-season RSV prophylaxis.
长效抗呼吸道合胞病毒（RSV）单克隆抗体最近已可用于预防严重疾病，包括两岁以下儿童因RSV住院。对于曾经历过首次严重RSV感染的儿童，再次住院风险的数据对于确定是否需要使用额外剂量的此类抗体进行二级预防仍然很重要。我们研究了一大群患者中RSV再次住院的风险，特别关注同季节再次住院情况。
基于一项正在进行的RSV监测计划，对2009年至2023年期间13个RSV流行季中发生的所有RSV再次住院情况进行回顾性单中心研究。我们分别计算了所有年龄段患者以及出生后头5年患者再次住院的总体率和同季节率，并对再次住院病例进行了临床描述。
在3143例曾因RSV首次住院的患者队列中，第二次RSV感染的再次住院总体风险（69例）和同季节再次住院风险（2例）分别为2.2%（95%置信区间（CI），1.73 - 2.79）和0.06%（95%CI 0.02 - 0.23）。出生至5岁儿童RSV再次住院率方面，所有再次住院率为2.3%（95%CI 1.76 - 3.07），同季节再次住院率为0.04%（95%CI 0.01 - 0.25）。再次住院的中位住院时长（LoS）（4.0天，四分位间距（IQR）3.0 - 6.0）显著短于首次住院的LoS（6.0天，IQR 4.0 - 9.0，p < 0.0001）。再次住院患者中，有基础疾病的儿童（68%）和早产儿童（40%）占主导。
同季节RSV再次住院极为罕见。一般而言，似乎没有必要常规给予一剂单克隆抗体以预防同季节再次住院。瑞士当前的建议涵盖了大多数后续季节再次入院的患者，因为他们有基础疾病，符合第二季RSV预防条件。
