We prospectively quantified disease severity associated with epidemiologic and socioeconomic parameters as well as the clinical factors in 195 previously healthy infants with confirmed respiratory syncytial virus (RSV) infection. Infants were enrolled into three subgroups according to disease severity: outpatients (82 patients), inpatients (100 patients), and intensive care unit patients (13 patients). Epidemiologic parameters such as gestational age, birth weight, chronologic age at presentation, and gender as well as socioeconomic factors such as ethnic origin, family history of asthma, exposure to cigarette smoke, number of family members, presence of pets at home, breast-feeding, and day-care attendance were not found to predict the severity of RSV illness in previously healthy infants. Our results emphasize the complexity of predicting disease severity in previously healthy infants with RSV infection and suggest that other parameters such as host genetic background might explain the clinical variability.
Get full access to this article
View all access options for this article.
References
1.
Kaneko M, Watanabe J, Kuwahara M, et al. Impact of respiratory syncytial virus infection as a cause of lower respiratory tract infection in children younger than 3 years of age in Japan. J Infect. 2002;44:240-243.
2.
Tsolia MN, Kafetzis D, Danelatou K, et al. Epidemiology of respiratory syncytial virus bronchiolitis in hospitalized infants in Greece. Eur J Epidemiol.2003;18:55-61.
3.
Lanari M, Giovannini M, Giuffre L, et al. Investigators R.A.DA.R. Study Group. Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity. Pediatr Pulmonol. 2002;33:458-465.
4.
Resch B, Gusenleitner W, Muller W. The impact of respiratory syncytial virus infection: a prospective study in hospitalized infants younger than 2 years. Infection. 2002;30:193-197.
5.
Constantopoulos AG, Kafetzis DA, Syrogiannopoulos GA, et al. Burden of respiratory syncytial viral infections on paediatric hospitals: a two-year prospective epidemiological study. Eur J Clin Microbiol Infect Dis.2002;21:102-107.
6.
Tissing WJ, van Steensel-Moll HA, Offringa M. Risk factors for mechanical ventilation in respiratory syncytial virus infection. Eur J Pediatr. 1993; 152:125-127.
7.
Kneyber MC, Brandenburg AH, Rothbarth PH, et al. Relationship between clinical severity of respiratory syncytial virus infection and subtype. Arch Dis Child. 1996;75:137-140.
8.
Baker KA, Ryan ME. RSV infection in infants and young children. What's new in diagnosis, treatment, and prevention?Postgrad Med. 1999;106:97-99.
9.
Wang EE, Law BJ, Stephens D. Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr.1995;126:212-219.
10.
Shay DK, Holman RC, Newman RD, et al. Bronchiolitis-associated hospitalizations among US children, 1980–1996. JAMA.1999;282:1440-1446.
11.
Weber MW, Milligan P, Hilton S, et al. Risk factors for severe respiratory syncytial virus infection leading to hospital admission in children in the Western Region of The Gambia. Int J Epidemiol. 1999;28:157-162.
12.
Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis. 1992;145:106-109.
13.
Kaneko M, Watanabe J, Ueno E, et al. Risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection in children. Pediatr Int. 2001;43:489-492.
14.
Liese JG, Grill E, Fischer B, et al, the Munich RSV Study Group. Incidence and risk factors of respiratory syncytial virus-related hospitalizations in premature infants in Germany. Eur J Pediatr. 2003;162:230-236.
15.
Brandenburg AH, Jeannet PY, Steensel-Moll HA, et al. Local variability in respiratory syncytial virus disease severity. Arch Dis Child. 1997; 77:410-414.
16.
Djelantik IG, Gessner BD, Soewignjo S, et al. Incidence and clinical features of hospitalization because of respiratory syncytial virus lower respiratory illness among children less than two years of age in a rural Asian setting. Pediatr Infect Dis J. 2003;22:150-157.
17.
Aujard Y, Fauroux B. Risk factors for severe respiratory syncytial virus infection in infants. Respir Med.2002;96:S9-S14.
18.
Law BJ, Carbonell-Estrany X, Simoes EA. An update on respiratory syncytial virus epidemiology: a developed country perspective. Respir Med.2002;96:S1-S7.
19.
Jansson L, Nilsson P, Olsson M. Socioeconomic environmental factors and hospitalization for acute bronchiolitis during infancy. Acta Paediatr.2002;91:335-338.
20.
Gurkan F, Kiral A, Dagli E, Karakoc F. The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis. Eur J Epidemiol.2000;16:465-468.
21.
Adler A, Ngo L, Tosta P, Tager IB. Association of tobacco smoke exposure and respiratory syncitial virus infection with airways reactivity in early childhood. Pediatr Pulmonol. 2001; 32:418-427.
22.
Bulkow LR, Singleton RJ, Karron RA, Harrison LH, Alaska RSV Study Group. Risk factors for severe respiratory syncytial virus infection among Alaska native children. Pediatrics.2002;109:210-216.
Cooke GS, Hill AV. Genetics of susceptibility to human infectious disease. Nat Rev Genet. 2001;2:967-977.
25.
Choi EH, Lee HJ, Yoo T, Chanock SJ. A common haplotype of interleukin-4 gene IL4 is associated with severe respiratory syncytial virus disease in Korean children. J Infect Dis. 2002; 186:1207-1211.
26.
Lahti M, Lofgren J, Marttila R, et al. Surfactant protein D gene polymorphism associated with severe respiratory syncytial virus infection. Pediatr Res. 2002;51:696-699.
27.
Hull J, Thomson A, Kwiatkowski D. Association of respiratory syncytial virus bronchiolitis with the interleukin 8 gene region in UK families. Thorax.2000;55:1023-1027.
28.
Tal G, Mandelberg A, Dalal I, et al. The common toll-like receptor 4 mutations are associated with severe respiratory syncytial virus disease. J Infect Dis. 2004;189:2057-2063.
