The Burgeoning Burden of Respiratory Syncytial Virus Among Children
Caroline Breese Hall
Affiliation: Departments of Pediatrics and Medicine, University of Rochester School of Medicine, 601 Elmwood Ave, Box 689, Rochester, NY 14642, USA.
Keywords: Respiratory syncytial virus epidemiology, pediatric respiratory infections, respiratory viral infections
Respiratory syncytial virus (RSV) was first isolated from infants by Chanock and colleagues in 1957. However,
control of this ubiquitous agent has yet to be achieved. RSV is recognized as the primary cause of hospitalization for acute
lower respiratory tract illness (LRTI) among infants worldwide. Among children <5 years old, annual hospitalization rates
in the United States (US) is 3/1000 children, and rates in Canada and European countries are similar. In the US the hospitalization
rate is 3 times higher than that from influenza or parainfluenza viral infections. Much less appreciated is the
clinical and economic burden from RSV outpatients, as few have specific diagnostic testing. Nevertheless, RSV in the US
is estimated to cause 1 of 334 hospitalizations, 1 of 38 emergency department visits, but 1 of 13 private practice visits.
These outpatient children tend to have moderate to severe illness with approximately three-fourths manifesting labored
respirations. RSV burden among outpatients, therefore, is considerable both in size and severity. The global burden of
RSV infection is unknown as few studies are from developing countries. Estimates indicate about one-fourth of all acute
LRTI occur among children <5 years, and the greatest burden is among children in developing countries. Currently the
only approved means of RSV prophylaxis is passive immunization with humanized F protein monoclonal antibody. Such
prophylaxis, however, has limited availability, is expensive, and is recommended only for infants most at risk for severe
RSV disease. Only widespread immunization of children is likely to diminish the current burden of RSV infection.
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