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. 2022 May 27:9:20499361221099447.
doi: 10.1177/20499361221099447. eCollection 2022 Jan-Dec.

Bronchiolitis hospitalizations in rural New England: clues to disease prevention

Peter F Wright  1 , Anne G Hoen  2 , J Dean Jarvis  3 , Michael S Zens  2 , Erika F Dade  2 , Margaret R Karagas  2 , Juliana Taube  4 , Elizabeth B Brickley  5
Affiliations

Bronchiolitis hospitalizations in rural New England: clues to disease prevention

Peter F Wright et al. Ther Adv Infect Dis. .

Abstract

Background: An improved understanding of the clinico-epidemiology of bronchiolitis hospitalizations, a clinical surrogate of respiratory syncytial virus (RSV) disease, is critical to inform public health strategies for mitigating the in-patient burden of bronchiolitis in early life.

Methods: A retrospective chart review was conducted of all bronchiolitis first admissions (N = 295) to the Children's Hospital at Dartmouth-Hitchcock, CHaD, between 1 November 2010 and 31 October 2017 using the relevant International Classification of Diseases (ICD)-9 and ICD-10 codes for this illness. Abstracted data included laboratory confirmation of RSV infection, severity of illness, duration of hospitalization, age at admission in days, weight at admission, prematurity, siblings, and relevant medical pre-existing conditions.

Results: Admissions for bronchiolitis were strongly associated with age of the child, the calendar month of an infant's birth, and the presence of older children in the family. Medical risk factors associated with admission included premature birth and underlying cardiopulmonary disease.

Conclusion: The very early age of hospitalization emphasizes the high penetration of RSV in the community, by implication the limited protection afforded by maternal antibody, and the complexity of protecting infants from this infection.

Plain language summary: Although risks for respiratory syncytial virus (RSV)/bronchiolitis hospitalization are well described, few studies have examined, with precision, the age-related frequency and severity of RSV/bronchiolitis. We also explore the implications of RSV clinico-epidemiology for our understanding of the pathogenesis of the disease and development of optimal approaches to prevention.

Keywords: bronchiolitis; hospitalization; respiratory syncytial virus.

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Conflict of interest statement

Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Wright serves as a scientific consultant to Sanofi-Pasteur, GlaxoSmithKline, and Meissa Vaccines. The other authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
The distribution of initial bronchiolitis hospitalizations at CHaD during seven successive RSV seasons. Shown are total admissions (solid line, N = 295) and those that involved admissions to the PICU (dashed line, N = 121).
Figure 2.
Figure 2.
Accrual of bronchiolitis hospitalizations at CHaD by age at admission during seven successive RSV seasons (N = 295) in term and premature infants; the line indicates the cumulative percentage of cases.
Figure 3.
Figure 3.
Accrual of initial bronchiolitis hospitalizations at CHaD by weight at admission during seven successive RSV seasons (N = 295) in term and premature infants; the line indicates the cumulative percentage of cases.
Figure 4.
Figure 4.
A heat-map of age at hospitalization in the first year of life for our cohort based on the presence or absence of an older sibling in the family. The yellow color in the 2 months of life highlights the younger age of hospitalization with siblings in the family.
See this image and copyright information in PMC

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