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. 2022 Aug 15;226(Suppl 2):S267-S281.
doi: 10.1093/infdis/jiac226.

Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review

Lauren C Bylsma  1 , Mina Suh  1 , Naimisha Movva  1 , Jon P Fryzek  1 , Christopher B Nelson  2
Affiliations

Mortality Among US Infants and Children Under 5 Years of Age with Respiratory Syncytial Virus and Bronchiolitis: A Systematic Literature Review

Lauren C Bylsma et al. J Infect Dis. .

Abstract

Background: A systematic literature review was conducted to summarize the mortality (overall and by disease severity factors) of US infants and children aged <5 years with respiratory syncytial virus (RSV) or all-cause bronchiolitis (ACB).

Methods: Comprehensive, systematic literature searches were conducted; articles were screened using prespecified eligibility criteria. A standard risk of bias tool was used to evaluate studies. Mortality was extracted as the rate per 100 000 or the case fatality ratio (CFR; proportion of deaths among RSV/ACB cases).

Results: Among 42 included studies, 36 evaluated inpatient deaths; 10 used nationally representative populations updated through 2013, and only 2 included late-preterm/full-term otherwise healthy infants and children. The RSV/ACB definition varied across studies (multiple International Classification of Diseases [ICD] codes; laboratory confirmation); no study reported systematic testing for RSV. No studies reported RSV mortality rates, while 3 studies provided ACB mortality rates (0.57-9.4 per 100 000). CFRs ranged from 0% to 1.7% for RSV (n = 15) and from 0% to 0.17% for ACB (n = 6); higher CFRs were reported among premature, intensive care unit-admitted, and publicly insured infants and children.

Conclusions: RSV mortality reported among US infants and children is variable. Current, nationally representative estimates are needed for otherwise healthy, late-preterm to full-term infants and children.

Keywords: LRTI; RSV; bronchiolitis; children; infants; lower respiratory tract infection; mortality; respiratory syncytial virus; systematic literature review.

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Conflict of interest statement

Potential conflicts of interest. EpidStrategies received a grant from Sanofi for this research. L. C. B., M. S., N. M., and J. P. F. are employees of EpidStrategies. C. B. N. is an employee of Sanofi and may hold shares and/or stock options in the company. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the study selection process. Abbreviations: PECOS, population, exposure, comparator, outcomes, and study design; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RSV, respiratory syncytial virus. aPubMed, EMBASE databases. bExcluded for not meeting PECOS criteria.
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