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. 2024 Nov;13(11):2395-2413.
doi: 10.1007/s40121-024-01058-2. Epub 2024 Oct 12.

Respiratory Syncytial Virus Risk Profile in Hospitalized Infants and Comparison with Influenza and COVID-19 Controls in Valladolid, Spain, 2010-2022

Mariana Haeberer  1 , Martin Mengel  2 , Rong Fan  3 , Marina Toquero-Asensio  4   5 , Alejandro Martin-Toribio  4   6 , Qing Liu  3 , Yongzheng He  3 , Sonal Uppal  3 , Silvia Rojo-Rello  4   7 , Marta Domínguez-Gil  4   7 , Cristina Hernán-García  4   7 , Virginia Fernández-Espinilla  4   7 , Jessica E Atwell  3 , Javier Castrodeza Sanz  4   7   6 , José M Eiros  4   7   6 , Ivan Sanz-Muñoz  4   5
Affiliations

Respiratory Syncytial Virus Risk Profile in Hospitalized Infants and Comparison with Influenza and COVID-19 Controls in Valladolid, Spain, 2010-2022

Mariana Haeberer et al. Infect Dis Ther. 2024 Nov.

Abstract

Introduction: We aimed to describe the risk profile of RSV infections among children aged ≤ 24 months in Valladolid from January 2010 to August 2022 and to compare them with influenza and COVID-19 controls.

Methods: We conducted a retrospective cohort study of all laboratory-confirmed RSV, influenza, and COVID-19 infections. We analyzed risk factors for RSV hospitalization and severity (length-of-stay ≥ 8 days, intensive-care-unit admission, in-hospital death or readmission < 30 days) and compared severity between hospitalized RSV patients vs. influenza and COVID-19 controls using multivariable logistic regression models.

Results: We included 1507 patients with RSV (1274 inpatient), 32 with influenza, and 52 COVID-19 controls. Hospitalized RSV (mean age 5.3 months) and COVID-19 (4 months) were younger than influenza (9.1 months) patients. Sixteen percent of patients had RSV within the first month of life. Most infants did not have comorbidities (74% RSV, 56% influenza, and 69% COVID-19). Forty-one percent of patients with RSV and influenza were coinfected vs. 27% COVID-19 (p = 0.04). Among RSV, hospitalization risk factors were prematurity (adjusted OR 3.11 [95% CI 1.66, 4.44]) and coinfection (2.03 [1.45, 2.85]). Risks for higher severity were maternal smoking (1.89 [1.07, 3.33]), prematurity (2.31 [1.59, 3.34]), chronic lung disease (2.20 [1.06, 4.58]), neurodevelopmental condition (4.28 [2.10, 8.73]), and coinfection (2.67 [2.09, 3.40]). Breastfeeding was protective against hospitalization (0.87 [0.80, 0.95]) and severity (0.81 [0.74, 0.88]), while complete vaccination schedule was protective against severity (0.51 [0.27, 0.97]). RSV had 2.47 (1.03, 5.96) higher risk of experiencing any severe outcome compared to influenza and did not show significant differences vs. COVID-19.

Conclusions: RSV hospitalizations were more frequent and severe than influenza, while severity was comparable to the early pandemic COVID-19. Currently, both influenza and COVID-19 vaccines are included in the maternal and childhood Spanish immunization schedule between the ages of 6 and 59 months. RSV monoclonal antibody is recommended for ≤ 6 months but a third of patients were aged 6-24 months. Maternal RSV vaccination can protect their children directly from birth and indirectly through breastfeeding.

Keywords: Hospitalization; Infants; Influenza; Premature infants; Respiratory syncytial virus; Risk factors; SARS-CoV-2.

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Conflict of interest statement

Mariana Haeberer, Rong Fan, Qing Liu, Sonal Uppal and Jessica Atwell are employees of Pfizer and may own Pfizer stock. Marina Toquero Asensio, Alejandro Martín Toribio, Silvia Rojo Rello, Marta Domínguez Gil, Cristina Hernán García, Virginia Fernández Espinilla, José M. Eiros, Javier Castrodeza Sanz, and Ivan Sanz-Muñoz received funding from Pfizer for data abstraction, protocol, and manuscript review. Alejandro Martín Toribio received funding by the call for UVa 2023 predoctoral contracts, co-funded by Banco Santander.

Figures

Fig. 1
Fig. 1
Distribution of hospitalized patients (percentage over total n = RSV 1274, influenza n = 32, COVID-19 n = 52) by infection and age in months, Valladolid, Spain, 2010–2022
Fig. 2
Fig. 2
Distribution of hospitalized RSV patients (percentage over total n = 1274) by age in weeks, Valladolid, Spain, 2010–2022
See this image and copyright information in PMC

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