Elucidating the outpatient burden of lower respiratory tract infections due to RSV and other viruses in children under 2 years of age: Clinical presentation, medical treatment, and family impact (Germany, 11/2022-10/2024)
- PMID: 41106463
- DOI: 10.1016/j.ijid.2025.108141
Elucidating the outpatient burden of lower respiratory tract infections due to RSV and other viruses in children under 2 years of age: Clinical presentation, medical treatment, and family impact (Germany, 11/2022-10/2024)
Abstract
Objectives: Worldwide, data on the burden of pediatric, outpatient-treated lower respiratory tract infections (LRTI) are limited. We investigated their viral etiology, clinical characteristics and family impact in Würzburg/Germany.
Methods: Children aged <2 years presenting with febrile LRTI at nine pediatric practices from 11/2022-10/2023 were recorded. In a subset, oropharyngeal swabs were tested with multiplex-PCR for 18 respiratory viruses; clinical data were physician-reported and parent-reported (14-days diary; 1/3/12-month follow-up).
Results: Among 474 recorded children, diagnoses were obstructive bronchitis/bronchiolitis (93.2%), pneumonia (3.4%), and stenosing laryngotracheitis (6.5%). Oropharyngeal swabs were collected from 107/474 (22.6%); RSV (33.6%), rhinovirus (27.1%), and hMPV (15.0%) were most frequently detected. Pediatricians classified 49.5%/48.6%/1.9% (of 107) as mildly/moderately/severely ill; 72.0% received beta-sympathomimetics; 15.0% antibiotics. In 65 diary-documented children, illness lasted 18 days (median; IQR 14-34), 46.2%/3.1% required additional visits/hospitalization, and parents reported 2.5 workdays missed (median). After 1/3/12 months, recurrent LRTI occurred in 11.3%/18.8%/35.5% and wheezing in 14.1%/20.2%/32.2%, with wheezing at 3- or 12-month follow-up associated with recurrent LRTI (Odds Ratio 13 and 7, P < 0.01).
Conclusions: Outpatient-treated LRTI in infants were usually mild/moderate but resolved slowly, with substantial family impact. RSV, rhinovirus, and hMPV predominated. Wheezing was reported in one-third after 12 months and was associated with recurrent LRTI. The present results provide a basis for assessing the impact of the recently recommended RSV immunization for all infants in Germany on the substantial burden of outpatient-treated LRTI in this particularly vulnerable age group.
Keywords: LRTI; Primary care; Respiratory viruses; Wheezing.
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This investigator-initiated study was financially supported by Sanofi Pasteur S.A. and AstraZeneca, with an unrestricted research grant. Johannes Liese received further research grants from GlaxoSmithKline (GSK), Janssen, MSD Sharp & Dohme, Julius Clinical, Pfizer, and Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), honoraria for lectures from AstraZeneca, GSK, Engelhard, MSD, and Nestle, and consulting fees from Enanta, Gilead Sciences, MSD, Pfizer, Siemens Health Care. Andrea Streng received further research grants from GSK, Janssen, MSD, Pfizer, and LGL. The other authors declare no conflict of interest.
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