Severe respiratory syncytial virus infection in older children
J. R. Groothuis, C. K. Salbenblatt and B. A. Lauer
Department of Pediatrics, University of Colorado School of Medicine, Denver.
Serious respiratory syncytial virus (RSV) disease requiring hospitalization
occurs primarily in infants younger than 12 months. The incidence, risk
factors, and clinical features in older children have not been studied
extensively. Of 282 children hospitalized at our institution with severe
RSV disease during a 3-year period, 62 (22%) were older than 12 months.
These 62 older children were matched for sex, onset of illness, and
hospital location with 62 hospitalized children younger than 12 months with
proved RSV infection. Older children had underlying chronic disease more
commonly than younger children (47 of 62 vs 24 of 62). Chronic illnesses in
older children included bronchopulmonary dysplasia and/or reactive airway
disease (34 of 47), congenital heart disease (9 of 47), gastrointestinal
disease (7 of 47), and genetic disorders (7 of 47). Three of the four
deaths from RSV infection occurred in older children; all four had
underlying disease (three with congenital heart disease and one with
biliary atresia). We conclude that children older than 12 months with
underlying disease are at increased risk for serious or fatal RSV infection
and are not always protected by previous RSV disease. Such older children
should be considered candidates for passive or active immunoprophylaxis
against RSV infection as such agents become available.
