ContextRespiratory syncytial virus (RSV) causes more lower respiratory tract
infections, often manifested as bronchiolitis, among young children than any
other pathogen. Few national estimates exist of the hospitalizations attributable
to RSV, and recent advances in prophylaxis warrant an update of these estimates.ObjectivesTo describe rates of bronchiolitis-associated hospitalizations and to
estimate current hospitalizations associated with RSV infection.Design and SettingDescriptive analysis of US National Hospital Discharge Survey data from
1980 through 1996.ParticipantsChildren younger than 5 years who were hospitalized in short-stay, nonfederal
hospitals for bronchiolitis.Main Outcome MeasureBronchiolitis-associated hospitalization rates by age and year.ResultsDuring the 17-year study period, an estimated 1.65 million hospitalizations
for bronchiolitis occurred among children younger than 5 years, accounting
for 7.0 million inpatient days. Fifty-seven percent of these hospitalizations
occurred among children younger than 6 months and 81% among those younger
than 1 year. Among children younger than 1 year, annual bronchiolitis hospitalization
rates increased 2.4-fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996.
During 1988-1996, infant hospitalization rates for bronchiolitis increased
significantly (P for trend <.001), while hospitalization
rates for lower respiratory tract diseases excluding bronchiolitis did not
vary significantly (P for trend = .20). The proportion
of hospitalizations for lower respiratory tract illnesses among children younger
than 1 year associated with bronchiolitis increased from 22.2% in 1980 to
47.4% in 1996; among total hospitalizations, this proportion increased from
5.4% to 16.4%. Averaging bronchiolitis hospitalizations during 1994-1996 and
assuming that RSV was the etiologic agent in 50% to 80% of November through
April hospitalizations, an estimated 51,240 to 81,985 annual bronchiolitis
hospitalizations among children younger than 1 year were related to RSV infection.ConclusionsDuring 1980-1996, rates of hospitalization of infants with bronchiolitis
increased substantially, as did the proportion of total and lower respiratory
tract hospitalizations associated with bronchiolitis. Annual bronchiolitis
hospitalizations associated with RSV infection among infants may be greater
than previous estimates for RSV bronchiolitis and pneumonia hospitalizations
combined.

https://jamanetwork.com/journals/jama/articlepdf/192009/joc81106.pdf

Bronchiolitis-associated hospitalizations among US children, 1980-1996.

• Respiratory syncytial virus is the most important cause of serious lower respiratory tract infection in children. For children followed up from birth in the Houston Family Study, the infection rate was 68.8/100 children less than 12 months of age and 82.6/100 during the second year of life. Virtually all children had been infected at least once by 24 months of age, and about one half had experienced two infections. Although lower respiratory tract disease (LRD) was common (22.4/100 during year 1 and 13.0/100 during year 2), most children had only one LRD illness. The risk of reinfection was inversely related to the level of neutralizing antibodies in the serum. Reinfection illnesses were generally mild, and risk of reinfection decreased to only 33.3/100 during year 4. Studies of children with LRD and surveys of hospitalizations provide the basis for an estimate of the number of children hospitalized each year during the respiratory syncytial virus epidemics. Almost 100,000 children in the United States experience an illness of sufficient severity to require hospitalization. (AJDC1986;140:543-546)

Risk of primary infection and reinfection with respiratory syncytial virus

This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized. In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.

/pdf/guidelines-for-preventing-health-care-associated-pneumonia-3ebalxrxyl.pdf

Guidelines for Preventing Health-Care-- Associated Pneumonia, 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee

guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action state- ment indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows: Pediatrics 2014;134:e1474-e1502

/pdf/clinical-practice-guideline-the-diagnosis-management-and-4kibp07y0e.pdf

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Respiratory syncytial virus (RSV) was first isolated from a chimpanzee with common-cold-like illness.(53a) Shortly thereafter, the virus was recovered from young children with severe lower respiratory tract disease in Baltimore. (11,16) Since its initial isolation from infants with respiratory disease almost 20 yr ago, RSV has emerged as the major lower respiratory tract pathogen of infancy and early childhood throughout the world. (3,15,16,69) In all geographic areas it is now clear that RSV is the major cause of bronchiolitis and pneumonia in infants and young children. RSV presents a special challenge to the epidemiologist since this virus exhibits a pattern of infection and disease unlike that of any of the other known respiratory tract viral pathogens. Unanswered are many pressing questions concerning the pathogenesis of serious life-threatening disease of the lower respiratory tract produced by this virus during early infancy.

Respiratory Syncytial Virus

Respiratory syncytial virus disease in infants despite prior administration of antigenic inactivated vaccine

Epidemiology of respiratory syncytial virus infection in washington, d.c.i. importance of the virus in different respiratory tract disease syndromes and temporal distribution of infection

Thirty-nine infants and children 6 months to 13 years of age received live 26°C grown respiratory syncytical (RS) virus (strain A2) by the oropharyngeal and nasopharyngeal route. RS virus was recovered from 22 individuals and 17 of these showed a significant rise in CF and/or plaque reduction serum antibody. Twelve of those from whom virus was recovered and an additional three from whom virus was not recovered showed a threefold or greater rise of RS nasal neutralizing activity. Thus 26 of the total showed some evidence of having been infected with the ES strain. The rate of infection was significantly greater in infants and children under 2 years of age than in older children. Infection in individuals older than 8 months of age was asymptomatic. Three infants infected with the vaccine strain had relatively minor respiratory tract illness. The findings from this study indicate that the low-temperature adapted virus retains a low level of virulence which is expressed only in individuals undergoing primary infection. Nonetheless, these studies have shown that it is possible to induce local and systemic immune responses to RS virus by means other than fully virulent natural infection.

Clinical and immunological response of infants and children to administration of low-temperature adapted respiratory syncytial virus.

Infections in 18,000 infants and children in a controlled study of respiratory tract disease. ii. variation in adenovirus infections by year and season

Gloria Pyles

Papers

Respiratory syncytial virus disease in infants despite prior administration of antigenic inactivated vaccine

Epidemiology of respiratory syncytial virus infection in washington, d.c.i. importance of the virus in different respiratory tract disease syndromes and temporal distribution of infection

Clinical and immunological response of infants and children to administration of low-temperature adapted respiratory syncytial virus.

Infections in 18,000 infants and children in a controlled study of respiratory tract disease. ii. variation in adenovirus infections by year and season