Respiratory syncytial virus (RSV) is a major cause of hospitalizations due to pneumonia and bronchiolitis. Substantial morbidity and socioeconomic burden are associated with RSV infection worldwide. Populations with higher susceptibility to developing severe RSV include premature infants, children with chronic lung disease of prematurity (CLDP) or congenital heart disease (CHD), elderly individuals aged > 65 years, and immunocompromised individuals. In the pediatric population, RSV can lead to long-term sequelae such as wheezing and asthma, which are associated with increased health care costs and reduced quality of life. Treatment for RSV is mainly supportive, and general preventive measures such as good hygiene and isolation are highly recommended. Although vaccine development for RSV has been a global priority, attempts to date have failed to yield a safe and effective product for clinical use. Currently, palivizumab is the only immunoprophylaxis (IP) available to prevent severe RSV in specific high-risk pediatric populations. Well-controlled, randomized clinical trials have established the efficacy of palivizumab in reducing RSV hospitalization (RSVH) in high-risk infants including moderate- to late-preterm infants. However, the American Academy of Pediatrics (AAP), in its 2014 policy, stopped recommending RSV IP use for ≥ 29 weeks’ gestational age infants. Revisions to the AAP policy for RSV IP have largely narrowed the proportion of pediatric patients eligible to receive RSV IP and have been associated with an increase in RSVH and morbidity. On the other hand, after reviewing the recent evidence on RSV burden, the National Perinatal Association, in its 2018 clinical practice guidelines, recommended RSV IP use for a wider pediatric population. As the AAP recommendations drive insurance reimbursements for RSV IP, they should be revised to help further mitigate RSV disease burden.

Objective This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis. Study Design Preterm (29–34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends. Results In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10–2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant. Conclusion RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.

Influenza A virus (IAV) is a major cause of respiratory infections worldwide, with the most severe cases occurring in the very young and in elderly individuals

1. Alexandra Vinci, MD* 2. Paul J. Lee, MD*,† 3. Leonard R. Krilov, MD*,† 1. *Children’s Medical Center, NYU Winthrop Hospital, Mineola, NY. 2. †State University of New York, Stony Brook School of Medicine, Stony Brook, NY. Human metapneumovirus (HMPV) is a frequent cause of upper and lower respiratory tract infections in children, immunocompromised patients, and adults. A lipid-enveloped, negative-sense, single-stranded RNA virus, HMPV is a member of the Paramyxoviridae family, which also includes respiratory syncytial virus (RSV) and the parainfluenza viruses. Since its discovery in the Netherlands in 2001 it has been found worldwide, with humans serving as its primary source of infection. It is spread by direct or close contact with infected secretions. Primates other than humans, such as macaque monkeys, develop signs and symptoms of disease after infection with HMPV. Although infection has not resulted from inoculation of HMPV in birds, there is an avian metapneumovirus subtype that commonly infects bird species. HMPV is composed of genetic groups A and B, which are divided further into 4 subclasses: A1, A2, B1, and B2. Most individuals have been infected by 5 years of age; however, following early infection, immunity to HMPV is weak and does not confer protection from the virus over a lifetime. No …

Since the initial identification of respiratory syncytial virus (RSV) in 1956, much has been learned about the epidemiological impact and clinical manifestations of RSV infections

The 2009 outbreak of novel influenza A H1N1 reached a pandemic status on June 11, 2009. Early detection is a key factor for management and infection-control practices. Recent studies have suggested a difference in performance of rapid influenza kits for influenza A H1N1. Our goal was to evaluate the performance of the QuickVue influenza A+B test (Quidel Corp., San Diego, CA) in an emergency department setting and determine the most current epidemiologic trends in our community. Results from 1137 samples for influenza A collected between April 8, 2009 and June 30, 2009 were retrospectively reviewed. Results of QuickVue influenza A+B test were compared with R-Mix viral culture and DFA results. Age distribution and hospitalization rates by age group were analyzed to further delineate the epidemiology of influenza A in a suburban hospital. The sensitivity of the rapid test was 77%, the specificity was 85%, the positive predictive value was 74%, and the negative predictive value was 87%. We found a similar age distribution for positive influenza tests and admissions when compared with the national Centers for Disease Control and Prevention data. The QuickVue influenza A+B test is a sensitive assay for the novel H1N1 strain of influenza. In our hospital, the group with highest risk of hospital admission was patients aged < 25 years.