Publication: Severe Respiratory syncytial virus infection in hospitalised children less than three years of age in a temperate and tropical climate in Australia

Severe Respiratory syncytial virus infection in hospitalised children less than three years of age in a temperate and tropical climate in Australia.
Butler J, Helen M, Ronny G, Traves A.
Madrid, Spain: The 35th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2017); 2017.



Each year in Australia there are approximately 10,000 hospitalisations for Respiratory Syncytial Virus (RSV) associated lower respiratory tract infections (LRTI), at a cost of up to $20 million dollars to the national health care system. Unfortunately, prior infection does not provider adequate immunity to re-infection.2 There are currently no vaccines licensed for administration, however there are several vaccines in various stages of development. Our study aimed to determine factors associated with increased severity of RSV infection in hospitalised children less than three years of age and to compare disease characteristics in a temperate versus a tropical climate.


Medical review of children up to three years of age admitted for laboratory proven RSV infection between January 1st 2013 and December 31st 2014 was conducted in a temperate (Women’s and Children’s Hospital, Adelaide, South Australia) and tropical (Paediatric Department, Cairns Hospital, Cairns, North Queensland) climate in Australia to assess any differences in severity of disease. Patient demographics, medical co-morbidities, length of stay and clinical features on presentation and any complications were also recorded. Severity of infection was determined using the validated Brisbane RSV Infection Severity Score (Table I) and multiple regression analysis was then used.


Characteristics of Study Population:rn496 children (383 at WCH and 113 at CH) were included in the study with 76, 323 and 97 patients identified as having mild, moderate or severe disease respectively. A higher proportion of hospitalised children in Cairns were Aboriginal or Torres Strait Islander (40%) compared to Adelaide (5.7%). rnRSV Infection Seasonality:rnSeasonal variation in hospitalisation was observed between temperate and tropical climates, but was not associated with disease severity. (Figure 1). Factors indepdendently predicting severe hospitalised RSVrnDecreasing age (OR = 0.95; 95%CI = 0.90 – 0.99, p = 0.020), and being Indigenous, increased  (OR=2.6; 95%CI =1.4 – 4.9, p = 0.002) the risk of severe RSV infection in hospitalised children. (Table II) Underlying respiratory (p = 0.029, OR=2.5; 95%CI = 1.1-5.8) or cardiac (OR=2.7; 95%CI = 1.1-6.4, p = 0.024) conditions, as well as the presence of tachypnoea on admission (OR=2.2; 95%CI = 1.2-4.1, p = 0.009), were also independent predictors of severe RSV infection. (Table

Ii) Conclusions:

The burden of hospitalised RSV associated LRTI is significant. Differing seasonal patterns between temperate and tropical areas within Australia have been identified, but this did not influence the severity of the hospitalised cases. Young infants, Indigenous children, and children with underlying respiratory and cardiac disease should be monitored closely for signs of deterioration. Additionally, infants with tachypnoea presentation, should be closely monitored during the admission. Such information may be able to further assist clinicians in identifying and assessing those children at risk of developing more severe disease once hospitalised.

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