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Heidtmann S, Baltaci Y, Meyer S, Zemlin M, Furtwängler R, Rissland J, Simon A. Inpatient Rsv-Management 2016-2022: Epidemiology and Adherence to A Bronchiolitis Treatment Standard at a German University Children's Hospital. KLINISCHE PADIATRIE 2024. [PMID: 38320581 DOI: 10.1055/a-2218-5171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND This study analyzes the RSV season 2021/2022 in a referral children's hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis. MATERIAL AND METHODS Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022). RESULTS The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021-2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics. CONCLUSIONS This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics.
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Affiliation(s)
- Solvej Heidtmann
- Pediatric Oncology and Hematology, TeleKasper Project, Saarland University Hospital, Homburg, Germany
| | - Yeliz Baltaci
- Pediatric Oncology and Hematology, TeleKasper Project, Saarland University Hospital, Homburg, Germany
| | - Sascha Meyer
- General Pediatrics and Neonatology, University Children̓s Hospital Homburg, Homburg, Germany
| | - Michael Zemlin
- General Pediatrics and Neonatology, University Children̓s Hospital Homburg, Homburg, Germany
| | - Rhoikos Furtwängler
- Pediatric Haematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Juergen Rissland
- Institute of Virology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, Saarland University Hospital, Homburg, Germany
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Langedijk AC, Bont LJ. Respiratory syncytial virus infection and novel interventions. Nat Rev Microbiol 2023; 21:734-749. [PMID: 37438492 DOI: 10.1038/s41579-023-00919-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
The large global burden of respiratory syncytial virus (RSV) respiratory tract infections in young children and older adults has gained increased recognition in recent years. Recent discoveries regarding the neutralization-specific viral epitopes of the pre-fusion RSV glycoprotein have led to a shift from empirical to structure-based design of RSV therapeutics, and controlled human infection model studies have provided early-stage proof of concept for novel RSV monoclonal antibodies, vaccines and antiviral drugs. The world's first vaccines and first monoclonal antibody to prevent RSV among older adults and all infants, respectively, have recently been approved. Large-scale introduction of RSV prophylactics emphasizes the need for active surveillance to understand the global impact of these interventions over time and to timely identify viral mutants that are able to escape novel prophylactics. In this Review, we provide an overview of RSV interventions in clinical development, highlighting global disease burden, seasonality, pathogenesis, and host and viral factors related to RSV immunity.
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Affiliation(s)
- Annefleur C Langedijk
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
- ReSViNET Foundation, Zeist, the Netherlands.
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Mahant S, Parkin PC, Thavam T, Imsirovic H, Tuna M, Knight B, Webster R, Schuh S, To T, Gill PJ. Rates in Bronchiolitis Hospitalization, Intensive Care Unit Use, Mortality, and Costs From 2004 to 2018. JAMA Pediatr 2022; 176:270-279. [PMID: 34928313 PMCID: PMC8689435 DOI: 10.1001/jamapediatrics.2021.5177] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization. There have been limited population-based studies examining hospitalization outcomes over time. OBJECTIVE To describe rates and trends in bronchiolitis hospitalization, intensive care unit (ICU) use, mortality, and costs. DESIGN, SETTING, AND PARTICIPANTS This cohort study used population-based health administrative data from April 1, 2004, to March 31, 2018, to identify bronchiolitis encounters using hospital discharge diagnosis codes in Ontario, Canada. Children younger than 2 years with and without bronchiolitis hospitalization were included. Data were analyzed from January 2020 to July 2021. MAIN OUTCOMES AND MEASURES Bronchiolitis hospitalization per 1000 person-years, ICU use per 1000 hospitalizations, mortality per 100 000 person-years, and costs per 1000 person-years adjusted to 2018 Canadian dollars and reported in 2018 US dollars. RESULTS Among 2 336 446 included children, 1 199 173 (51.3%) were male. During the study period, 43 993 children (1.9%) younger than 2 years had 48 058 bronchiolitis hospitalizations at 141 hospitals. Bronchiolitis accounted for 48 058 of 360 920 all-cause hospitalizations (13.3%) and 215 654 of 2 566 348 all-cause hospital days (8.4%) in children younger than 2 years. Bronchiolitis hospitalization was stable over time, at 14.0 (95% CI, 13.6-14.4) hospitalizations per 1000 person-years in 2004-2005 and 12.7 (95% CI, 12.2-13.1) hospitalizations per 1000 person-years in 2017-2018 (annual percent change [APC], 0%; 95% CI, -1.6 to 1.6; P = .97). ICU admission increased significantly from 38.1 (95% CI, 32.2-44.8) per 1000 hospitalizations in 2004-2005 to 87.8 (95% CI, 78.3-98.0) per 1000 hospitalizations in 2017-2018 (APC, 7.2%; 95% CI, 5.4-8.9; P < .001). Over the study period, bronchiolitis mortality was 2.8 (95% CI, 2.3-3.4) per 100 000 person-years and remained stable (APC, 1.1%; 95% CI, -8.4 to 11.7; P = .85). Hospitalization costs per 1000 person-years increased from $49 640 (95% CI, $49 617-$49 663) in 2004-2005 to $58 632 (95% CI, $58 608-$58 657) in 2017-2018 (APC, 3.0%; 95% CI, 1.3-4.8; P = .002). CONCLUSIONS AND RELEVANCE From 2004 to 2018, bronchiolitis hospitalization and mortality rates remained stable; however, ICU use and costs increased substantially. This represents a major increase in high-intensity hospital care and costs for one of the most common and cumulatively expensive conditions in pediatric hospital care.
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Affiliation(s)
- Sanjay Mahant
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Thaksha Thavam
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | | | - Meltem Tuna
- ICES, Ottawa, Ontario, Canada,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Braden Knight
- ICES, Ottawa, Ontario, Canada,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Ontario Child Health Support Unit (OCHSU), Ottawa, Ontario, Canada
| | - Richard Webster
- Ontario Child Health Support Unit (OCHSU), Ottawa, Ontario, Canada,Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Suzanne Schuh
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada,Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Peter J. Gill
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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