The Underrecognized Burden of Respiratory Syncytial Virus Among Infants Presenting to US Emergency Departments

Abstract

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract illness (LRI) in infants and young children and one of the most frequently detected respiratory viruses among hospitalized children.1 In the United States, the RSV season generally occurs between November and March; however, season onset and offset, duration, and peak can have considerable regional and local variability.2 Many infants infected with RSV develop mild upper respiratory tract disease that resolves uneventfully in 8 to 15 days. However, pneumonia and bronchiolitis are apparent in up to 40% of children on their initial RSV infection.3 RSV disease is often not diagnosed as there is debate whether RSV testing of infants with bronchiolitis changes management. The American Academy of Pediatrics, in their bronchiolitis management guidelines, specifically does not recommend RSV testing.3 Although results are rapidly available with antigen testing, the lack of sensitivity and specificity limits its usefulness4; cell culture and virus isolation lack sensitivity and are expensive, and results are not available for days.5 Although reverse transcription polymerase chain reaction (RT-PCR) is the most sensitive test available for RSV detection during peak and off-peak seasons,1 it is infrequently used in the emergency department (ED) setting owing to the expense and lack of available results while the child is in the ED.1 Given the limitations of routine diagnostic testing for RSV, it is likely that RSV in the ED setting is underrecognized. The objective of this analysis was to compare the prevalence of RSV assessed by RT-PCR with that of primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis among infants presenting to US EDs with LRI or apnea.