Elucidating the outpatient burden of lower respiratory tract infections due to RSV and other viruses in children under 2 years of age: Clinical presentation, medical treatment, and family impact (Germany, 11/2022-10/2024)
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Worldwide, data on the burden of pediatric, outpatient-treated lower respiratory tract infections (LRTI) are limited. We investigated their viral etiology, clinical characteristics and family impact in Würzburg/Germany. METHODS: Children aged <2 years presenting with febrile LRTI at nine pediatric practices from 11/2022-10/2023 were recorded. In a subset, oropharyngeal swabs were tested with multiplex-PCR for 18 respiratory viruses; clinical data were physician-reported and parent-reported (14-days diary; 1/3/12-month follow-up). RESULTS: Among 474 recorded children, diagnoses were obstructive bronchitis/bronchiolitis (93.2%), pneumonia (3.4%), and stenosing laryngotracheitis (6.5%). Oropharyngeal swabs were collected from 107/474 (22.6%); RSV (33.6%), rhinovirus (27.1%), and hMPV (15.0%) were most frequently detected. Pediatricians classified 49.5%/48.6%/1.9% (of 107) as mildly/moderately/severely ill; 72.0% received beta-sympathomimetics; 15.0% antibiotics. In 65 diary-documented children, illness lasted 18 days (median; IQR 14-34), 46.2%/3.1% required additional visits/hospitalization, and parents reported 2.5 workdays missed (median). After 1/3/12 months, recurrent LRTI occurred in 11.3%/18.8%/35.5% and wheezing in 14.1%/20.2%/32.2%, with wheezing at 3- or 12-month follow-up associated with recurrent LRTI (Odds Ratio 13 and 7, P < 0.01). CONCLUSIONS: Outpatient-treated LRTI in infants were usually mild/moderate but resolved slowly, with substantial family impact. RSV, rhinovirus, and hMPV predominated. Wheezing was reported in one-third after 12 months and was associated with recurrent LRTI. The present results provide a basis for assessing the impact of the recently recommended RSV immunization for all infants in Germany on the substantial burden of outpatient-treated LRTI in this particularly vulnerable age group.
Authors: Katharina J. Hecker, Hanna Bethe, Géraldine Engels, Kerstin Knies, Christine Krempl, Benedikt Weissbrich, Johannes Liese, Andrea Streng, Wolfgang Brosi, Elke Brosi, Simon Berzel, Kathrin Heinke, Henrike Zillhardt, Gabriele Lieb, Uwe Sack, Silvia Glotzbach-Sack, Margarethe Kozuschek, Johannes Hausmann, Anna Weber, Stephan Jarosch, Manuel Langer, Annette Hein, Martin Herbst, Heike Backmann, Anna-Teresa Schneiderbanger, Roland Metzner, Christa Kitz
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,900
OpenAlex ID: W4415215368