Health conditions and RSV-related Pediatric Intensive Care Unit admissions in children during their second RSV season
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Importance Respiratory syncytial virus (RSV) hospitalization rates are highest among children <2 years of age. RSV immunization with infant monoclonal antibody or maternal vaccine is recommended to protect all U.S. infants in their first RSV season. For certain high-risk children aged 8−19 months entering their second RSV season, the monoclonal antibody nirsevimab is recommended. Little is known regarding preexisting health conditions as risk factors for RSV-associated respiratory failure in children during their second season. Objectives To describe children admitted to the pediatric intensive care unit (PICU) for RSV during their second RSV season by preexisting health conditions, and to compare demographic and clinical characteristics across groups. Design, Setting, and Participants Surveillance registry of children 8-<24 months old admitted to the PICU in 30 pediatric hospitals in the 2023-2024/2024-2025 RSV seasons. All children had an RSV-positive respiratory sample and received respiratory support with high flow nasal cannula, noninvasive ventilation, or invasive mechanical ventilation (IMV). Exposure Preexisting health conditions potentially increasing risk of severe RSV disease. Main Outcomes and Measures Patients were classified into four mutually exclusive groups by preexisting health conditions: 1) U.S. nirsevimab eligible criteria, 2) other identified RSV risk conditions (with some evidence of increased risk for severe RSV), 3) other preexisting conditions, and 4) no preexisting conditions. Patient demographic characteristics and level of respiratory support received were compared. Results Among 574 children: 47 (8.2%) had U.S. nirsevimab eligibility criteria, 76 (13.2%) had other RSV risk conditions, 96 (16.7%) had other preexisting conditions, and 355 (61.8%) had none. A higher proportion of children with nirsevimab eligibility factors (40.4%) than those with other identified RSV risk conditions (17.1%) required IMV, which was higher than other (10.4%) or no (5.9%) preexisting health conditions (p trend <0.001). Conclusions and Relevance Approximately 20% of children admitted to the PICU with severe RSV were in the defined groups that met U.S. nirsevimab-eligibility criteria or that had an identified RSV risk condition associated with known risk for severe RSV. A considerable proportion of both groups of children required IMV for respiratory support. These findings may help inform future deliberations regarding U.S. second season nirsevimab-eligibility recommendations. Key Points Question What preexisting health conditions are present in children aged 8–<24 months admitted to the pediatric intensive care unit for severe RSV disease in their second RSV season and how do clinical outcomes differ? Findings Among 574 children, 8% were eligible for nirsevimab in the U.S. and 13% had other preexisting conditions with known risk for severe RSV. Children with preexisting conditions, particularly those eligible for nirsevimab, were more likely to require invasive mechanical ventilation than those without. Meaning These findings may inform future deliberations regarding which children in their second RSV season might benefit from RSV preventive products.
Source: medRxiv
Authors: Regina M. Simeone, Laura D. Zambrano, Margaret M. Newhams, Amanda B. Payne, Amber O. Orzel-Lockwood, Natasha B. Halasa, Jemima Calixte, Aline B. Maddux, Kathleen Chiotos, Satoshi Kamidani, Hillary Crandall, Danielle M. Zerr, Melissa A. Cameron, Shira J. Gertz, Bria M. Coates, Kelly N. Michelson, Jennifer E. Schuster, Ryan A. Nofziger, Jigar C. Chauhan, Mia Maamari, Steven L. Shein, Michele Kong, Janet R. Hume, Lora M. Martin, Judith A. Guzman-Cottrill, Samina S. Bhumbra, Katherine Irby, Mary Allen Staat, Tamara T. Bradford, Kari Wellnitz, Melissa S. Stockwell, Matt Zinter, Stephanie P. Schwartz, Saul Hymes, Emily R. Levy, Austin Biggs, Katherine Lindsey, Angela P. Campbell, Adrienne G. Randolph
Institutions: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Boston Children's Hospital, Vanderbilt University Medical Center, Children's Hospital Colorado, University of Colorado Anschutz, Children's Hospital of Philadelphia, Emory University, Children's Healthcare of Atlanta, Primary Children's Hospital, University of Utah, University of Washington, Seattle Children's Research Institute, University of California San Diego, Rady Children's Hospital-San Diego, Saint Barnabas Medical Center, Lurie Children's Hospital, Children's Mercy Hospital, University of Missouri–Kansas City, Akron Children's Hospital, Children's Medical Center, The University of Texas Southwestern Medical Center, Rainbow Babies & Children's Hospital, University of Alabama at Birmingham, University of Minnesota, University of Mississippi Medical Center, Oregon Health & Science University, Indiana University Indianapolis, Indiana University School of Medicine, Indiana University – Purdue University Indianapolis, Arkansas Children's Hospital, Cincinnati Children's Hospital Medical Center, University of Cincinnati, University of Cincinnati Medical Center, Louisiana State University, Children's Hospital of New Orleans, Louisiana State University Health Sciences Center New Orleans, University of Iowa, University of Iowa Health Care, Columbia University, University of California, San Francisco, UCSF Benioff Children's Hospital, University of North Carolina at Chapel Hill, University of North Carolina Hospitals, Albany Medical College, Mayo Clinic, Medical University of South Carolina, Harvard University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G2491226629
OpenAlex ID: W7166660811