Effects of Respiratory Syncytial Virus Infection in Infancy on Asthma and Respiratory Allergy in 6-Year-Old Children

Panagiota Kitsantas, PhD; Lavanya Nirmalraj, MBBS, MS

Disclosures

South Med J. 2018;111(11):698-702. 

In This Article

Abstract and Introduction

Abstract

Objective: The purpose of this study was to examine the association between respiratory syncytial virus (RSV) infection in early infancy and health conditions such as asthma and respiratory allergies at 6 years of age in a cohort of US children born at term with no medical issues at birth.

Methods: Data (1542 records) from the Infant Feeding Practices Study II and the Year Six Follow-Up study were used in the analysis. Descriptive statistics and logistic regression were conducted to estimate the magnitude and direction of potential associations between children's health conditions such as asthma, hay fever, or respiratory allergy, and RSV infection during infancy.

Results: A substantial proportion of children with RSV infection in infancy were reported to have developed asthma (10.3%) and hay fever or respiratory allergy (9.4%) by 6 years of age. Analyses revealed that children with RSV infection in infancy were more likely to develop asthma (odds ratio 1.99, 95% confidence interval 1.06–3.74), and hay fever or respiratory allergy (odds ratio 2.13, 95% confidence interval 1.28–3.57) by 6 years of age. In addition, the risk of developing asthma and hay fever or respiratory allergy by 6 years of age increased considerably with a family history of these conditions.

Conclusions: Our findings support the need for understanding and monitoring the long-term health outcomes of RSV infection in infancy. Appropriate prevention and treatment measures for RSV infection during infancy may reduce the incidence of associated long-term adverse health outcomes. Knowledge of the long-term complications of RSV infection in infancy, such as asthma, hay fever, or respiratory allergy, can aid in the prevention and better management of these health conditions.

Introduction

Respiratory syncytial virus (RSV) infection is one of the major causes of childhood respiratory morbidity. RSV infection among children in the United States younger than 5 years old has been associated with an estimated 57,527 hospitalizations and 2.1 million outpatient visits per year.[1] Most lower respiratory tract illnesses accompanied by wheezing in the first 3 years of life are associated with RSV infection.[2] RSV infection in infancy has been linked with recurrent wheezing and asthma during childhood.[3,4]

The American Academy of Pediatrics has recommended immunoprophylaxis since 1997, and in 2014 recommended palivizumab against RSV infection for infants at greater risk of hospitalization, including preterm infants without chronic lung or heart disease.[5] Immunoprophylaxis and palivizumab have been shown to be effective in the United States at reducing RSV hospitalizations in children at risk.[6] These strategies are not considered cost-effective, however, and thus they are not widely used unless the infants and children are known to have underlying health issues, are born premature, or both.[7–9] Although infants and children with underlying medical conditions are more likely to experience severe RSV infection-related complications, most of the infants who are hospitalized because of RSV infection complications do not have known medical problems.[10]

The lack of a cost-effective treatment method that can be applied to all affected children makes the prevention of RSV infection challenging. Monitoring RSV infection and its sequelae in childhood is therefore important, given the disease burden it can cause in infants and children.[11] The purpose of this study was to examine the association between RSV infection in infancy and asthma and respiratory allergies, including hay fever, at 6 years of age in a cohort of children in the United States born at term and with no medical issues present at birth. Monitoring the prevalence of RSV infection in infancy and associated morbidity later in childhood are two important steps toward the surveillance of long-term complications and establishment of potential prevention strategies.

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