RESEARCH ARTICLE


Risk Factors for Severe Respiratory Syncytial Virus Lower Respiratory Tract Infection



Constanze Sommer1, Bernhard Resch1, *, Eric A.F Simões2, 3
1 Medical University Graz, Austria
2 University of Colorado, Denver, and Children’s Hospital Colorado, USA
3 University of Padjadjaran, Bandung, Indonesia


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© Sommer et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Division of Neonatology, Pediatric Department Medical University hospital Graz Auenbruggerplatz 30, A- 8036 Graz, Austria; Tel: 0043 316 385 81134; Fax: 0043 316 385 2678; E-mail: bernhard.resch@medunigraz.at


Abstract

RSV infection is a leading cause of lower respiratory tract infection, especially in High-risk infants with a history of prematurity, bronchopulmonary dysplasia (BPD), congenital heart disease (CHD), neuromusculair impairment, immunodeficiency, and Down syndrome. Host related risk factors that have been identified to be associated with severe RSV related lower respiratory tract infection include young age below 6 months at the beginning of RSV season, multiple birth, male sex, low socioeconomic status and parental education, crowded living conditions, young siblings, maternal smoking and indoor smoke pollution, malnutrition/small for gestational age, family history of atopy or asthma, low cord serum RSV antibody titers, and living at altitude.

Risk factors increasing the risk of acquisition of RSV have been identified to be birth before and/or during RSV season, day care attendance, presence of older siblings in school or day-care, and lack of breast feeding. Some of these risk factors are discussed controversially and some of them are found continuously throughout the literature.

Given the high cost of RSV prophylaxis, especially for the large population of late preterm infants, algorithms and risk score systems have been published that could identify high-risk infants for treatment with palivizumab out of this gestational age group. Several models reported on an average sensitivity and specificity of 70 percent and, thus, are helpful to identify infants at high risk for severe RSV infection and need for prophylaxis with palivizumab.

Keywords: Syncytial virus, immune complex reaction, IgA antibodies, RSV disease, cellular immunity.