Clinical and economic impact on the primary care system of respiratory syncytial virus infection in children under 5 years.

Abstract

INTRODUCTION AND OBJECTIVES: The burden of disease and costs of respiratory syncytial virus (RSV) infections in children under 5 years in pediatric primary care are not well known. PATIENTS AND METHODS: Observational, prospective, and analytical study of children with suspected RSV respiratory infection confirmed by molecular testing. Thirty-seven pediatricians in eight autonomous communities recruited patients aged 0-59 months with suspected RSV infection from November 2021 to January 2024. The data were collected on the day of recruitment and at 14 and 30 days. We evaluated direct and indirect health care costs. RESULTS: Of the 517 recruited children, 206 (39.8%) tested positive for RSV (64.5% for type A; 35.4% for type B; and 2.36% for both A and B). There were significant differences in the proportion of children with dyspnea in the RSV-positive group compared to the RSV-negative group (50.0% vs 31.8%; P < .001). In the RSV-positive group, a higher proportion of infants aged less than 12 months, compared to other age groups, visited the emergency department (39.6% versus 22.5%; P = .010) and required hospital admission (25.0% versus 9.5%; P = .004). Inhaled bronchodilators were administered to 58.4%, inhaled corticosteroids to 9.7%, oral corticosteroids to 11.9%, and antibiotics to 18.3%. In the subset of school-aged children, 69.2% missed at least one day of school (median, 8 days; IQR, 5-14). The total cost per episode was ;458, with significant differences between infants (;507) and children aged 1?year or older (;419) (mean difference, ;88; 95% CI, 76-99; P < .001). The only differences between autonomous communities were in the use of bronchodilators and the frequency of emergency department visits. CONCLUSIONS: Infection by RSV in early childhood places a significant clinical, economic and health care resource burden in out-of-hospital settings, which supports the implementation of effective preventive measures.