Older children diagnosed as having complex critical conditions (CCCs) carry a greater burden of respiratory syncytial virus (RSV)–related serious illness and death, suggesting the need for preventive interventions, researchers write in JAMA Network Open.
A team led by Children’s National Hospital researchers in Washington, DC, analyzed electronic health record data on 6,430 US RSV-related admissions to intensive care units (ICUs) of children aged 2 to 17 years from January 2017 to June 2023.
Although recent studies suggest that critical RSV disease extends beyond infancy and early childhood, preventive strategies such as vaccination are still targeted to infants and older adults, leaving high-risk older children unprotected, the authors noted.
Plausibility of vaccinating older children
RSV-associated ICU admissions represented 8.3% of 77,395 ICU admissions among children aged 2 to 17 years, occurring within 119,782 ICU admissions in children of all ages. In-hospital death occurred in 7.5% of all ICU admissions and accounted for 65.9% of 735 RSV deaths among all ages.
Active immunization of older children is biologically plausible, although optimal vaccine strategies likely depend on age and prior RSV exposure.
Of all ICU admissions, 39.8% occurred in children aged 2 to 4 years, 37.2% in those 5 to 12 years, and 23.0% in those 13 to 17.
At least one CCC category was documented in 57.2% of admissions, and three or more were listed in 25.9%. The most common categories were neurologic or neuromuscular (24.0%), gastrointestinal (22.9%), and cardiovascular (19.0%). Technology dependence was present in 28.9% of admissions and transplant status in 3.2%.
A total of 93.8% of children who died had at least one CCC (mortality odds ratio, 12.76). The median number of CCC organ system categories among survivors was one, compared with four among those who died.
Risk factors for death were older age, greater medical complexity, longer ICU and hospital stay, and need for mechanical ventilation, vasoactive drugs, or both therapies.
“Active immunization of older children is biologically plausible, although optimal vaccine strategies likely depend on age and prior RSV exposure,” the authors wrote. “Additional studies are needed to determine safety, effectiveness, as well as optimal vaccine approaches and target populations among older children.”