Respiratory syncytial virus (RSV), a single-stranded RNA virus, is a leading cause of hospitalization in infants, especially ≤ 2 months of life. In the light new immunization strategies adoption, we described epidemiological and clinical characteristics of RSV-associated hospitalizations in pediatric and neonatal intensive care units of the Policlinico Foggia Hospital, Apulia Region, Italy. Hospitalized children with a laboratory-confirmed RSV infection from 2011 to 2023 were retrospectively evaluated. Clinical information was collected from Hospital Discharge Registry in the period 2011–2020. The proportion of the hospitalization for acute respiratory infections (ARIs) associated to RSV was calculated and the hospitalization cost was analyzed by using the diagnosis-related group reimbursement rate. The anticipated impact of immunization either with monoclonal antibodies or maternal immunization on the number of hospitalizations was estimated. All analyses and quality assessment were performed using STATA/SE15.0. A total of 1,005 RSV-cases were included in the study, of which 86.3% occurred between December-March. In the period 2011–2020, 832 RSV-cases were matched with the corresponding hospital admissions; 75.2% were aged < 1 year (49.6% 0–2 months). Bronchiolitis was the most frequent admission diagnosis occurring in 63.3% of patients; 25% of children were affected by a very severe RSV-disease. Younger age ≤ 2 months (OR:14.8, 95%CI:8.30–26.31, p = 0.000), higher length-of-hospital-stay (OR:1.01, 95%CI:1.0–1.02, p = 0.030) and history of prematurity (OR:4.4, 95%CI:1.57–12.11, p = 0.005) were associated with a higher disease severity. RSV caused 48.9% of ARIs among children < 1 year. The mean cost of an RSV-associated hospitalization was 3,036 euros/year, with the higher cost in the 0–2 months age group (4,225 euros/year). Immunization programs with nirsevimab could prevent 51.4 RSV hospitalizations/year and 18.1 very severe RSV disease/year in infants < 1 year of age. RSV vaccine could prevent 46.1 of hospitalizations/year caused by RSV within 180 days after birth. Our study contributes to outlining the baseline profile of RSV-associated hospitalizations among Italian children by providing epidemiological/clinical/economic estimates. While awaiting new recommendations on immunization, healthcare-workers should persist in implementing public health measures and appropriate case management to control RSV seasonal epidemics. Strengthened laboratory RSV surveillance is needed to inform the implementation of the new immunization strategies.

中文翻译：

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儿童呼吸道合胞病毒相关住院治疗：意大利回顾性观察研究

呼吸道合胞病毒 (RSV) 是一种单链 RNA 病毒，是婴儿（尤其是 2 个月以内的婴儿）住院的主要原因。根据新免疫策略的采用，我们描述了意大利普利亚地区 Policlinico Foggia 医院儿科和新生儿重症监护病房中 RSV 相关住院的流行病学和临床特征。对 2011 年至 2023 年实验室确诊的 RSV 感染住院儿童进行回顾性评估。临床信息是从 2011 年至 2020 年期间的医院出院登记处收集的。计算与RSV相关的急性呼吸道感染（ARIs）住院比例，并利用诊断相关组报销率分析住院费用。估计了单克隆抗体免疫或母体免疫对住院人数的预期影响。所有分析和质量评估均使用 STATA/SE15.0 进行。该研究共纳入 1,005 例 RSV 病例，其中 86.3% 发生在 12 月至 3 月期间。2011年至2020年期间，832例RSV病例与相应的入院病例进行了匹配；75.2% 的年龄 < 1 岁（49.6% 0-2 个月）。毛细支气管炎是最常见的入院诊断，占 63.3% 的患者发生率；25% 的儿童患有非常严重的 RSV 疾病。年龄小于 2 个月（OR：14.8，95%CI：8.30–26.31，p = 0.000），住院时间较长（OR：1.01，95%CI：1.0–1.02，p = 0.030）和病史早产率（OR：4.4，95％CI：1.57-12.11，p = 0.005）与较高的疾病严重程度相关。1 岁以下儿童中 48.9% 的 ARI 是由 RSV 引起的。RSV 相关住院的平均费用为 3,036 欧元/年，其中 0-2 个月年龄组的费用较高（4,225 欧元/年）。对于 1 岁以下的婴儿，使用 nirsevimab 进行免疫接种计划每年可以预防 51.4 例 RSV 住院病例和 18.1 例非常严重的 RSV 疾病/年。RSV 疫苗在出生后 180 天内每年可预防 46.1 例由 RSV 引起的住院治疗。我们的研究通过提供流行病学/临床/经济估计，有助于概述意大利儿童中与 RSV 相关的住院治疗的基线情况。在等待新的免疫建议的同时，医护人员应坚持实施公共卫生措施和适当的病例管理，以控制 RSV 季节性流行。需要加强实验室 RSV 监测，为新免疫策略的实施提供信息。