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Respiratory Syncytial Virus
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PEDIATRICS Vol. 110 No. 2 August 2002, pp. e20-e20

ELECTRONIC ARTICLE

Respiratory Syncytial Virus Infection in Navajo and White Mountain Apache Children

Jana Bockova, MD, MSC*, Katherine L. O’Brien, MD, MPH{ddagger}, Jane Oski, MD{ddagger}, Janne’ Croll, MPAS, PA-C{ddagger}, Raymond Reid, MD, MPH{ddagger}, Robert C. Weatherholtz, BS{ddagger}, Mathuram Santosham, MD, MPH{ddagger} and Ruth A. Karron, MD*,§

* Johns Hopkins University School of Medicine, Division of Pediatric Infectious Diseases, Baltimore, Maryland; and the Johns Hopkins Bloomberg School of Public Health
{ddagger} Center for American Indian Health
§ Center for Immunization Research, Baltimore, Maryland

Objective. The hospitalization rate for bronchiolitis of any cause among US children younger than 1 year is estimated at 31.2 per 1000. No data exist on respiratory syncytial virus (RSV)-specific hospitalization rates among high-risk Native Americans other than Alaska Natives, for whom the incidence of RSV hospitalization was estimated at 150 per 1000 among infants younger than 1 year. We aimed to estimate RSV hospitalization rates among Navajo and White Mountain Apache children younger than 2 years.

Methods. We conducted prospective population-level hospital-based surveillance to determine RSV hospitalization rates among Navajo and White Mountain Apache children younger than 2 years. From 1997 to 2000, all children who were admitted for acute lower respiratory tract infection between October 1 and March 31 had a nasopharyngeal aspirate obtained and tested for RSV by commercial enzyme immunoassay kits. We reviewed charts of children who tested positive for RSV antigen to determine disease severity.

Results. During 3 RSV seasons (1997–2000), 51.3% of 1837 admissions for acute lower respiratory tract infection among children younger than 2 years were attributed to RSV infection. The overall seasonal RSV hospitalization rate among children younger than 2 years was 63.6 per 1000 and 91.3 per 1000 among children younger than 1 year. In a univariate analysis, predictors of severity included age <6 months (relative risk: 6.8; 95% confidence interval: 3.1–17.0).

Conclusions. Navajo and White Mountain Apache children are at high risk for RSV disease requiring hospitalization. A lower threshold for hospitalization or underlying chronic conditions that predispose to severe RSV disease do not seem to explain high RSV hospitalization rates in this population.

Key Words: respiratory syncytial virus • American Indian • hospitalization • lower respiratory tract infection • bronchiolitis • surveillance

Abbreviations: RSV, respiratory syncytial virus • CHD, congenital heart disease • CLD, chronic lung disease • ALRI, acute lower respiratory tract infection • IHS, Indian Health Service • NP, nasopharyngeal aspirate • JHH, Johns Hopkins Hospital • OR, odds ratio

Received for publication Dec 5, 2001; Accepted Apr 8, 2002.


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