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PEDIATRICS Vol. 112 No. 2 August 2003, pp. 285-290

Sequelae of Severe Respiratory Syncytial Virus Infection in Infancy and Early Childhood Among Alaska Native Children

Rosalyn J. Singleton, MD^*,, Greg J. Redding, MD, Toby C. Lewis, MD^||, Patricia Martinez, MD^¶, Lisa Bulkow, MS^*, Barbara Morray, RN, Helen Peters, RN^*,, James Gove, RN^*, Carol Jones, RN^#, David Stamey, RT, Deborah F. Talkington, PhD^**, Jeffrey DeMain, MD, John T. Bernert, PhD, Jay C. Butler, MD^*

^* Centers for Disease Control and Prevention, National Center for Infectious Diseases, Arctic Investigations Program Anchorage, Alaska
Alaska Native Tribal Health Consortium, Anchorage, Alaska
University of Washington School of Medicine, Seattle, Washington
^|| University of Michigan, Schools of Medicine and Public Health, Ann Arbor, Michigan
^¶ Yukon Kuskokwim Health Corporation, Bethel, Alaska
^# University of Chicago, Chicago, Illinois
^** Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases, Atlanta, Georgia
Providence Alaska Medical Center, Anchorage, Alaska
Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, Georgia

Objective. In 1993–1996, we conducted a nested case-control study to determine risk factors for hospitalization with respiratory syncytial virus (RSV) infection among Alaska Native infants and young children. In the current study, we returned to former RSV case-patients and their control subjects during 1999–2001 to determine whether children who are hospitalized with RSV at <2 years of age are more likely to develop chronic respiratory conditions.

Methods. For each former RSV case-patient and control subject from remote villages in southwest Alaska, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed chest radiographs. Case-patients were identified through surveillance for RSV hospitalization, and matched control subjects without lower respiratory infection (LRI)-related hospitalization were identified.

Results. Hospitalization for RSV infection was associated with a significant increase in wheezing, LRIs, and asthma diagnosis during the first 4 years of life. The association decreased with age and was no longer significant by 5 years of age. However, hospitalization for RSV infection was associated with increased respiratory symptoms and increased chronic productive cough at 5 to 8 years of age. Children who were hospitalized with RSV were not more likely at follow-up to have allergies, eczema, or a positive family history of asthma.

Conclusions. Severe RSV infection in infancy may produce airway injury, which is manifested in chronic productive cough with or without wheezing and recurrent LRIs. Although the association of RSV infection with wheezing seems to be transient, children remain at higher risk for chronic productive cough at 5 to 8 years of age. RSV prevention modalities may prevent sequelae that occur early and later in childhood.

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Key Words: Alaska Native • respiratory syncytial virus • asthma

Abbreviations: RSV, respiratory syncytial virus • YK, Yukon-Kuskokwim • ISAAC, International Study on Asthma and Allergies in Children • LRI, lower respiratory infection • RR, relative risk • CI, confidence interval • OR, odds ratio

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Received for publication Nov 11, 2002; Accepted Jan 29, 2003.

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