PEDIATRICS Vol. 99 No. 3 March 1997, pp. e9 (doi:10.1542/peds.99.3.e9)
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PEDIATRICS Vol. 99 No. 3 March 1997, p. e9
Copyright ©1997 by the American Academy of Pediatrics

ELECTRONIC ARTICLE:
PICNIC (Pediatric Investigators Collaborative Network on Infections in Canada) Study of the Role of Age and Respiratory Syncytial Virus Neutralizing Antibody on Respiratory Syncytial Virus Illness in Patients With Underlying Heart or Lung Disease

Received Jul 1, 1996; accepted Sep 24, 1996.

Elaine E. L. Wang*, Barbara J. LawDagger , Joan L. Robinson§, Simon Dobsonpar , Suliman al Jumaah*, Derek Stephens*, François D. Boucher, Jane McDonald#, Ian Mitchell**, and Noni E. MacDonaldDagger Dagger

From the * Hospital for Sick Children and University of Toronto, Toronto, Ontario; the Dagger  Winnipeg Children's Hospital and University of Manitoba, Winnipeg; the § University of Alberta Hospital and University of Alberta, Edmonton; par  British Columbia's Children's Hospital and University of British Columbia, Vancouver;  Centre Hospitalier de l'Université de Laval and L'Université de Laval, Québec City; # Montreal Children's Hospital and McGill University, Montreal; ** Alberta Children's Hospital and University of Calgary, Calgary; and Dagger Dagger  Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa.

Objective.  To determine the effects of age and respiratory syncytial virus (RSV) antibody status on frequency and severity of RSV infections in children with underlying heart or lung disease.

Design.  Cohort study conducted during two consecutive RSV seasons.

Setting.  Ambulatory patients at eight Canadian pediatric tertiary care centers.

Methods.  Subjects under 3 years old with underlying heart disease who were digoxin-dependent or had not received corrective cardiac surgery or with underlying lung disease were enrolled. Demographic information and an acute sera for RSV neutralizing antibody was obtained on enrollment. Weekly telephone follow-up consisting of a respiratory illness questionnaire was followed with a home visit to obtain a nasopharyngeal aspirate when there was new onset of respiratory symptoms. The specimen was used to detect RSV antigen. RSV illnesses were grouped as upper or lower respiratory tract infection (LRI) based on clinical and radiographic findings. RSV hospitalizations were considered to be those RSV infections that resulted in hospitalization.

Results.  Of 427 enrolled subjects, 160 had underlying lung disease only, 253 had underlying heart disease only, and 14 had both. Eleven percent and 12% of lung and heart disease groups, respectively, had an RSV LRI. Three percent and 6% of lung and heart disease groups, respectively, were hospitalized with RSV infection. A significant decrease in frequency of RSV LRI and RSV hospitalization occurred with increasing age, with a major drop in those older than 1 year vs those younger than 1 year. Acute sera were available from 422 subjects. Geometric mean RSV antibody titers demonstrated a U-shaped distribution with increasing age. The trend to lower antibody concentrations in premature infants did not reach statistical significance. The frequency of RSV infection and RSV LRI was lower in patients with antibody at a titer more than 100, although the difference for RSV hospitalization was not statistically significant. These differences remained significant after age adjustment.

Conclusion.  Both age and RSV antibody status impact on RSV illness and LRI. Reduction in illness frequency with increasing age may lead to more informed targeting of those children most likely to benefit from RSV immune globulin prophylaxis. respiratory syncytial virus, cohort study, passive prophylaxis, neutralizing antibody.




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