Pediatric respiratory syncytial virus rehospitalization rate - a retrospective observational study from Switzerland.

Abstract

Background Long-acting monoclonal antibodies against Respiratory Syncytial Virus (RSV) have recently become available for prevention of severe disease including RSV hospitalization in children below two years of age. Data on the risk of rehospitalization among children, who had suffered from severe first RSV episode, remain important to inform the need for secondary prevention using a (additonal) dose of such an antibody. We studied the risk of RSV rehospitalization in a large cohort of patients with a particular focus on same-season rehospitalizations.Methods Retrospective single-center study of all RSV rehospitalizations occurring in 13 RSV seasons between 2009 and 2023 based on an ongoing RSV surveillance program. We calculated the overall and same-season rates of rehospitalizations for patients of any age and for the first 5 years of life, respectively, and provide a clinical description of of rehospitalization cases.Results In a cohort of 3'143 patients having had a primary RSV hospitalization, the overall risk of rehospitalization (69 cases) and same-season risk of rehospitalization (2 cases) for a second RSV infection were 2.2% (95% confidence interval (CI), 1.73-2.79) and 0.06% (95% CI 0.02-0.23), respectively. The figures for the RSV rehospitalization rates from birth until age 5 years of age were 2.3% (95% CI 1.76-3.07) for all rehospitalizations and 0.04% (95% CI 0.01-0.25) for same-season rehospitalizations. The median length of stay (LoS) of rehospitalizations (4.0 days, interquartile range (IQR) 3.0-6.0) was significantly shorter than the LoS of first hospitalizations (6.0 days, IQR 4.0-9.0, p < 0.0001). Children with a pre-existing condition (68%) and those born prematurely (40%) predominated among rehospitalized patients.Conclusion Same-season RSV rehospitalizations were exquisitely rare. Routine administration of a dose of a monoclonal antibody for protection against a same-season rehospitalization does not appear to be generally warranted. The majority of patients with subsequent season readmission would be covered by the current recommendations in Switzerland as they had pre-existing conditions making them eligible for second-season RSV prophylaxis.