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Abstract
Respiratory syncytial virus (RSV) is the leading cause of childhood respiratory hospitalization all over the world. There are several potential vaccine candidates and antivirals targeting RSV in different phases of clinical trials. Once an effective vaccine or therapy becomes available, country-specific burden of disease data are likely to be needed to prioritize and/or target the intervention to the highest risk groups. Data on burden of childhood severe RSV disease from Australia are limited. I aimed to quantify the burden of severe RSV disease and identify risk factors at a population level.
Three studies were conducted. In the first I performed a retrospective analysis of linked administrative population based datasets comprising a birth cohort of almost one million children born in NSW between 2001-2010. The incidence of RSV hospitalization/1000 children-year among children aged <5 years was 11.0 for Indigenous children, 81.5 for children with bronchopulmonary dysplasia, 10.2 for preterm children with gestational age (GA) 32-36 weeks, 27.0 for children with GA 28-31 weeks, 39.0 for children with GA <28weeks and 6.7 for term children with low birth weight. Severe RSV disease was also found to incur a substantial direct health care cost amounting to more than AUD nine million in NSW.
Having confirmed that preterm infants suffer a high incidence of severe RSV disease, I conducted a prospective study into the risk of these infants acquiring nosocomial RSV infection in the neonatal intensive care unit (NICU) during their birth hospitalization. The findings suggested that with optimal implementation of hand
hygiene, the risk of neonates acquiring nosocomial RSV infection from environmental sources within NICU, in the absence of an outbreak, is low.
Finally, I assessed the comparable risk factors for severe RSV disease in the birth cohort of the first study and estimated the population attributable risk of each to quantify the burden of disease potentially preventable by eliminating these factors. Maternal smoking during pregnancy was associated with a 26-45% increased risk across sub-groups. Interventions promoting cessation of maternal smoking during pregnancy might reduce the burden of RSV disease by up to 24%; Indigenous children yielding the maximum benefit.