title: Respiratory syncytial virus infection in Navajo and White Mountain Apache children.
abstract: 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.
authors.affiliation: Johns Hopkins University School of Medicine, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA.
authors.forename: Jana
authors.initials: J
authors.lastname: Bockova
authors.forename: Katherine L
authors.initials: KL
authors.lastname: O'Brien
authors.forename: Jane
authors.initials: J
authors.lastname: Oski
authors.forename: Janne'
authors.initials: J
authors.lastname: Croll
authors.forename: Raymond
authors.initials: R
authors.lastname: Reid
authors.forename: Robert C
authors.initials: RC
authors.lastname: Weatherholtz
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Karron
mesh_terms: D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D016015:Logistic Models; D011159:Population Surveillance; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000208:ethnology; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology