Sequelae of severe respiratory syncytial virus infection in infancy and early childhood among Alaska Native children.
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.
Singleton
Rosalyn J
RJ
Centers for Disease Control and Prevention, National Center for Infectious Diseases, Arctic Investigations Program Anchorage, Anchorage, Alaska 99508, USA. ris2@cdc.gov
Redding
Greg J
GJ
Lewis
Toby C
TC
Martinez
Patricia
P
Bulkow
Lisa
L
Morray
Barbara
B
Peters
Helen
H
Gove
James
J
Jones
Carol
C
Stamey
David
D
Talkington
Deborah F
DF
DeMain
Jeffrey
J
Bernert
John T
JT
Butler
Jay C
JC
D000367:Age Factors; D000413:Alaska; D001249:Asthma / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007198:Indians, North American; D007223:Infant; D008297:Male; D012135:Respiratory Sounds / Q000209:etiology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D012136:Respiratory Syncytial Viruses; D012141:Respiratory Tract Infections / Q000209:etiology