1761. The Under-Recognized Burden of RSV Among Infants Presenting to US Emergency Departments
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • 1761 poster.pdf (1.0 MB)
  • Background: As with other respiratory viruses, respiratory syncytial virus (RSV) disease is often not recognized due to its varied presentation and a lack of testing. The purpose of this study was to determine the prevalence of RSV by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis among infants presenting to US emergency departments with lower respiratory tract illness (LRI) or apnea.

    Methods: A previous, 2-year RSV season observational study of infants presenting to 32 US emergency departments with LRI or apnea was conducted in 2006–2008. Samples for reverse transcription polymerase chain reaction (RT-PCR) testing and primary ICD-9 diagnoses were collected; enrollment occurred during shoulder (September 1−October 31, April 1−May 31) and peak (January 15−February 15) RSV periods. The RSV positivity rate was calculated post hoc by ICD-9 code.

    Results: In shoulder and peak months of the RSV seasons, data were available for 3070 and 1100 infants, respectively; 620 (20%) and 678 (62%), respectively, tested positive for RSV.  Among those children who were subsequently determined to have PCR-confirmed RSV, only 25% and 35% had an RSV-specific ICD-9 diagnosis assigned at discharge during shoulder and peak months, respectively.  Among those without an RSV-specific discharge diagnosis, RSV positivity was most frequent among children with acute bronchiolitis (50%, 116/231), acute bronchiolitis due to other infectious organisms (33%, 455/1393), other dyspnea and respiratory abnormalities (30%, 44 of 148), cough (24%, 29/121), pneumonia (20%, 42/207), wheezing (20%, 37 of 185), acute upper respiratory illness of unspecified site (15%, 31/210), and fever (12%, 19/163). RSV positivity rates were higher during peak months relative to shoulder months.

    Conclusion: RSV disease in infants is often not diagnosed by providers and manifests as multiple different diagnoses. RSV-specific ICD-9 codes identified only 25%−35% of the total RSV illness. RSV positivity varied significantly by ICD-9 diagnosis and time during the RSV season. More precise estimates of the proportion of various diagnoses attributable to RSV can facilitate more accurate assessments of the burden of RSV.

    Christopher Ambrose, MD1, Xionghua Wu, PhD1 and Doris Makari, MD2, (1)MedImmune, LLC, Gaithersburg, MD, (2)Medimmune, LLC, Gaithersburg, MD


    C. Ambrose, MedImmune: Employee, Salary

    X. Wu, MedImmune, LLC: Employee, Salary

    D. Makari, MedImmune, LLC: Employee, Salary

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.