There has been a decline in non-COVID-19 respiratory infections associated with pandemic mitigation efforts. Before the pandemic, lower respiratory tract infections like respiratory syncytial virus (RSV) would fill beds in children’s hospitals around the country with infants who had none of the usual medical high-risk factors (e.g., prematurity or underlying chronic disease) that you might think would be associated with a child at risk to be hospitalized with RSV. So if underlying medical conditions were not the reason why children with RSV were being hospitalized, then one might turn to the role that sociodemographic and psychosocial factors might be playing in those being hospitalized with RSV. Those factors are what Fitzpatrick et al (10.1542/peds.2020-029090) opted to study in infants and toddlers less than 3 years of age hospitalized for RSV.
The authors looked at more than 11,700 hospitalizations for RSV infection in Ontario between 2012 and 2018 and linked sociodemographic data with health and laboratory data to see which of these factors were most strongly associated. Most notably if an infant or toddler had a young mother, a mother who had a history of criminal involvement, or a mother with mental health or addiction concerns, there was a high risk for hospital admission for RSV. The authors also identified protective factors such as mother’s using welfare-based drug insurance or having older siblings vaccinated.
What can we learn from this study that will help us reduce the prevalence of not just RSV, but all respiratory viruses including SARS-CoV-2? Plenty, according to an accompanying commentary (10.1542/peds.2020-038356) by Drs. Mary Caserta and Edward Walsh from Rochester, New York. They note how valuable this paper is for turning our attention not just to the pathophysiology of a particular virus in terms of its transmission dynamics, but also to the social determinants of health that may be contributing substantively to a child being at increased risk for a hospitalization due to a lower respiratory tract infection. Why is this so? The authors of this insightful commentary provide a number of reasons as well as preventive strategies that can be implemented at the level of an individual family or community. Caserta and Walsh along with Fitzpatrick et al also wonder whether those at increased risk for admission based on their social determinants of health might warrant being included in those considered “high risk” for prophylactic therapy with monoclonal antibodies like palivizumab. This study and commentary remind us of the importance of addressing social needs to improve child health.
