131 - Pediatric Respiratory Syncytial Virus Infections in Hawaii

Publication Number: 131.6398

Arianna M. Antoku, Hawaii Pacific Health, Honolulu, HI, United States; Chieko Kimata, Hawaii Pacific Health, Honolulu, HI, United States; Natascha Ching, University of Hawaii, John A. Burns School of Medicine, Kapiolani Medical Center for Women & Children, Honolulu, HI, United States

Background: Respiratory syncytial virus (RSV) causes lower respiratory tract infections in infants and young children often requiring hospitalization. RSV in Hawaii persists year-round compared to the seasonal pattern on the continental US.

Objective: This study characterized pediatric RSV hospitalizations and disease severity in Hawaii.

Design/Methods: A retrospective chart review analyzed pediatric RSV hospitalizations from January 2016 to May 2024 at Kapiolani Medical Center for Women & Children and Wilcox Medical Center. Illness severity was classified as mild (no oxygen support), moderate (non-invasive oxygen support), or severe (intubation). Univariable and multivariable logistic regression models were performed to assess associations between demographic and clinical variables with two outcomes: illness severity and intensive care unit (ICU) admission. The model was adjusted for age, prematurity, cardiovascular and pulmonary disease, and interactions among comorbidities.

Results: Among 937 RSV encounters, 40.8% were female, median age was 7 mos (IQR 2–17) and 67.3% were ≤12 mos. Primary races included 50.9% Native Hawaiian or Other Pacific Islander, 31.6% Asian, 13.3% White, 2.0% Black or African American, 0.2% American Indian or Alaska Native, and 1.9% unknown. 67.7% had government insurance. Median length of stay was 2 days (IQR 1–3), with 33.3% having ≥1 reported comorbidity (prematurity, pulmonary, cardiovascular disease, immunocompromised). Illness severity was distributed as 21.5% mild, 69.8% moderate, and 8.8% severe, with 24.8% of patients requiring the ICU. Prematurity (aOR=2.80, 95%CI: 1.69-4.64) and pulmonary disease (aOR=1.79, 95%CI: 1.09-2.94) were significantly associated with an increased likelihood of severe illness. Both prematurity (aOR=2.01, 95%CI: 1.18-3.40) and pulmonary disease (aOR=2.33, 95%CI: 1.37-3.96) were also associated with increased ICU admission (Table 1). RSV admissions in Hawaii occurred year-round.

Conclusion(s): The majority of pediatric hospitalization required moderate to severe respiratory support underscoring the need for monitoring those with high-risk comorbidities. This study highlights premature birth and pulmonary disease as significant risk factors for severe RSV hospitalization and intensive care among pediatric patients in Hawaii. Continued preventative strategies for RSV in all pediatric patients and high-risk groups should be promoted given Hawaii’s unique year-round RSV seasonality.

Table 1. Odds Ratio (OR) and adjusted Odds Ratio (aOR) for Illness Severity and ICU Status
*Adjusted for age, cardiovascular status, pulmonary status, premature status, and interactions among these comorbidities