Written by Kimiko Dunbar
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In children less than 5 years old, RSV is associated with a higher risk of ICU admission and mechanical ventilation compared to influenza and COVID-19; however, in-hospital mortality is higher for COVID and influenza.
Choose your poison
RSV, influenza, and COVID-19 are the most common viruses identified in children hospitalized with a viral respiratory infection. Children under the age of 5 are at especially high risk of adverse outcomes when hospitalized with flu, COVID, or RSV. This retrospective cohort study assessed whether RSV leads to more severe outcomes than COVID-19 or influenza for children under 5 years. Among 56,634 hospitalizations, RSV cases had higher rates of ICU admission (28.2%), supplemental oxygen (46.1%), and mechanical ventilation (12.0%) vs. COVID-19 and influenza. RSV posed 1.5–2x greater risk of these outcomes (e.g., RR for oxygen vs. COVID-19: 2.00, 95%CI 1.86–2.15). Children < 1 year with RSV had a higher incidence of every measure of severe disease than those 2-5 years old, excluding risk of death. In-hospital mortality was higher for influenza (0.4%) and COVID (0.3%) than for RSV (0.1%). Unfortunately, given limitations of the data set, children were clustered according to year of age; therefore, authors were able to assess subsets of children within one age group, such as 0-6 mo vs. 6-12 mo. Additionally, vaccination status was not captured in the dataset.
How does this change my practice?
We have vaccines/antibodies for all these viruses. If nothing else, this study adds fuel to the fire when counseling families on the importance of immunization, especially for the young, who are more vulnerable. I have a healthy respect for all of these viruses, although I’m slightly more wary of RSV in a kid less than 1.
Source
Clinical Outcomes in Children <5 Years of Age Hospitalized for Respiratory Syncytial Virus, COVID-19 or Influenza in the United States. Pediatr Infect Dis J. 2025 May 23. doi: 10.1097/INF.0000000000004866. Epub ahead of print. PMID: 40440707
