Readmission Following Respiratory Syncytial Virus Hospitalization among Children < 5 Years of Age

Abstract Background Hospitalization with lower respiratory infection (LRI) by Respiratory Syncytial Virus (RSV) and other respiratory viruses is common in young children. However, the likelihood of readmission following RSV LRI compared to other common respiratory viral infections is unknown. Methods This prospective study included children <5 years and hospitalized with laboratory-confirmed RSV LRI at two hospitals in Salt Lake City, Utah, from October 31, 2019, to April 30, 2022. For comparison, we retrospectively identified children < 5 years, hospitalized during the same period with Influenza virus (IV) or human metapneumovirus (hMPV) LRI. Readmissions were tracked for 1.5 years post-discharge. We calculated the incidence proportion of readmissions and estimated hazard ratios using Cox proportional hazards model with Covariate Balancing Propensity Score. Results Among children hospitalized with RSV, IV and hMPV LRI, all-cause hospital readmission was common, with 30-day readmission proportions ranging between 5% and 9% and increasing to between 19% and 30%, 1.5 years post-discharge. Respiratory-related readmission varied by virus, with RSV having higher proportions, increasing to 16.8% 1.5 years post-discharge, compared to 6-7% with IV and hMPV. After adjusting for confounders, RSV hospitalization was associated with an increased hazard of respiratory-related readmission within 1.5-years after hospitalization compared to IV (HR 3.62, 95% CI 1.13-11.64) or hMPV (HR 3.56, 95% CI 1.14-11.06). Conclusion Respiratory-related readmission proportion was higher and progressive over time among children <5 years with an index RSV admission compared to IV and hMPV. This underscores the critical need for prevention of RSV infection in infants and young children through RSV immunization strategies.