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David K. Shay, MD, MPH; Robert C. Holman, MS; Robert D. Newman, MD, MPH; Lenna L. Liu, MD, MPH; James W. Stout, MD, MPH; Larry J. Anderson, MD

JAMA. 1999;282:1440-1446.

Context  Respiratory syncytial virus (RSV) causes more lower respiratory tract infections, often manifested as bronchiolitis, among young children than any other pathogen. Few national estimates exist of the hospitalizations attributable to RSV, and recent advances in prophylaxis warrant an update of these estimates.

Objectives  To describe rates of bronchiolitis-associated hospitalizations and to estimate current hospitalizations associated with RSV infection.

Design and Setting  Descriptive analysis of US National Hospital Discharge Survey data from 1980 through 1996.

Participants  Children younger than 5 years who were hospitalized in short-stay, nonfederal hospitals for bronchiolitis.

Main Outcome Measure  Bronchiolitis-associated hospitalization rates by age and year.

Results  During the 17-year study period, an estimated 1.65 million hospitalizations for bronchiolitis occurred among children younger than 5 years, accounting for 7.0 million inpatient days. Fifty-seven percent of these hospitalizations occurred among children younger than 6 months and 81% among those younger than 1 year. Among children younger than 1 year, annual bronchiolitis hospitalization rates increased 2.4-fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996. During 1988-1996, infant hospitalization rates for bronchiolitis increased significantly (P for trend <.001), while hospitalization rates for lower respiratory tract diseases excluding bronchiolitis did not vary significantly (P for trend = .20). The proportion of hospitalizations for lower respiratory tract illnesses among children younger than 1 year associated with bronchiolitis increased from 22.2% in 1980 to 47.4% in 1996; among total hospitalizations, this proportion increased from 5.4% to 16.4%. Averaging bronchiolitis hospitalizations during 1994-1996 and assuming that RSV was the etiologic agent in 50% to 80% of November through April hospitalizations, an estimated 51,240 to 81,985 annual bronchiolitis hospitalizations among children younger than 1 year were related to RSV infection.

Conclusions  During 1980-1996, rates of hospitalization of infants with bronchiolitis increased substantially, as did the proportion of total and lower respiratory tract hospitalizations associated with bronchiolitis. Annual bronchiolitis hospitalizations associated with RSV infection among infants may be greater than previous estimates for RSV bronchiolitis and pneumonia hospitalizations combined.

Author Affiliations: Respiratory and Enteric Viruses Branch (Drs Shay and Anderson) and Office of the Director (Mr Holman), Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga; Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle (Drs Newman, Liu, and Stout); and Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle (Dr Stout).

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