Acute respiratory illness duration and quality of life by RSV status in healthy term infants

Background

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory tract infections (ARTIs) among young children. While the majority of RSV infections are managed in the community, existing evidence has largely focused on severe or hospitalised cases. We aimed to compare symptom duration and health-related quality of life (HRQoL), between RSV-positive (RSV+) and RSV-negative (RSV-) community ARTIs in healthy term infants.

Methods

Infants were enrolled in a prospective, multi-country cohort across the United Kingdom, Spain, Finland, and the Netherlands. Symptomatic infants were systematically tested for RSV. Caregivers recorded daily symptoms and HRQoL (EQ-VAS) for 14 consecutive days or until symptoms resolved. HRQoL and symptom duration were summarised by RSV status and healthcare resource use (no medical attendance [non-MA] vs ambulatory care [AMB]).

Results

We recruited 1041 infants at birth and identified 1353 ARTIs in 641 children during their first RSV season. RSV+ had longer mean symptom duration than RSV- in non-MA patients (12.2 vs 10.7 days [p < 0.01]), while in AMB patients, the difference was smaller and not significant (12.4 vs 11.9 days). During the first week, RSV+ showed higher proportions of pain/discomfort and worries/sad/unhappy and lower EQ-VAS scores across both AMB and non-MA episodes. Pain/discomfort peaked at day 4 in RSV + (49.5% non-MA; 80.4% AMB) versus day 3 (40.1%) in non-MA and day 5 (60.6%) in AMB for RSV-, while worries/sad/unhappy peaked at day 2 in RSV- (42.7% non-MA; 56.1% AMB) and later in RSV + (day 3: 59.2% non-MA; day 5: 74.7% AMB).

Conclusions

Mild to moderate RSV+ ARTI episodes in healthy term infants, managed in the community, were associated with prolonged symptom duration and measurable declines in HRQoL. These findings are vital to inform RSV prevention policy, as the burden of these non-severe disease episodes may outweigh that of more severe disease episodes, because of their more frequent occurrence.

Key messages

• RSV infection in early life should not be dismissed as a trivial “common cold”-like illness, but recognised as a cause of substantial short-term morbidity, even in otherwise healthy infants.

• Our results underscore the importance for continued attention to RSV prevention strategies in early life, particularly through effective immunisation.