Study reveals protection gap for older, medically complex children in RSV fatalities

A recent US study highlights that children aged 2 to 17 with serious underlying conditions are disproportionately affected by RSV-related ICU deaths, exposing a significant gap in current prevention strategies as the RSV season approaches.

A new US study suggests that RSV deaths among children aged 2 to 17 in intensive care are overwhelmingly concentrated among those with serious underlying medical conditions, underscoring a protection gap for older, medically complex children as RSV season approaches. Researchers led by Children’s National Hospital in Washington, D.C., examined electronic health records from more than 100 health systems and found that nearly two-thirds of RSV-related paediatric ICU deaths in the dataset occurred in children aged 2 and above, even though that group accounted for less than half of RSV-related ICU admissions.

The findings, published in JAMA Network Open and reported by CIDRAP and MedPage Today, cover January 2017 through June 2023 and include 13,732 paediatric ICU admissions involving RSV, among them 735 deaths. Of the 6,430 admissions and 484 deaths in children aged 2 to 17, 93.8% of those who died had at least one complex chronic condition. More than half of older children admitted to intensive care had at least one such condition, and about a quarter had three or more.

The most common illnesses in this group were neurological or neuromuscular disorders, gastrointestinal conditions and cardiovascular disease. About 29% of the older children admitted needed medical technology such as feeding tubes or breathing support, and a small share had received a transplant. The risk of death rose sharply with the number of chronic conditions: children with at least one complex condition had almost 13 times the odds of dying, while those with three or more had roughly 22 times the odds. Children who died were also older than survivors and tended to have more organ systems affected.

The study’s authors said the results highlight an important prevention gap. At present, RSV protection is focused on infants and older adults. The Centres for Disease Control and Prevention recommends maternal vaccination during pregnancy to protect babies, and long-acting antibody products such as nirsevimab or clesrovimab for infants, but it does not recommend those antibodies for children 20 months or older. No RSV vaccine is approved for older children, leaving medically fragile children past infancy without a targeted option.

The study does not prove RSV alone caused every death, since it was an observational review of medical records and included only children sick enough to require intensive care. It also covers the years of disrupted RSV circulation during the pandemic. Even so, the pattern is consistent with earlier research showing that severe RSV outcomes are much more likely in children with existing health problems. Public health guidance from the CDC also notes that RSV spreads through respiratory droplets, direct contact and contaminated surfaces, and that the virus typically surges in autumn and winter. For families caring for medically complex children, that means planning ahead with clinicians, watching closely for breathing problems and other warning signs, and reducing exposure where possible.