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Ask any pediatrician to name the viral infection responsible for the most identifiable syndrome with the most predictable seasonality, and their most likely response will be respiratory syncytial virus.
According to a study from some of the most tenacious investigators of respiratory viral infection1, approximately 2.1 million infants and children younger than 5 years of age require medical attention (hospitalization, emergency department, or outpatient visits) each year because of RSV infection. Children younger than 2 years are more likely to be hospitalized than older children, and infants younger than 6 months and those born prematurely are most likely to require hospitalization. However, three-quarters of the children who require medical care are between 1 and 5 years of age, and the majority of infants and children hospitalized because of RSV infection have no underlying medical problem.
The 2009 influenza H1N1 epidemic generated a great deal of publicity and fear. The concern is understandable if one considers the uncertainty among experts about the potential virulence of the new epidemic strain. By the end of 2009, however, according to estimates from the Centers for Disease Control and Prevention, the rate of hospitalization because of H1N1 influenza for children younger than 5 years was about 5.7 per 10,000-about one-tenth the annual rate for RSV infection.1
An important reason for the lack of attention given to RSV infection by the public at large, however, is the age group most affected. Schools don't close because of RSV, and, though parents of infected young children may have to miss work, there is little discussion about potential spread of infection to coworkers.
Are we missing something important here? Should pediatricians join together to raise awareness about hand hygiene, restricting exposure of infants and young children to adults and older children with colds, and the importance of developing a vaccine to prevent RSV? If we work with media to publicize RSV's annual costs and morbidity (and occasional mortality) might this issue get the attention it deserves?
DR MCMILLAN, editor-in-chief of Contemporary Pediatrics, is professor of pediatrics, vice chair for pediatric education, and director of the pediatric residency training program, Johns Hopkins University School of Medicine, Baltimore.
1. Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360(6):588-598.