Inpatient Burden of Respiratory Syncytial Virus in Children ≤2 Years of Age in Germany: A Retrospective Analysis of Nationwide Hospitalization Data, 2019-2021

OBJECTIVES:

Respiratory syncytial virus (RSV) is a pathogen that causes respiratory tract disease, such as pneumonia, bronchitis, and bronchiolitis in seasonal waves. Infants and young children are primarily affected. However, national epidemiological RSV surveillance and resource use data are limited. This study aims to quantify the number of RSV-associated hospitalizations in children ≤2 years of age and related inpatient resource use in Germany.

METHODS:

We retrospectively analyzed publicly available nationwide hospitalization data from the Institute for the Hospital Remuneration System (InEK) for the calendar years 2019 to 2021. All cases with a principal diagnosis of severe acute respiratory infection (SARI, ICD-10 codes J09-J22) were extracted. RSV cases were defined as cases with a principal RSV diagnosis of either J12.1 (pneumonia), J20.5 (bronchitis) or J21.0 (bronchiolitis). Mean length of stay (LOS), intensive-care unit (ICU) admission and use of mechanical ventilation were retrieved for RSV hospitalizations.

RESULTS:

From 2019 to 2021, there were 72,821 hospitalizations (26,052, 15,407 and 31,362 in 2019, 2020 and 2021, respectively) with a principal diagnosis of RSV in children ≤2 years of age in Germany. In this age group, RSV accounted for 39.2% of all SARI hospitalizations. The majority of RSV hospitalizations (54,342) occurred in infants (age <1), with RSV causing 57.8% of all SARI hospitalizations in this age group. In 48.1% of RSV cases in children ≤2 years of age the principal diagnosis was bronchiolitis, followed by bronchitis (28.8%) and pneumonia (23.1%). Mean LOS was 4.5 days, 5.6% of cases were admitted to ICU and 4.6% of cases were mechanically ventilated.

CONCLUSIONS:

RSV causes substantial disease burden and is a leading cause of SARI-associated hospital admissions in children ≤2 years of age in Germany. Our results confirm the need to explore and evaluate strategies to prevent RSV in infants and young children.