Asthma-related Pediatric Healthcare Utilization after Hospitalization for RSV and Other Viral Lower Respiratory Tract Infections

Guy Hazan, Mai Ofri, Lital Hertz et al.  Open Forum Infectious Diseases, Volume 13, Issue 7, July 2026, ofag402, https://doi.org/10.1093/ofid/ofag402

Abstract

Background

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) in infants. Although influenza, parainfluenza, and human metapneumovirus also contribute to LRTI-related hospitalizations, their comparative population-level healthcare burden is not well defined. This study compared population-level healthcare utilization (HCU) associated with RSV-LRTI and LRTI caused by other respiratory viruses (ORspV-LRTI).

Methods

This nationwide retrospective cohort study used electronic health records from Clalit Health Services (CHS), covering more than 5 million individuals in Israel. Infants born in 2015–2023 and hospitalized before 12 months of age with PCR-confirmed viral LRTI during the RSV season were included. Acute healthcare utilization (HCU) was assessed within 30 days following hospital discharge, and long-term respiratory HCU was evaluated through 6 years of age.

HCU was expressed as population-level event rates per 100 000 live births during the study period, and incidence rate ratios (IRRs) were estimated using quasi-Poisson regression.

Results

Cumulative healthcare utilization through 6 years of age in
children with RSV-LRTI and ORspV-LRTI.

The cohort included 5822 infants (4951 RSV-LRTI; 871 ORspV-LRTI). RSV-LRTI infants were younger at hospitalization (median 2.7 vs 4.4 months; P < .001); Acute HCU was markedly higher in the RSV-LRTI group, including hospitalization duration (IRR = 6.90; 95% CI 4.07–12.6), and anti-asthma medications use (IRR = 4.77–8.04, P < .001 for all). Elevated HCU persisted long-term, with higher rates of respiratory medication use, pediatric pulmonologist visits (94.3 vs 16.3 per 100 000; IRR 6.44), and respiratory-related hospitalizations (IRR = 5.39) through 6 years of age. These findings remained consistent in subgroups of younger children and those who experienced more severe disease during the index bronchiolitis hospitalization.

Conclusions

RSV-associated LRTI in infancy is associated with substantially greater population-level HCU than LRTI caused by other respiratory viruses, both acutely and throughout early childhood, supporting prioritization of early-life RSV prevention strategies.

PDF