P4A159: Laboratory-confirmed Respiratory Syncytial Virus (RSV)-associated Hospitalization and ICU Admission Rates Among US Children and Adolescents < 18 Years Old, by Race and Ethnicity over Four Seasons—rsv-net, 2018–2019 to 2021–2022

Background: Respiratory syncytial virus (RSV) is a leading cause of hospitalization for young children. The COVID-19 pandemic demonstrated higher COVID-19-associated hospitalization rates among racial and ethnic minority children compared to non-Hispanic White children. Limited data describe racial and ethnic disparities in RSV-associated pediatric hospitalizations.

Methods: RSV-NET conducts population-based active surveillance for RSV-associated hospitalizations in 12 states, covering 8.9% of the U.S. population. Case-patients are residents of defined catchment areas with positive, provider-ordered RSV tests ≤ 14 days before or during hospitalization. From October 2018–September 2022, overall age-adjusted hospitalization and ICU admission rates per 100,000 population for children < 18 years old were calculated by race and ethnicity using U.S. census catchment denominators; unadjusted rates were calculated for age sub-groups. Rates were not adjusted for RSV testing practices. Rates for non-Hispanic American Indian or Alaska Native (AI/AN) children are not presented because of small numbers.

Results: From 2018–2019 through 2021–2022, 19,204 laboratory-confirmed pediatric RSV-associated hospitalizations were reported. Of those, 7,657 (39.9%) children were < 6 months, 2,998 (15.6%) were 6– < 12 months, 3,749 (19.5%) were 12– < 24 months, 3,695 (19.2%) were 2– < 5 years, 909 (4.7%) were 5– < 12 years, and 196 (1%) were 12– < 18 years old. Unadjusted hospitalization rates were highest among children < 6 months, ranging from 725–1435 per 100,000 population across seasons, and decreased with age, ranging from 284–563, 204–334, 63–122, 4–14.2, and 1.5–3.1 per 100,000 population among children 6– < 12 months, 12– < 24 months, 2– < 5 years, 5– < 12 years, and 12– < 18 years old, respectively. Among children < 2 years old, rates were highest in 2019–2020; among children ≥ 2 years, rates were highest in 2021–2022. Rates were lowest in 2020–2021 for all children.

Race or ethnicity were known for 17,778 (92.6%) children. In total, 7,774 (43.7%) hospitalized children were non-Hispanic White, 4,252 (23.9%) were non-Hispanic Black, 4,199 (23.6%) were Hispanic, 1,082 (6.1%) were non-Hispanic Asian/Pacific Islander (API), and 146 (0.8%) were non-Hispanic AI/AN. Patterns of age-adjusted hospitalization and ICU admission rates for children < 18 years were similar to unadjusted rates for children < 5 years (Figures 1 and 2). From 2018–2019 through 2021–2022, hospitalization rates were highest among Black and Hispanic children and lowest among White and API children. Age-adjusted ICU admission rate ratios for Black children < 18 years old compared with White children ranged from 1.3 (95% confidence Interval (CI), 1.2–1.4) to 1.9 (95% CI, 1.9–2.1) across seasons.

Conclusion: Racial and/or ethnic differences were present in RSV-associated hospitalization and ICU rates among U.S. children, with higher rates among Black and Hispanic children. When vaccines or products targeting prevention of infant RSV disease become available, equitable access will be critical to minimize disparities in RSV hospitalizations.