Managed Care - November 2008 - (Page RSV3)

RSV Disease in the Pediatric Population: Epidemiology, Seasonal Variability, And Long-Term Outcomes ERIC A. F. SIMÕES, MD, DCH Professor of Pediatrics, Division of Infectious Diseases University of Colorado Denver Health Sciences Center and The Children’s Hospital, Denver By the age of 2 years, most children will have acquired fines the onset of an RSV season as the first of 2 consecua respiratory syncytial virus (RSV) infection (Glezen tive weeks during which the median percentage of speci1986). For most of these children, the RSV infection will mens testing positive for RSV antigen is 10 percent or be unremarkable, but a subset of children, notably infants greater, and offset is the last of 2 consecutive weeks when born prematurely or with congenital heart disease the median percentage of positive specimens is 10 per(CHD), is at an increased risk for severe RSVcent or greater (CDC 2007). When analyzed by associated lower respiratory tract infection these definitions in terms of the broad U.S. (LRTI), particularly bronchiolitis. In the census regions (Northeast, South, Midwest, United States, up to 126,000 infants are hospiWest), it has been found that the RSV season talized each year because of severe RSV disease varies from region to region and within any (Shay 1999). Additionally, from 1990 through given region from year to year (Panozzo 2007). 1999, the estimated annual number of RSVThe South has the earliest onset (median onset associated deaths was 235. Ninety-four perin late November [week 47], with a range from cent of these deaths occurred in infants, week 41 to week 51), and the longest duration accounting for 5.3 deaths per 100,000 person(16 weeks; range, 13–20 weeks). The Midwest ERIC A. F. years among infants and 0.2 deaths per 100,000 has the latest onset (median onset in early JanSIMÕES, MD, person-years among children aged 1 to 4 uary [week 1], with a range from week 50 to DCH (Thompson 2003). week 5) and the shortest duration (13 weeks; range 10–16 weeks). The Figure on page 4 shows reRSV seasonality gional RSV trends from July 2000 through July 2006. Analyses within states show substantial variations in The RSV season in the United States, as acknowledged RSV seasonality, which are lost in regional reports. In the by the American Academy of Pediatrics (AAP), generally southwest, northwest, and north regions of Florida, for extends from November through March with a peak in example, RSV seasons range from 7 to 8 months, while January or February (AAP 2006), but considerable geoin central and southeastern Florida, the RSV seasons last graphic and temporal variation in RSV seasonality exists. 11 or 12 months (Light 2008). The Centers for Disease Control and Prevention deIn Colorado, we have analyzed 10 years of RSV hosEric A. F. Simões, MD, DCH, received his MD from the Univerpitalization data at the local level using ZIP code tabulation areas (ZCTAs), which are comparable to ZIP codes, sity of Madras, India, in 1984 and obtained his Fellowship in Peand we have noticed considerable geographic and temdiatric Infectious Disease from the University of Colorado Health poral variations (Zachariah 2008). In some locales, the Sciences Center. He has been an invited speaker at numerous naRSV seasons lasted only 3 months, whereas in others, the tional and international symposia, and has been a guest editor and seasons exceeded 5 months. For about one third of all reviewer for more than 30 journals. Simões has been involved with Colorado children, the RSV season is less than 5 months, the Integrated Management of Childhood Illness, a program debut for another third, the RSV season lasts 6 or 7 months, veloped by the World Health Organization (WHO) to reduce i.e., comparable to much of Florida. We also have found childhood and infant mortality in the developing world, and is a that local weather conditions affect RSV activity through scientific consultant for the WHO Division of Child and Adolescomplex interactions of temperature and humidity cent Health and Development. Simões’ research interests focus on (Yusuf 2007), and we speculate that this might affect the the epidemiology and prevention of acute respiratory infections, stability of the virus in the large-particle aerosols or specifically RSV and Streptococcus pneumoniae. SUPPLEMENT / RSV 3

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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