RSV Epidemic Hits American Indian and Alaska Native Children

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According to a recent study published in Pediatrics, American Indian/Alaska Native (AI/AN) children have been found to experience significantly high rates of respiratory syncytial virus (RSV)-associated acute respiratory illness (ARI) hospitalization. The research, conducted by a team from the Johns Hopkins Bloomberg School of Public Health, sheds light on the urgent need for improvements in the healthcare and socioeconomic conditions of these communities. 

The study, led by Jessica E. Atwell, Ph.D., M.P.H., involved active, facility-based surveillance for ARI among hospitalized AI/AN children from November 2019 to May 2020. A total of 324 children under the age of 5 from Chinle, Arizona (Navajo Nation); Whiteriver, Arizona (White Mountain Apache Tribal lands); and Anchorage and the Yukon-Kuskokwim (YK) Delta regions of Alaska were enrolled. These children met the World Health Organization’s case definition for extended severe ARI. 

The researchers discovered that 53 percent of the children tested positive for RSV, highlighting the significant impact of this virus on the health of AI/AN children. Notably, one-third of RSV-associated hospitalizations occurred in infants younger than 6 months. The average length of stay ranged from 3.5 to 5.7 days across different locations, with the highest utilization of supplemental oxygen observed in Whiteriver at 100 percent and Anchorage at 70 percent.

Annual RSV-associated hospitalization rates per 1,000 children younger than 6 months old varied between 35.7 and 132.3 for Anchorage and the YK Delta, respectively. For children younger than 5 years old, the rates ranged from 7.7 to 32.7 for Anchorage and the YK Delta, respectively. 

The study also noted a significant decrease in the number of children hospitalized with ARI following the implementation of COVID-19 pandemic mitigation measures in spring 2020. However, the researchers acknowledge that these observations may underestimate the true pre-COVID-19 rates, particularly in Alaska, where the respiratory season typically extends into late April and May. 

The authors of the study emphasize that these findings highlight the ongoing challenges faced by AI/AN children in terms of high rates of RSV-associated ARI hospitalization. They call for urgent improvements in the socioeconomic determinants of health for these communities, as well as the development of RSV-prevention products. It is worth noting that several authors of the study have disclosed ties to the pharmaceutical industry, which may be relevant in considering potential biases or conflicts of interest. 

The study underscores the significant burden of RSV-associated acute respiratory illness hospitalization among AI/AN children. The high rates of hospitalization and the vulnerability of infants emphasize the pressing need for targeted interventions and support to improve the health outcomes of these communities. Addressing the socioeconomic determinants of health and developing effective prevention strategies for RSV are crucial steps toward reducing the impact of respiratory illnesses on AI/AN children. 

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