RSV-healthcare associated infection: epidemiology and deaths at an Australian tertiary paediatric hospital

Ms Gemma Saravanos1,2, Ms Claire Nayda3, Ms Trish Maldigri3, Professor Marilyn Cruickshank3, Professor Alison Kesson1,3, Dr Philip Britton1,3,4

1University Of Sydney, Sydney, Australia, 2National Centre for Immunisation Research and Surveillance, Sydney, Australia, 3Sydney Children’s Hospital Network, Sydney, Australia, 4Marie Bashir Institute of Infectious Diseases and Biosecurity, Sydney, Australia

Introduction: RSV-healthcare associated infection (RSV-HAI) is associated with poor outcomes but is not routinely captured via hospital surveillance systems. We aimed to describe the epidemiology of RSV-HAI and estimate the case fatality rate (CFR) amongst RSV-HAI at a major Australian paediatric hospital.

Methods: RSV detections between 2016 to 2020 in children aged <16 years were reviewed and classified according to case definitions based on the recognized RSV incubation period of 2-8 days. We described RSV-HAI and community-acquired infections by month and year of detection, age at detection, sex, time from admission to detection and RSV subtype. The rate of RSV-HAI per 10,000 bed-days was calculated by month and year. CFR amongst RSV-HAI was estimated using data from a previous study of RSV-attributable deaths.

Results: We identified 176 RSV-HAI, majority in autumn-winter months (126, 71.6%). Median age at detection was 1.6 years (IQR 0.4-5.8) compared to 0.7 years (0.3-1.7) for community-acquired cases (p=<0.001). For RSV-HAI, the median time from admission to RSV detection was 5 days. Rates of RSV-HAI varied by month and largely reflected seasonal trends. There were no RSV-HAI from January 2020 to August 2020. The estimated CFR was 0.8% amongst RSV-HAI.

Conclusion: RSV-HAI appears more frequent than expected and the CFR is likely a minimum estimate. Cases occur predominantly, but not exclusively, during seasonal peaks of community-acquired RSV. Understanding local RSV-HAI epidemiology can inform targeted prevention strategies. Optimizing surveillance can support timely implementation of interventions, communication with stakeholders and benchmarking with other paediatric facilities.


Gemma is a PhD candidate undertaking research into severe acute respiratory infections in Australian children. Her research seeks understand the epidemiology of viral infections, such as respiratory syncytial virus, to inform disease prevention strategies.

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