CSTE Position Statement(s)
Over 57,000 hospitalizations, 500,000 emergency department visits and 1.5 million outpatient clinic visits among children <5 years of age are attributed to respiratory syncytial virus (RSV) infections each year in the United States. RSV-associated deaths among children <5 years of age are thought to be uncommon, estimated at 100-500 per year. Among US adults, an estimated 177,000 hospitalizations and 14,000 deaths associated with RSV infections occur annually. However, these are likely underestimates of RSV-associated deaths. In recent years, laboratory testing for RSV has increased in availability and practice. A more accurate assessment of RSV-associated deaths is important for establishing a baseline level of mortality ahead of the potential licensures of vaccines, immunoprophylaxis products, and anti-viral therapies. Additionally, a better understanding about who is at risk of RSV-associated deaths may help identify populations to target for interventions.
A respiratory syncytial virus (RSV)-associated death is defined for surveillance purposes as a death resulting from a clinically compatible illness that was confirmed to be RSV by an appropriate laboratory or rapid diagnostic test. There should be no period of complete recovery between the illness and death.
A death should not be categorized as an RSV-associated death if:
- There is no laboratory confirmation of RSV infection.
- The RSV illness is followed by full recovery to baseline health status prior to death.
- After review and consultation, it is determined that RSV infection did not contribute to death.
Laboratory Criteria For Diagnosis
Confirmatory laboratory evidence:
Laboratory testing for respiratory syncytial virus infection may be done on pre- or post-mortem clinical specimens, and include identification of RSV (A, B, or unspecified) infection by a positive result by at least one of the following:
- Isolation of respiratory syncytial virus by tissue cell culture
- Detection of respiratory syncytial virus nucleic acid by reverse-transcriptase polymerase chain reaction (RT-PCR) or other nucleic acid detection assay
- Detection of respiratory syncytial virus antigen by immunofluorescent antibody staining (direct or indirect)
- Detection of respiratory syncytial virus antigens by immunochromatographic or similar rapid laboratory test
- Detection of respiratory syncytial virus antigens from autopsy specimens by immunohistochemical (IHC) staining
A death meeting the clinical and laboratory criteria.