Pediatric RSV Mortality Rises With Chronic Condition Burden

A retrospective multicenter cohort study published in JAMA Network Open found that children aged 2 to 17 years account for a substantial share of severe respiratory syncytial virus (RSV) disease, with mortality concentrated among those who have underlying pediatric complex chronic conditions (CCCs).

Using the Oracle Electronic Health Record Real-World Data database, researchers led by Taylor L. Olson, MD, of Children's National Hospital, analyzed ICU admissions from more than 100 US health systems between January 2017 and June 2023. The study characterized RSV-associated ICU admissions and mortality in this age group and evaluated associations between CCCs and death, an area the authors said has received less attention than RSV disease in infants.

The cohort included 6,430 RSV-associated ICU admissions among children aged 2 to 17 years, representing 8.3% of all ICU admissions in that age range. Median ICU length of stay was 2.9 days, and 32.0% of admissions required positive pressure ventilation. Hospital mortality occurred in 484 admissions (7.5%), accounting for nearly two-thirds (65.9%) of all RSV-associated pediatric deaths across the ages studied.

At least one CCC was present in 57.2% of admissions and 93.8% of deaths. Mortality rose sharply with CCC burden: children with three or more CCC categories had 22.56-fold higher unadjusted odds of death than those without CCCs (95% CI, 15.44-32.97). After multivariable adjustment, malignant neoplasm (adjusted mortality odds ratio [AMOR], 4.27), neurologic or neuromuscular disease (AMOR, 2.66), respiratory disease (AMOR, 2.36), and transplant status (AMOR, 2.18) showed the strongest independent associations with mortality.

The authors noted limitations common to retrospective EHR-based research, including reliance on diagnosis coding to identify RSV-associated cases, an inability to adjust for illness severity at admission, and a focus restricted to the ICU setting that limits generalizability to less severe RSV disease. They concluded that severe RSV disease extends well beyond infancy and that children with specific or multiple chronic conditions may be candidates for expanded RSV prevention strategies.

Source: Olson TL, Trujillo Rivera EA, Patel AK, Mejias A, Pollack MM. Respiratory Syncytial Virus–Associated Disease in Children Receiving Intensive Care. JAMA Netw Open. Published online September 16, 2026.  doi:10.1001/jamanetworkopen.2026.34138