Key result
Having two or more underlying diseases independently increased the risk of severe RSV infection requiring ICU admission by more than five-fold (OR 5.34) in hospitalized children under 5 years of age.
Why the study?
While RSV epidemiology is well characterized in temperate climates, data from subtropical regions such as Okinawa, Japan, remain limited.
Observational (n=1,541)
Yes
Odds Ratio: 5.34 (95% CI 1.9–14.95)
p-value: p=0.001
In a subtropical Japanese setting, younger age, siblings, and underlying diseases were independent risk factors for severe RSV infection in children under 5.
Younger age and siblings raise severe RSV risk in Okinawa; extends subtropical epidemiology but leaves optimal prevention timing open.
BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (ALRTIs) in infants and young children worldwide. While its epidemiology is well-characterized in temperate climates, data from subtropical regions such as Okinawa, Japan, remain limited. This study aimed to describe the clinical and demographic characteristics, risk factors, and seasonality of moderate-to-severe RSV infections in children under 5 years across Okinawa. METHODS: This retrospective, multicenter study analyzed pediatric cases of laboratoryconfirmed RSV infection requiring hospitalization between April 2017 and March 2021. Data were collected from four core hospitals across Okinawa Prefecture. Patients were categorized as having moderate or severe disease based on ICU admission status. Demographic variables, underlying diseases, household and childcare characteristics, and seasonal trends were assessed. RESULTS: A total of 1541 hospitalized RSV cases were included, of which 117 (7.6%) were classified as severe. Overall, 89.0% were under 24 months of age, with the highest burden in the 0-2 month group. In univariate analysis, severe cases were significantly younger, more likely to have siblings, and less likely to attend nursery school compared with moderate cases. The overall prevalence of underlying diseases did not differ between groups; however, having two or more underlying diseases was significantly associated with severity. Multivariate logistic regression confirmed younger age, the presence of siblings, and underlying diseases (both any and multiple) as independent risk factors for severe infection. Seasonal peaks occurred consistently in summer during 2017-2019. In contrast, in 2020, coinciding with the onset of the COVID-19 pandemic, the epidemic curve became broader and peak timings varied across hospitals. Overall, the total number of cases decreased by 62% compared with the pre-pandemic average. CONCLUSIONS: This study provides a comprehensive region-wide assessment of moderate-to-severe pediatric RSV infections in a subtropical setting in Japan. Despite not including data on the use of palivizumab, nirsevimab, or maternal vaccination, the findings provide essential baseline data to guide the implementation of new preventive strategies tailored to local epidemiology.
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Fukuoka–Araki et al. (2025) conducted an observational in Moderate-to-severe respiratory syncytial virus (RSV) infection (n=1,541). Two or more underlying diseases vs. Fewer than two underlying diseases was evaluated on Severe RSV infection requiring ICU admission (OR 5.34, 95% CI 1.90-14.95, p=0.001). Having two or more underlying diseases independently increased the risk of severe RSV infection requiring ICU admission by more than five-fold (OR 5.34) in hospitalized children under 5 years of age.
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