{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:24:36Z","timestamp":1780485876764,"version":"3.54.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004339","name":"Sanofi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004339","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Respiratory syncytial virus (RSV) is the leading cause of infant hospitalization in the United States. Understanding healthcare utilization associated with medically attended (MA) RSV lower respiratory tract infection (LRTI) might inform research priorities aimed at reducing RSV-associated pediatric morbidity. We described healthcare utilization during acute MA RSV LRTI episodes within a geographically diverse cohort of infants in the United States.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We created retrospective cohorts of infants born in the United States from July 1, 2016 through February 29, 2020 in each of three de-identified insurance claims datasets: Merative MarketScan Commercial Claims and Encounters, Multi-State MarketScan Medicaid, and Optum\u2019s de-identified Clinformatics \u00ae Data Mart. We identified infants\u2019 first MA RSV LRTI diagnosis during their first RSV season and followed them for 7 subsequent days to record outpatient, emergency department, and inpatient hospital utilization. We calculated the number of outpatient visits, emergency department visits, and inpatient hospital stays occurring during this acute episode and estimated the proportion of episodes involving \u2265 2 visits to a given healthcare setting.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In the CCAE database, we identified 25,409 acute MA RSV LRTI episodes under the specific RSV definition and 69,068 under the sensitive definition. In the MDCD database, these totals were 67,357 and 170,744, while in the CDM database, they were 12,402 and 31,363, respectively. Across data sources, 34%\u201369% of infants\u2019 first acute MA RSV LRTI episodes involve 2 or more visits to a healthcare setting within 7 days. The percentage of episodes involving at least 2 visits ranged from 34\u201362% among healthy term infants, 38\u201365% for Palivizumab-eligible infants, and 38\u201369% for infants with other comorbidities.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Within a week of their first MA RSV LRTI diagnosis, infants frequently experience at least 2 visits to one or more healthcare settings, regardless of their comorbidity profile. The percentage of MA RSV LRTI episodes involving at least 2 visits to a healthcare setting may vary by insurance claims database, even between commercial payers.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0313573","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T18:26:37Z","timestamp":1739211997000},"page":"e0313573","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Healthcare utilization during acute medically attended episodes of respiratory syncytial virus-related lower respiratory tract infection among infants in the United States"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8144-4273","authenticated-orcid":true,"given":"Jason R.","family":"Gantenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3025-7811","authenticated-orcid":true,"given":"Robertus","family":"van Aalst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Diakun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M.","family":"Bengtson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan L.","family":"Limone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher B.","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Savitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew R.","family":"Zullo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"pone.0313573.ref001","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0140-6736(10)60206-1","article-title":"Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: A systematic review and meta-analysis","volume":"375","author":"H Nair","year":"2010","journal-title":"The Lancet"},{"issue":"6","key":"pone.0313573.ref002","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1097\/EDE.0000000000001092","article-title":"Hospitalizations associated with respiratory syncytial virus and influenza in children, including children diagnosed with asthma.","volume":"30","author":"E Goldstein","year":"2019","journal-title":"Epidemiology"},{"key":"pone.0313573.ref003","first-page":"143","article-title":"Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000.","author":"S Leader","year":"2003","journal-title":"The Journal of Pediatrics"},{"issue":"Supplement_2","key":"pone.0313573.ref004","doi-asserted-by":"crossref","first-page":"S154","DOI":"10.1093\/infdis\/jiac120","article-title":"Respiratory syncytial virus is the leading cause of United States infant hospitalizations, 2009\u20132019: A study of the National (Nationwide) Inpatient Sample.","volume":"226","author":"M Suh","year":"2022","journal-title":"The Journal of Infectious Diseases"},{"issue":"1","key":"pone.0313573.ref005","doi-asserted-by":"crossref","first-page":"e20193611","DOI":"10.1542\/peds.2019-3611","article-title":"Respiratory syncytial virus-associated hospitalizations among young children: 2015\u20132016","volume":"146","author":"B Rha","year":"2020","journal-title":"Pediatrics"},{"issue":"2","key":"pone.0313573.ref006","doi-asserted-by":"crossref","first-page":"X20","DOI":"10.1542\/peds.2013-0303d","article-title":"Respiratory syncytial virus\u2013associated hospitalizations among children less than 24 months of age","volume":"132","author":"CB Hall","year":"2013","journal-title":"Pediatrics"},{"issue":"2","key":"pone.0313573.ref007","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1542\/peds.2014-1665","article-title":"Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection","volume":"134","author":"MT Brady","year":"2014","journal-title":"Pediatrics"},{"issue":"4","key":"pone.0313573.ref008","doi-asserted-by":"crossref","first-page":"e0152208","DOI":"10.1371\/journal.pone.0152208","article-title":"Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997\u20132012; respiratory syncytial virus.","volume":"11","author":"A Doucette","year":"2016","journal-title":"PLoS ONE."},{"issue":"Supplement_2","key":"pone.0313573.ref009","doi-asserted-by":"crossref","first-page":"S195","DOI":"10.1093\/infdis\/jiac201","article-title":"A systematic literature review of the burden of respiratory syncytial virus and health care utilization among united states infants younger than 1 year","volume":"226","author":"M Suh","year":"2022","journal-title":"The Journal of Infectious Diseases"},{"issue":"34","key":"pone.0313573.ref010","doi-asserted-by":"crossref","first-page":"920","DOI":"10.15585\/mmwr.mm7234a4","article-title":"Use of nirsevimab for the prevention of respiratory syncytial virus disease among infants and young children: Recommendations of the Advisory Committee on Immunization Practices\u2014United States, 2023.","volume":"72","author":"JM Jones","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"Supplement_2","key":"pone.0313573.ref011","doi-asserted-by":"crossref","first-page":"S164","DOI":"10.1093\/infdis\/jiac185","article-title":"Medically attended illness due to respiratory syncytial virus (RSV) infection among infants born in the United States between 2016 and 2020.","volume":"226","author":"JR Gantenberg","year":"2022","journal-title":"The Journal of Infectious Diseases"},{"key":"pone.0313573.ref012","article-title":"RSV Clinical Trial Tracker.","author":"PATH.org"},{"issue":"3","key":"pone.0313573.ref013","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/infdis\/jix275","article-title":"Determining the Seasonality of Respiratory Syncytial Virus in the United States: The Impact of Increased Molecular Testing","volume":"216","author":"CM Midgley","year":"2017","journal-title":"The Journal of Infectious Diseases"},{"key":"pone.0313573.ref014","article-title":"The National Respiratory and Enteric Virus Surveillance System (NREVSS).","author":"Centers for Disease Control and Prevention","journal-title":"Respiratory syncytial virus surveillance"},{"issue":"2","key":"pone.0313573.ref015","first-page":"119","article-title":"Approximate is better than \u201cexact\u201d for interval estimation of binomial proportions.","volume":"52","author":"A Agresti","year":"1998","journal-title":"The American Statistician"},{"issue":"6","key":"pone.0313573.ref016","doi-asserted-by":"crossref","first-page":"e1453","DOI":"10.1542\/peds.2010-0507","article-title":"Risk factors in children hospitalized with RSV bronchiolitis versus non\u2013RSV bronchiolitis","volume":"126","author":"CG Garc\u00eda","year":"2010","journal-title":"Pediatrics"},{"key":"pone.0313573.ref017","doi-asserted-by":"crossref","first-page":"204993612211121","DOI":"10.1177\/20499361221112171","article-title":"Comparison of clinical presentations and burden of respiratory syncytial virus in infants across three distinct healthcare settings in davidson county, tennessee.","volume":"9","author":"DA Rankin","year":"2022","journal-title":"Therapeutic Advances in Infectious Disease"},{"key":"pone.0313573.ref018","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jpeds.2021.03.036","article-title":"Respiratory virus surveillance in infants across different clinical settings","volume":"234","author":"Z Haddadin","year":"2021","journal-title":"The Journal of Pediatrics"},{"key":"pone.0313573.ref019","article-title":"FDA approves new drug to prevent RSV in babies and toddlers.","author":"Office of the Commissioner"},{"issue":"6","key":"pone.0313573.ref020","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1093\/infdis\/jiaa752","article-title":"Respiratory syncytial virusassociated hospitalization rates among US infants: A systematic review and meta-analysis, respiratory syncytial virus","volume":"225","author":"JM McLaughlin","year":"2022","journal-title":"The Journal of Infectious Diseases"},{"issue":"1","key":"pone.0313573.ref021","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-021-06399-8","article-title":"Economic and disease burden of RSV-associated hospitalizations in young children in France, from 2010 through 2018.","volume":"21","author":"C Demont","year":"2021","journal-title":"BMC Infectious Diseases"},{"issue":"6","key":"pone.0313573.ref022","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1111\/irv.12665","article-title":"Evaluation of using ICD-10 code data for respiratory syncytial virus surveillance.","volume":"14","author":"W Cai","year":"2019","journal-title":"Influenza and Other Respiratory Viruses"},{"issue":"12","key":"pone.0313573.ref023","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1002\/hsr2.91","article-title":"Prevalence of Infant Bronchiolitis-Coded Healthcare Encounters Attributable to RSV; respiratory syncytial virus.","volume":"1","author":"KN Turi","year":"2018","journal-title":"Health Sci Rep."},{"issue":"477","key":"pone.0313573.ref024","article-title":"Births in the United States, 2022.","author":"JA Martin","year":"2023","journal-title":"NCHS Data Brief."},{"issue":"5","key":"pone.0313573.ref025","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/01.ede.0000135174.63482.43","article-title":"A structural approach to selection bias.","volume":"15","author":"MA Hern\u00e1n","year":"2004","journal-title":"Epidemiology"},{"issue":"1","key":"pone.0313573.ref026","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/EDE.0000000000000409","article-title":"Selection bias due to loss to follow up in cohort studies.","volume":"27","author":"CJ Howe","year":"2016","journal-title":"Epidemiology"},{"issue":"4","key":"pone.0313573.ref027","doi-asserted-by":"crossref","first-page":"558","DOI":"10.3390\/idr14040059","article-title":"Impact of COVID-19 on the changing patterns of respiratory syncytial virus infections.","volume":"14","author":"I Garg","year":"2022","journal-title":"Infectious Disease Reports"},{"issue":"11","key":"pone.0313573.ref028","first-page":"e42","article-title":"COVID-19 public health measures and respiratory syncytial virus. The Lancet Child &","volume":"4","author":"PN Britton","year":"2020","journal-title":"Adolescent Health"},{"issue":"10","key":"pone.0313573.ref029","doi-asserted-by":"crossref","first-page":"3106","DOI":"10.1002\/ppul.25582","article-title":"During the COVID-19 pandemic where has respiratory syncytial virus gone?","volume":"56","author":"GD Mattia","year":"2021","journal-title":"Pediatric Pulmonology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0313573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T18:26:47Z","timestamp":1739212007000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0313573"}},"subtitle":[],"editor":[{"given":"Farhana","family":"Haque","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,2,10]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0313573","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,10]]}}}