Bronchiolitis-associated hospitalizations among American Indian and Alaska Native children

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Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract illness among infants and young children. Respiratory system diseases account for a large proportion of hospitalizations in American Indian and Alaska Native (AI/AN) children; however, aggregate estimates of RSV-associated hospitalizations among AI/AN children have not been made. We used Indian Health Service hospitalization data from 1990 through 1995 to describe hospitalizations associated with bronchiolitis, the most characteristic clinical manifestation of RSV infection, among AI/AN children <5 years old. The overall bronchiolitis-associated hospitalization rate among AI/AN infants <1 year old was considerably higher (61.8 per 1000) than the 1995 estimated bronchiolitis hospitalization rate among all US infants (34.2 per 1000). Hospitalization rates were higher among male infants (72.2 per 1000) than among females infants (51.1 per 1000). The highest infant hospitalization rate was noted in the Navajo Area (96.3 per 1000). Hospitalizations peaked annually in January or February, consistent with national peaks for RSV detection. Bronchiolitis hospitalizations accounted for an increasing proportion of hospitalizations for lower respiratory tract illnesses. Bronchiolitis-associated hospitalization rates are substantially greater for AI/AN infants than those for all US infants. This difference may reflect an increased likelihood of severe RSV-associated disease or a decreased threshold for hospitalization among AI/AN infants with bronchiolitis compared with all US infants. AI/AN children would receive considerable benefit from lower respiratory tract illness prevention programs, including an RSV vaccine, if and when one becomes available.