The clinical impact of serious respiratory disease in children under the age of two during the 2021-2022 bronchiolitis season in the United Kingdom and Ireland
The clinical impact of serious respiratory disease in children under the age of two during the 2021-2022 bronchiolitis season in the United Kingdom and Ireland
复制标题
2021-2022 年英国和爱尔兰细支气管炎季节期间严重呼吸道疾病对两岁以下儿童的临床影响
DOI：
10.1101/2023.02.22.23285616
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Williams T
中科院分区：
文献类型：
--
作者：
Williams T
2020年为减少SARS-CoV-2的传播而采取的干预措施在随后的一年导致儿童感染，包括呼吸道合胞病毒（RSV）的广泛减少。然而，从2021年春季开始，英国和爱尔兰开始经历一场不寻常的儿童呼吸道疾病的季节性流行。方法：我们进行了一项前瞻性观察队列研究（BronchStart），招募了2021年5月1日至2022年4月30日在英格兰、苏格兰和爱尔兰的59个急诊科（ED）就诊的年龄为0-23个月、临床诊断为毛细支气管炎、下呼吸道感染或首次发作哮鸣的儿童。我们收集了患者人口统计学和临床表现的基线数据，以及7天的随访数据。我们使用高粒度BronchStart临床数据以及全国英格兰和苏格兰入院数据集来推断Covid-19大流行前典型年份RSV疾病的影响，并提供疾病年度影响的最新估计，为实施抗RSV干预措施提供信息。BronchStart研究收集了17179名儿童的17899份ED报告的数据。其中，6825人（38.1%）入院接受进一步观察或治疗，458人（2.6%）需要在高依赖病房（HDU）接受护理，154人（0.9%）住进儿科重症监护病房（PICU）。在5788名入院并接受呼吸道合胞病毒检测的儿童中，41.8%的整体研究队列和48.7%的0-11个月大的儿童呈阳性。入院的危险因素包括早产和先天性心脏病。具有这些危险因素的患者也更有可能接受氧气治疗，或被送入HDU或PICU。然而，84.5%住进观察病房的患者、78.1%住进病房的患者、67.7%住进HDU的患者和50.0%住进PICU的患者没有确定的合并症。根据英格兰和苏格兰的入院数据，我们估计每年有12167名呼吸道合胞病毒感染的婴儿在二级护理中接受低流量氧气，4998名高流量氧气和6198名抗生素治疗。虽然RSV是该队列的主要病原体，但在1岁以下的严重呼吸道病毒感染入院患者中，51.3%与该病毒无关。虽然早产和先天性心脏病是入院、HDU和PICU的危险因素，但除PICU外，所有级别护理的大多数入院都是以前健康的足月婴儿。
BackgroundInterventions introduced in 2020 to reduce the spread of SARS-CoV-2 led to a widespread reduction in childhood infections, including respiratory syncytial virus (RSV), in the subsequent year. However, from the spring of 2021 onwards the United Kingdom and Ireland began to experience an unusual out of season epidemic of childhood respiratory disease.MethodsWe conducted a prospective observational cohort study (BronchStart), enrolling children aged 0-23 months presenting with clinician-diagnosed bronchiolitis, lower respiratory tract infection or first episode of wheeze in 59 Emergency Departments (ED) across England, Scotland and Ireland from 1 May 2021 to 30 April 2022. We collected baseline data on patient demographics and clinical presentation, and follow-up data at 7 days. We used high-granularity BronchStart clinical data together with national English and Scottish admission datasets to infer the impact of RSV disease in a typical year before the Covid-19 pandemic, and to provide an up-to-date estimate of the annual impact of disease to inform implementation of anti-RSV interventions.FindingsThe BronchStart study collected data on 17,899 ED presentations for 17,179 children. Of these, 6,825 (38.1%) were admitted to hospital for further observation or treatment, 458 (2.6%) required care in a high dependency unit (HDU), and 154 (0.9%) were admitted to a paediatric intensive care unit (PICU). Of the 5,788 children admitted and tested for RSV, 41.8% of the overall study cohort, and 48.7% of those 0-11 months of age, were positive. Risk factors for hospital admission included prematurity and congenital cardiac disease. Patients with these risk factors were also more likely to receive oxygen therapy, or be admitted to a HDU or PICU. However, 84.5% of those admitted to an observation unit, 78.1% of those admitted to a ward, 67.7% of those admitted to HDU and 50.0 % of those admitted to PICU had no identified comorbidity. Using admissions data for England and Scotland we estimate that every year 12,167 infants with RSV infection receive low flow oxygen, 4,998 high flow oxygen and 6,198 a course of antibiotic therapy in secondary care.InterpretationAlthough RSV was the major pathogen in this cohort, 51.3% of admissions for serious respiratory viral infections in those aged <1 year of age were not associated with the virus. Whilst prematurity and congenital cardiac disease were risk factors for admission to hospital, HDU and PICU, the majority of these admissions, for all levels of care except PICU, were in previously healthy term born infants.
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影响因子：
11.8
作者：
Kristensen, Kim;Hjuler, Thomas;Stensballe, Lone G.
通讯作者：
Stensballe, Lone G.
影响因子：
3.1
作者：
Stein RT;Bont LJ;Zar H;Polack FP;Park C;Claxton A;Borok G;Butylkova Y;Wegzyn C
通讯作者：
Wegzyn C
影响因子：
3.6
作者：
Hasegawa, Kohei;Goto, Tadahim;Camargo, Carlos A., Jr.
通讯作者：
Camargo, Carlos A., Jr.
为今后呼吸道合胞病毒疫苗的实施做好准备。
DOI：
--
发表时间：
2020
期刊：
The Lancet Respiratory Medicine
影响因子：
--
作者：
T. Williams;Sonnie Kim;D. Spiro;H. Campbell
通讯作者：
H. Campbell
影响因子：
4.5
作者：
Harris PA;Taylor R;Thielke R;Payne J;Gonzalez N;Conde JG
通讯作者：
Conde JG