Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children
Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children
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DOI：
10.1542/peds.113.6.1758
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发表时间：
2004-06-01
期刊：
影响因子：
8
通讯作者：
Schwartz, B
中科院分区：
文献类型：
--
作者：
Iwane, MK;Edwards, KM;Schwartz, B
目标。呼吸道合胞病毒(RSV)、流感病毒和副流感病毒(PIV)在幼儿中造成严重的发病率。虽然目前只有流感病毒感染和疾病是疫苗可预防的，但针对RSV和PIV的疫苗正在开发中。我们建立了一个前瞻性的、积极的基于人群的监测网络，以提供对幼儿病毒性急性呼吸道疾病(ARI)住院率的准确估计，并衡量加强疫苗使用对这些比率的潜在影响。从2000年10月1日至2001年9月30日，在纽约州门罗县(罗切斯特地区)和田纳西州戴维森县(纳什维尔地区)，对因急性呼吸窘迫综合征住院的幼儿进行了基于人群的前瞻性监测。符合条件的5岁以下儿童是居住在监测县并因发烧或急性呼吸道疾病住院的儿童。病毒培养和聚合酶链式反应从所有监测儿童的鼻腔和喉咙样本中鉴定出病毒。我们测量了基于人群的RSV、流感病毒和PIV的住院率，以及对每种病毒的人口统计学、临床和风险因素评估。在812名符合条件的住院患者中，有592名(73%)儿童入院。在登记的儿童中，发现RSV的占20%，流感占3%，PIV占7%，其他呼吸道病毒占36%，未检测到病毒的占39%。5岁以下儿童急性呼吸窘迫综合征的住院率为千分之十八。每1000名儿童的RSV、PIV和流感病毒阳性住院率分别为3.5、1.2和0.6。年龄较小(特别是1岁)、黑人和西班牙裔种族/民族、男性和存在慢性基础疾病与较高的住院率相关。这项研究证实，5岁以下的儿童，特别是1岁以下的儿童，因RSV、流感和PIV而住院的负担很大。流感疫苗的推广使用以及RSV和PIV疫苗的发展有可能显著降低ARIS的儿科发病率。
Objective. Respiratory syncytial virus (RSV), influenza virus, and parainfluenza viruses (PIV) cause significant morbidity in young children. Although only influenza virus infection and illness is currently vaccine-preventable, vaccines are under development for RSV and PIV. We established a prospective, active population-based surveillance network to provide precise estimates of hospitalization rates for viral acute respiratory illness (ARI) in young children and to measure the potential impact of enhanced vaccine usage on these rates.Methods. Prospective, active population-based surveillance was conducted in young children who were hospitalized for ARI from October 1, 2000, to September 30, 2001, in Monroe County, New York ( Rochester area) and Davidson County, Tennessee ( Nashville area). Eligible children younger than 5 years were those who resided in surveillance counties and were hospitalized for febrile or acute respiratory illness. Viral culture and polymerase chain reaction identified viruses from nasal and throat samples obtained from all surveillance children. We measured population-based rates of hospitalization for RSV, influenza virus, and PIV as well as demographic, clinical, and risk factor assessment for each virus.Results. Of 812 eligible hospital admissions, 592 (73%) children were enrolled. Of the enrolled children, RSV was identified in 20%, influenza in 3%, PIV in 7%, other respiratory viruses in 36%, and no detectable virus in 39%. Population-based rates of ARI hospitalizations in children younger than 5 years were 18 per 1000. Viruspositive hospitalization rates per 1000 children were 3.5 for RSV, 1.2 for PIV, and 0.6 for influenza virus. Younger age ( particularly < 1 year), black and Hispanic race/ethnicity, male gender, and presence of chronic underlying illness were associated with higher hospitalization rates.Conclusions. This study confirms that children younger than 5 years and particularly children younger than 1 year have a high burden of hospitalization from RSV, influenza, and PIV. The enhanced use of influenza vaccine and the development of RSV and PIV vaccines have the potential to reduce markedly the pediatric morbidity from ARIs.