Respiratory syncytial virus infection in elderly and high-risk adults
Respiratory syncytial virus infection in elderly and high-risk adults
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DOI：
10.1056/nejmoa043951
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发表时间：
2005-04-28
影响因子：
158.5
通讯作者：
Walsh, EE
中科院分区：
文献类型：
--
作者：
Falsey, AR;Hennessey, PA;Walsh, EE
背景：呼吸道合胞病毒（RSV）是一种日益被认可的成人疾病病因。社区老年人和高危成人的流行病学和临床效果数据有助于评估疫苗开发的必要性。方法：在连续四个冬季，我们评估了健康老年患者（大于/等于 65 岁）和高危成人（患有慢性心脏病或肺病的患者）以及因急性心肺疾病住院的患者的前瞻性队列中的所有呼吸道疾病。 RSV感染和甲型流感的诊断基于培养、逆转录酶聚合酶链反应和血清学研究。结果：共有608名健康老年患者和540名高危成人纳入前瞻性监测，并纳入1388名住院患者。总共评估了 2514 种疾病。前瞻性队列中的 102 名患者和 142 名住院患者中发现 RSV 感染，前瞻性队列中的 44 名患者和 154 名住院患者中诊断出甲型流感。每年有 3% 至 7% 的健康老年患者和 4% 至 10% 的高危成人感染 RSV。在健康的老年患者中，RSV 感染导致就诊的人数少于流感患者；然而，两组高危成年人对医疗保健服务的使用情况相似。在住院队列中，RSV 感染和甲型流感导致的住院时间、重症监护使用率（分别为 15% 和 12%）和死亡率（分别为 8% 和 7%）相似。根据《国际疾病分类》第 9 版、出院时临床修改诊断代码，RSV 感染占肺炎住院的 10.6%、慢性阻塞性肺疾病的 11.4%、充血性心力衰竭的 5.4%、哮喘的 7.2%。结论：RSV 感染是老年人和高危成人的重要疾病，其疾病负担与非大流行性甲型流感相似。流感疫苗接种率较高的人群。有效的 RSV 疫苗可能会给这些成年人带来好处。
BACKGROUND:Respiratory syncytial virus (RSV) is an increasingly recognized cause of illness in adults. Data on the epidemiology and clinical effects in community-dwelling elderly persons and high-risk adults can help in assessing the need for vaccine development.METHODS:During four consecutive winters, we evaluated all respiratory illnesses in prospective cohorts of healthy elderly patients (greater/equal 65 years of age) and high-risk adults (those with chronic heart or lung disease) and in patients hospitalized with acute cardiopulmonary conditions. RSV infection and influenza A were diagnosed on the basis of culture, reverse-transcriptase polymerase chain reaction, and serologic studies.RESULTS:A total of 608 healthy elderly patients and 540 high-risk adults were enrolled in prospective surveillance, and 1388 hospitalized patients were enrolled. A total of 2514 illnesses were evaluated. RSV infection was identified in 102 patients in the prospective cohorts and 142 hospitalized patients, and influenza A was diagnosed in 44 patients in the prospective cohorts and 154 hospitalized patients. RSV infection developed annually in 3 to 7 percent of healthy elderly patients and in 4 to 10 percent of high-risk adults. Among healthy elderly patients, RSV infection generated fewer office visits than influenza; however, the use of health care services by high-risk adults was similar in the two groups. In the hospitalized cohort, RSV infection and influenza A resulted in similar lengths of stay, rates of use of intensive care (15 percent and 12 percent, respectively), and mortality (8 percent and 7 percent, respectively). On the basis of the diagnostic codes of the International Classification of Diseases, 9th Revision, Clinical Modification at discharge, RSV infection accounted for 10.6 percent of hospitalizations for pneumonia, 11.4 percent for chronic obstructive pulmonary disease, 5.4 percent for congestive heart failure, and 7.2 percent for asthma.CONCLUSIONS:RSV infection is an important illness in elderly and high-risk adults, with a disease burden similar to that of nonpandemic influenza A in a population in which the prevalence of vaccination for influenza is high. An effective RSV vaccine may offer benefits for these adults.