Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.
Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance.
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DOI：
10.1086/606055
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发表时间：
2009-11-01
期刊：
影响因子：
--
通讯作者：
Medley GF
中科院分区：
文献类型：
--
作者：
Nokes DJ;Ngama M;Bett A;Abwao J;Munywoki P;English M;Scott JA;Cane PA;Medley GF
虽然有必要制定一个理由接种疫苗，严重呼吸道合胞病毒（RSV）疾病的负担在儿童中的资源贫乏的设置仍然很难界定。我们对2002年至2007年在肯尼亚沿海地区基利菲地区医院住院的5岁以下儿童的重症和极重症肺炎进行了前瞻性监测。通过免疫荧光法筛选鼻标本中的RSV抗原。估计了明确定义的用户人群的发生率。在25，149名住院患者中，7，359名（29%）患有重度或极重度肺炎，其中6，026名（82%）入组。RSV患病率为15%（婴儿为20%），流行期间为27%（婴儿为32%）。>=3个月的病例比例为65%，>=6个月的病例比例为43%。五岁以下儿童的平均年住院率为293/100，000（95% CI 271-371），婴儿的平均年住院率为1，107/100，000（1，012 - 1，211）。医院附近地区的入院率翻了一番。很少有RSV病例具有危及生命的临床特征或并发严重疾病，相关死亡率为2.2%。在这种低收入环境中，RSV相关肺炎的住院率很高，与美国的估计相当，但大大低估了整个社区的负担。在>2个月大的儿童中，即在反应较差的年龄组之外，有效的疫苗可以预防大部分RSV疾病。严重程度数据表明，RSV疫苗接种的基础是预防发病率而不是死亡率。对肯尼亚一家农村医院的儿科住院患者进行6年监测，提供了低收入环境中RSV肺炎的明确发病率估计值和临床特征。数据表明，接种疫苗应基于发病率，而不是死亡率，目标人群为2个月以上的年龄组。
Although necessary in developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in the resource poor setting remains poorly defined. We conducted prospective surveillance of severe and very severe pneumonia in children aged less than 5 years admitted between 2002 and 2007 to Kilifi district hospital, coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated for the well-defined user population. Out of 25,149 admissions 7,359 (29%) had severe or very severe pneumonia, of whom 6,026 (82%) were enrolled. RSV prevalence was 15% (20% in infants) and 27% during epidemics (32% in infants). The proportion of cases >=3 months was 65% and >=6 months was 43%. Average annual hospitalization rates were 293 per 100,000 children under five years (95% CI 271-371) and 1,107 per 100,000 infants (1,012-1,211). Admission rates were double in the region close to the hospital. Few RSV cases had life-threatening clinical features or concurrent serious illnesses, and associated mortality was 2.2%. In this low-income setting, rates of hospital admission with RSV-associated pneumonia are substantial, comparable to estimates from the US, yet considerably under-estimate the full community burden. An effective vaccine in children >2 months old, that is, outside the poor-responder age group, could prevent a large portion of RSV disease. Severity data suggest the basis for RSV vaccination will be the prevention of morbidity not mortality. Six years surveillance of pediatric admissions to a rural Kenyan hospital provides well-defined incidence estimates and clinical characteristics of RSV pneumonia in a low-income setting. Data argue for vaccination based on morbidity, not mortality, targeted at age groups >2 months.
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影响因子：
9.4
作者：
Kuypers, Jane;Wright, Nancy;Morrow, Rhoda
通讯作者：
Morrow, Rhoda
DOI：
10.1056/nejmoa0804877
发表时间：
2009-02-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
Hall CB;Weinberg GA;Iwane MK;Blumkin AK;Edwards KM;Staat MA;Auinger P;Griffin MR;Poehling KA;Erdman D;Grijalva CG;Zhu Y;Szilagyi P
通讯作者：
Szilagyi P
影响因子：
3.3
作者：
Weber, MW;Mulholland, EK;Greenwood, BM
通讯作者：
Greenwood, BM
影响因子：
15.8
作者：
Nokes, D. James;Abwao, John;Williams, Thomas N.
通讯作者：
Williams, Thomas N.
影响因子：
5.5
作者：
Wright, Peter F.;Karron, Ruth A.;Murphy, Brian R.
通讯作者：
Murphy, Brian R.