Hospital admissions and need for mechanical ventilation in children with respiratory syncytial virus before and during the COVID-19 pandemic: a Danish nationwide cohort study.
Hospital admissions and need for mechanical ventilation in children with respiratory syncytial virus before and during the COVID-19 pandemic: a Danish nationwide cohort study.
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DOI：
10.1016/s2352-4642(22)00371-6
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发表时间：
2023-03
影响因子：
36.4
通讯作者：
Holm, Mette
中科院分区：
文献类型：
--
作者：
Nygaard, Ulrikka;Hartling, Ulla Birgitte;Nielsen, Jens;Vestergaard, Lasse Skafte;Dungu, Kia Hee Schultz;Nielsen, Jeppe Sylvest Angaard;Sellmer, Anna;Matthesen, Astrid Thaarup;Kristensen, Kim;Holm, Mette
在COVID-19限制放宽后，呼吸道合胞病毒（RSV）的发病率在多个国家有所增加。我们旨在研究与2019冠状病毒病大流行前的四个RSV季节相比，2021年夏季和秋季RSV复苏期间RSV相关住院和机械通气需求的年龄相关风险。我们还旨在描述需要机械通气的临床并发症。这项基于人群的队列研究纳入了2021年夏季和秋季RSV复苏期间丹麦住院的0-17岁RSV患者，以及COVID-19前的四个RSV季节（2016-17、2017-18、2018-19和2019-20）。我们从丹麦国家患者登记处检索了RSV相关住院数据，并通过2021- 2022年前瞻性实时数据收集和2016-17至2019- 2020年RSV季节回顾性数据收集，从丹麦所有8个儿科和新生儿重症监护病房检索了接受机械通气儿童的人口统计学和临床详细信息。重度RSV疾病的风险因素定义为年龄小于3个月或重度合并症。我们计算了从第21周至第二年第20周每个RSV季节每10万人中RSV相关住院的风险。我们还计算了每10万人中接受机械通气的风险率，以及从第21周至第二年第20周的每个RSV季节期间1000例RSV相关住院病例。我们通过将2021-22年的住院和机械通气风险率除以四次COVID-19前RSV流行（2016-17至2019-20）的年平均风险率，计算了住院和机械通气的风险比（RR）。我们使用Fisher精确检验比较RR。我们比较了有和没有严重RSV疾病危险因素的儿童之间导致插管的并发症。该研究注册于ClinicalTrials.gov，NCT 05186597。在310423名5岁以下丹麦儿童中，RSV相关住院的平均人数从2016-17年至2019-20年RSV季节的1477人（SD 226）增加到2021-22年RSV季节的3000人（RR 2.0 [95% CI 1.9 - 2.1]）。2021-22年，54名RSV患儿接受了机械通气，而2016-17年至2019-20年RSV季节每年有15-28名患儿接受机械通气（2·3 [1·6-3·3]）。24-59月龄儿童的住院率和机械通气需求增幅最大（住院率为4.1 [3.6 - 4.7];机械通气为4.6 [1.7 - 12.6]）。在住院的儿童中，2021- 2022年和2019冠状病毒病前四个季节的机械通气风险相似（风险率为14.3/1000例RSV相关入院[95%CI 10.4 - 19.3] vs 12.9 [10.1 - 16.1]; RR 1.1 [95%CI 0.8 - 1.6]）。在研究的所有RSV季节中，在小于3个月的儿童或患有严重合并症的儿童中，87名儿童中有69名（79%）因细支气管炎导致呼吸衰竭而接受机械通气。在46例无重度RSV风险因素的儿童中，40例（87%）因其他并发症接受机械通气，包括神经系统（n=16; 35%）、心脏（n=1; 2%）和肺部并发症（n=23; 50%;例如，支气管扩张剂治疗后出现喘息、重度细菌合并感染和气胸）。在丹麦，在2021年放宽COVID-19限制后RSV复苏期间，RSV疾病对个别儿童的严重程度似乎并没有增加。然而，年龄较大的儿童的住院率较高，可能是由于推迟了首次RSV感染或最近没有再感染。没有严重RSV疾病风险因素的年龄较大的儿童有非典型并发症，导致插管。如果对健康婴儿进行新的RSV预防性干预可以延迟首次RSV感染，则可能会有更多的年龄较大的儿童因非典型临床表型而不是经典的细支气管炎而入院。国家高等教育和科学部以及丹麦创新基金。
The incidence of respiratory syncytial virus (RSV) increased in several countries after the relaxation of COVID-19 restrictions. We aimed to investigate the age-related risk of RSV-associated hospital admissions and need for mechanical ventilation during the RSV resurgence in summer and autumn 2021 compared with the four RSV seasons preceding the COVID-19 pandemic. We also aimed to describe the clinical complications necessitating mechanical ventilation. This population-based cohort study included patients aged 0–17 years admitted to hospital with RSV in Denmark during the RSV resurgence in summer and autumn 2021, and the four pre-COVID-19 RSV seasons (2016–17, 2017–18, 2018–19, and 2019–20). We retrieved data on RSV-associated hospital admissions from the Danish National Patient Registry and demographic and clinical details of children who received mechanical ventilation through prospective real-time data collection in 2021–22 and retrospective data collection for the 2016–17 to 2019–20 RSV seasons from all eight paediatric and neonatal intensive care units in Denmark. Risk factors for severe RSV disease were as defined as age younger than 3 months or severe comorbidities. We calculated the risk of RSV-associated hospital admissions per 100 000 population in each RSV season from week 21 to week 20 of the following year. We also calculated the risk rate of receiving mechanical ventilation per 100 000 population and 1000 RSV-associated hospital admissions during each RSV season from week 21 to week 20 of the following year. We calculated risk ratios (RRs) for hospital admission and mechanical ventilation by dividing the risk rate of hospital admission and mechanical ventilation in 2021–22 by annual mean risk rates in the four pre-COVID-19 RSV epidemics (2016–17 to 2019–20). We compared RRs using Fisher's exact test. We compared complications leading to intubation between children with and without risk factors for severe RSV disease. The study is registered at ClinicalTrials.gov, NCT05186597. Among 310 423 Danish children aged younger than 5 years, the mean number of RSV-associated hospital admissions increased from 1477 (SD 226) in the 2016–17 to 2019–20 RSV seasons to 3000 in the 2021–22 RSV season (RR 2·0 [95% CI 1·9–2·1]). 54 children with RSV received mechanical ventilation in 2021–22 compared with 15–28 annually in the 2016–17 to 2019–20 RSV seasons (2·3 [1·6–3·3]). The highest increase in hospital admissions and need for mechanical ventilation occurred among children aged 24–59 months (4·1 [3·6–4·7] for hospital admission; 4·6 [1·7–12·6] for mechanical ventilation). Among children admitted to hospital, the risk of mechanical ventilation was similar in 2021–22 and the four pre-COVID-19 seasons (risk rate 14·3 per 1000 RSV-associated hospital admissions [95% CI 10·4–19·3] vs 12·9 [10·1–16·1]; RR 1·1 [95% CI 0·8–1·6]). Across all RSV seasons studied, among children younger than 3 months or those with severe comorbidities, respiratory failure due to bronchiolitis led to mechanical ventilation in 69 (79%) of 87 children. Of 46 children with no risk factors for severe RSV, 40 (87%) received mechanical ventilation due to additional complications, including neurological (n=16; 35%), cardiac (n=1; 2%), and pulmonary complications (n=23; 50%; eg, wheeze responsive to bronchodilator therapy, severe bacterial co-infections, and pneumothorax). In Denmark, RSV disease did not seem to be more severe for the individual child during the RSV resurgence in 2021 following relaxation of COVID-19 restrictions. However, hospital admissions were higher among older children, possibly due to a postponed first RSV infection or no recent reinfection. Older children without risk factors for severe RSV disease had atypical complications that led to intubation. If new RSV-preventive interventions for healthy infants delay first RSV infection, a higher number of older children might be admitted to hospital due to atypical clinical phenotypes, rather than classical bronchiolitis. National Ministry of Higher Education and Science and the Innovation Fund Denmark.
影响因子：
4.1
作者：
Lanari M;Vandini S;Capretti MG;Lazzarotto T;Faldella G
通讯作者：
Faldella G