Respiratory syncytial virus hospitalization in middle-aged and older adults
Respiratory syncytial virus hospitalization in middle-aged and older adults
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DOI：
10.1016/j.jcv.2017.09.001
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发表时间：
2017-11-01
影响因子：
8.8
通讯作者：
Monto, Arnold S.
中科院分区：
文献类型：
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作者：
Malosh, Ryan E.;Martin, Emily T.;Monto, Arnold S.
背景：呼吸道合胞病毒(RSV)在住院成人中的重要性日益被认识，但主要是在65岁的人中。目的：我们试图描述RSV在住院成年人中与流感相比的流行病学和临床严重性。研究设计：在两个流感季节从密歇根两家医院前瞻性地招募患有急性呼吸道疾病(ARI)且持续时间为10天的成年人。收集的样本通过实时逆转录聚合酶链式反应(RT-PCR)进行RSV和流感检测。对RSV阳性标本进行病毒载量和亚型测定。我们使用多变量Logistic回归来评估与RSV和感染结局相关的因素。结果：1259例住院患者中检出呼吸道合胞病毒84例(7%)，其中呼吸道合胞病毒B型55例，甲型呼吸道合胞病毒29例。50岁至年龄段患病率最高(40/460，8.7%)，98%的呼吸道合胞病毒感染者至少有一种慢性合并症。RSV检测与肥胖相关(OR：1.71，95%CI：0.99~3.06，P=0.03)。呼吸道合胞病毒携带者较晚入院，与流感患者相比，查尔森合并症指数的中位数(3vs2p<；0.001)更高。呼吸道合胞病毒相关性住院的临床严重程度与流感相关住院相似。讨论：在本研究中，我们观察到50-年龄段的成年人中呼吸道合胞病毒相关性住院的频率最高，其中许多人患有慢性合并症。我们的结果表明，将这些人纳入未来的RSV疫苗接种策略可能会带来好处。
Background: The importance of Respiratory Syncytial Virus (RSV) is increasingly recognized in hospitalized adults, but mainly in those >= 65 years.Objectives: We sought to describe the epidemiology and clinical severity of RSV compared to influenza in hospitalized adults >= 18 years.Study design: Adults hospitalized with acute respiratory illnesses (ARI) of >= 10 days duration were prospectively enrolled from two Michigan hospitals during two influenza seasons. Collected specimens were tested for RSV and influenza by real-time, reverse transcription polymerase chain reaction (RT-PCR). Viral load and subtype were determined for RSV-positive specimens. We evaluated factors associated with RSV and outcomes of infection using multivariable logistic regression. RSV-positive patients were separately compared to two reference groups: RSV-negative and influenza-negative, and influenza-positive patients.Results: RSV was detected in 84 (7%) of 1259 hospitalized individuals (55 RSV-B, 29 RSV-A). The highest prevalence was found in 50-64 year olds (40/460; 8.7%); 98% of RSV cases in this age group had at least one chronic comorbidity. RSV detection was associated with obesity (OR: 1.71 95% CI: 0.99-3.06, p=0.03). Individuals with RSV were admitted to the hospital later in their illness and had a higher median Charlson comborbidity index (3 vs 2 p < 0.001) compared to those with influenza. Clinical severity of RSV-associated hospitalizations was similar to influenza-associated hospitalizations.Discussion: In this study we observed the highest frequency of RSV-associated hospitalizations among adult 50-64 years old; many of whom had chronic comorbidities. Our results suggest the potential benefit of including these individuals in future RSV vaccination strategies.