Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: Systematic review and meta-analysis.
Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: Systematic review and meta-analysis.
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DOI：
10.7189/jogh.05.020416
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发表时间：
2015-12
影响因子：
7.2
通讯作者：
Nair H
中科院分区：
文献类型：
--
作者：
Shi T;Balsells E;Wastnedge E;Singleton R;Rasmussen ZA;Zar HJ;Rath BA;Madhi SA;Campbell S;Vaccari LC;Bulkow LR;Thomas ED;Barnett W;Hoppe C;Campbell H;Nair H
呼吸道合胞病毒（RSV）是幼儿急性下呼吸道感染（ALRI）中最常见的病原体，也是入院的重要原因。RSV感染的高发病率及其潜在的严重结局使得识别和优先考虑发生RSV相关ALRI风险较高的儿童变得非常重要。我们的目的是确定幼儿RSV相关ALRI的危险因素。我们对4个数据库进行了系统性文献综述，并从RSV全球流行病学网络（RSV GEN）合作者处获得了未发表的研究。所有合格研究的质量根据改良的GRADE标准进行评估。我们进行了荟萃分析，以估计单个风险因素的比值比和95%置信区间（CI）。我们确定了20项“高质量”的研究（3项为未发表的数据），这些研究调查了5岁以下儿童中RSV相关ALRI的18个危险因素。其中，8个危险因素与RSV相关的ALRI显著相关。其比值比（OR）及其相应的95%置信区间（CI）的荟萃估计值为早产儿1.96（95% CI 1.44-2.67），低出生体重1.91（95% CI 1.45-2.53），男性为1.23（95% CI 1.13-1.33），有兄弟姐妹1.60（95% CI 1.32-1.95），母亲吸烟1.36（95% CI 1.24-1.50），特应性病史1.47（95% CI 1.16-1.87），无母乳喂养2.24（95% CI 1.56-3.20）和拥挤1.94（95% CI 1.29-2.93）。虽然没有足够的研究来生成HIV的荟萃估计，但所有文章（无论质量评分如何）都报告了HIV与RSV相关ALRI之间的显著相关性。这项研究提出了一个全面的报告之间的关联强度的各种社会人口学危险因素和RSV相关的ALRI的幼儿。其中一些可接受的风险因素与已确定的（全因）ALRI风险因素相似，因此，除了新型RSV疫苗的未来影响外，作为国家控制计划的一部分，针对ALRI风险因素的国家行动预计将减少RSV的疾病负担。进一步的研究，识别，访问和分析额外的未发表的RSV数据集可以进一步提高这些估计的精度。
Respiratory syncytial virus (RSV) is the most common pathogen identified in young children with acute lower respiratory infection (ALRI) as well as an important cause of hospital admission. The high incidence of RSV infection and its potential severe outcome make it important to identify and prioritise children who are at higher risk of developing RSV–associated ALRI. We aimed to identify risk factors for RSV–associated ALRI in young children. We carried out a systematic literature review across 4 databases and obtained unpublished studies from RSV Global Epidemiology Network (RSV GEN) collaborators. Quality of all eligible studies was assessed according to modified GRADE criteria. We conducted meta–analyses to estimate odds ratios with 95% confidence intervals (CI) for individual risk factors. We identified 20 studies (3 were unpublished data) with “good quality” that investigated 18 risk factors for RSV–associated ALRI in children younger than five years old. Among them, 8 risk factors were significantly associated with RSV–associated ALRI. The meta–estimates of their odds ratio (ORs) with corresponding 95% confidence intervals (CI) are prematurity 1.96 (95% CI 1.44–2.67), low birth weight 1.91 (95% CI 1.45–2.53), being male 1.23 (95% CI 1.13–1.33), having siblings 1.60 (95% CI 1.32–1.95), maternal smoking 1.36 (95% CI 1.24–1.50), history of atopy 1.47 (95% CI 1.16–1.87), no breastfeeding 2.24 (95% CI 1.56–3.20) and crowding 1.94 (95% CI 1.29–2.93). Although there were insufficient studies available to generate a meta–estimate for HIV, all articles (irrespective of quality scores) reported significant associations between HIV and RSV–associated ALRI. This study presents a comprehensive report of the strength of association between various socio–demographic risk factors and RSV–associated ALRI in young children. Some of these amenable risk factors are similar to those that have been identified for (all cause) ALRI and thus, in addition to the future impact of novel RSV vaccines, national action against ALRI risk factors as part of national control programmes can be expected to reduce burden of disease from RSV. Further research which identifies, accesses and analyses additional unpublished RSV data sets could further improve the precision of these estimates.