The burden of respiratory syncytial virus infection in young children.
The burden of respiratory syncytial virus infection in young children.
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DOI：
10.1056/nejmoa0804877
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发表时间：
2009-02-05
期刊：
影响因子：
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通讯作者：
Szilagyi P
中科院分区：
文献类型：
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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
呼吸道合胞病毒（RSV）在导致婴儿住院方面的主要作用已得到广泛认可，但幼儿中RSV感染的总体负担仍不明确。
我们在美国三个县对5岁以下儿童的急性呼吸道感染进行了基于人群的前瞻性监测。我们纳入了2000年至2004年期间住院的儿童以及2002年至2004年期间在急诊科和儿科门诊就诊的儿童。通过培养和逆转录酶 - 聚合酶链反应检测RSV。从家长和病历中获取临床信息。我们计算了与RSV感染相关的基于人群的住院率，并估算了与RSV相关的门诊就诊率。
在参与研究的5067名儿童中，919名（18%）患有RSV感染。总体而言，在11月至次年4月期间，RSV与20%的住院病例、18%的急诊科就诊病例以及15%的门诊就诊的急性呼吸道感染病例相关。6个月以下儿童的年平均住院率为每1000名儿童17例，5岁以下儿童为每1000名儿童3例。大多数儿童没有并存疾病。只有早产和低龄是住院的独立危险因素。据估算，5岁以下儿童中与RSV相关的门诊就诊率是急诊科的三倍。门诊患者患有中度严重的与RSV相关的疾病，但很少有疾病（3%）被诊断为是由RSV引起的。
在美国，RSV感染在住院和门诊环境中都与儿童的大量发病相关。大多数感染RSV的儿童此前身体健康，这表明仅针对高危儿童的控制策略对RSV感染的总体疾病负担影响有限。
The primary role of respiratory syncytial virus (RSV) in causing infant hospitalizations is well recognized, but the total burden of RSV infection among young children remains poorly defined. We conducted prospective, population-based surveillance of acute respiratory infections among children under 5 years of age in three U.S. counties. We enrolled hospitalized children from 2000 through 2004 and children presenting as outpatients in emergency departments and pediatric offices from 2002 through 2004. RSV was detected by culture and reverse-transcriptase polymerase chain reaction. Clinical information was obtained from parents and medical records. We calculated population-based rates of hospitalization associated with RSV infection and estimated the rates of RSV-associated outpatient visits. Among 5067 children enrolled in the study, 919 (18%) had RSV infections. Overall, RSV was associated with 20% of hospitalizations, 18% of emergency department visits, and 15% of office visits for acute respiratory infections from November through April. Average annual hospitalization rates were 17 per 1000 children under 6 months of age and 3 per 1000 children under 5 years of age. Most of the children had no coexisting illnesses. Only prematurity and a young age were independent risk factors for hospitalization. Estimated rates of RSV-associated office visits among children under 5 years of age were three times those in emergency departments. Outpatients had moderately severe RSV-associated illness, but few of the illnesses (3%) were diagnosed as being caused by RSV. RSV infection is associated with substantial morbidity in U.S. children in both inpatient and outpatient settings. Most children with RSV infection were previously healthy, suggesting that control strategies targeting only high-risk children will have a limited effect on the total disease burden of RSV infection.