Hall Caroline Breese, Weinberg Geoffrey A, Iwane Marika K, Blumkin Aaron K, Edwards Kathryn M, Staat Mary A, Auinger Peggy, Griffin Marie R, Poehling Katherine A, Erdman Dean, Grijalva Carlos G, Zhu Yuwei, Szilagyi Peter
Department of Pediatrics, the University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
N Engl J Med. 2009 Feb 5;360(6):588-98. doi: 10.1056/NEJMoa0804877.
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.
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充分认识，但RSV感染在幼儿中的总体负担仍未明确界定。
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年住院的儿童以及2002年至2004年在急诊科和儿科诊所就诊的门诊儿童。通过培养和逆转录聚合酶链反应检测RSV。从家长和医疗记录中获取临床信息。我们计算了基于人群的与RSV感染相关的住院率，并估计了与RSV相关的门诊就诊率。
在纳入研究的5067名儿童中，919名（18%）感染了RSV。总体而言，从11月至4月，RSV与20%的住院、18%的急诊科就诊以及15%的急性呼吸道感染门诊就诊相关。6个月以下儿童的年均住院率为每1000名儿童中有17例，5岁以下儿童为每1000名中有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。估计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RSV相关疾病，但很少有疾病（3%）被诊断为由RSV引起。
在美国儿童的住院和门诊环境中，RSV感染都与相当高的发病率相关。大多数感染RSV的儿童此前健康，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。
