欧洲甲型H1N1大流行性流感与先天性异常患病率的关联：一项生态时间序列研究。
The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study.
作者信息
Luteijn Johannes Michiel, Addor Marie-Claude, Arriola Larraitz, Bianchi Fabrizio, Garne Ester, Khoshnood Babak, Nelen Vera, Neville Amanda, Queisser-Luft Annette, Rankin Judith, Rounding Catherine, Verellen-Dumoulin Christine, de Walle Hermien, Wellesley Diana, Wreyford Ben, Yevtushok Lyubov, de Jong-van den Berg Lolkje, Morris Joan, Dolk Helen
机构信息
From the aInstitute of Nursing Research/School of Nursing, University of Ulster, Newtownabbey, United Kingdom; bDivision of Medical Genetics, Lausanne, Switzerland; cPublic Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, CIBER Epidemiología y Salud Pública-CIBERESP, Madrid, Spain; dUnit of Epidemiology, Institute of Clinical Physiology, Pisa, Italy; eDepartment of Paediatrics, Hospital Lillebaelt, Kolding, Denmark; fINSERM U953, Paris, France; gProvinciaal Instituut voor Hygiene, Antwerp, Belgium; hIMER Registry-Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy; iUniversity Medical Center of the Johannes Gutenberg University, Mainz, Germany; jInstitute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom; kNational Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom; lInstitut de Pathologie et de Génétique, Charleroi, Belgium; mDepartment of Genetics, University Medical Center Groningen, University of Groningen, Eurocat, Groningen, The Netherlands; nWessex Clinical Genetics Service, Princess Anne Hospital, Southampton, United Kingdom; oSchool of Clinical Sciences, University of Bristol, Bristol, United Kingdom; pOMNI-Net for Children, Rivne Medical Diagnostic Center, Rivne, Ukraine; qDivision of Pharmacy, Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen, The Netherlands; and rCentre for Environmental and Preventive Medicine, Queen Mary University of London, London, United Kingdom.
出版信息
Epidemiology. 2015 Nov;26(6):853-61. doi: 10.1097/EDE.0000000000000372.
BACKGROUND
In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of congenital anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons.
METHODS
We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal congenital anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the congenital anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies.
RESULTS
There was no evidence for an increased overall prevalence of congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons.
CONCLUSIONS
Our data do not suggest an overall association of pandemic or seasonal influenza with congenital anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.
背景
在欧洲先天性异常监测系统（EUROCAT）针对2009年流感大流行的监测反应背景下，我们试图确定在一般情况下，暴露于流感季节的妊娠中先天性异常患病率是否有可检测到的增加，以及2009年大流行期间的任何增加是否比其他季节更大。
方法
我们基于15个EUROCAT登记处报告的26967例2007年1月至2011年3月受孕的非染色体先天性异常妊娠进行了生态时间序列分析。对EUROCAT定义的异常亚组进行分析，根据是否有与流感相关的先前假设进行划分。流感季节暴露基于世界卫生组织的数据。计算患病率比，将在胚胎-胎儿发育的先天性异常特定关键期暴露于流感季节的妊娠与未暴露的妊娠进行比较。
结果
没有证据表明暴露于流感季节的妊娠中先天性异常的总体患病率增加。我们在2009年大流行性流感季节检测到室间隔缺损、三尖瓣闭锁和狭窄的患病率增加，但在2007 - 2011年流感季节未检测到。对于没有先前假设的先天性异常，法洛四联症的患病率在流感季节大幅降低。
结论
我们的数据不表明大流行或季节性流感与先天性异常患病率之间存在总体关联。一种解释是，先前基于个体的研究中发现的明显流感效应被其他风险因素混淆或相互作用。心脏异常与大流行性流感的关联可能具有毒株特异性。
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