Meskill Sarah D, Revell Paula A, Chandramohan Lakshmi, Cruz Andrea T
Sections of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Department of Pathology, Baylor College of Medicine, Houston, TX, USA.
Am J Emerg Med. 2017 Mar;35(3):495-498. doi: 10.1016/j.ajem.2016.12.001. Epub 2016 Dec 8.
Respiratory syncytial virus (RSV) and influenza have varying degree of seasonal overlap.
To determine the prevalence of co-infection of RSV and influenza compared to the prevalence of those infections independently when both are in season.
This was a retrospective cross-sectional study of children evaluated between July 2010 and June 2013 for viral respiratory infection using multiplex PCR. Seasonality was defined retrospectively as weeks when >2% of the total annual positive tests were obtained and was calculated for influenza A, influenza B, and RSV independently. Periods of overlapping seasonality of RSV and influenza A and RSV and influenza B were identified. The expected incidences of co-infection were modeled as the product of the incidences of the individual viruses.
13,664 specimens were sent for PCR during the study period. Over all 3 seasons, RSV overlapped with influenza A and B for 22 and 18weeks, respectively; in 2011-12, RSV overlapped with neither influenza A nor B. Based on modeling, there were 6-7 fold fewer cases of RSV/influenza co-infection observed than expected: RSV/influenza A 77 vs. 12, (p≤0.001; RSV/influenza B 76 vs. 11 (p≤0.001).
The observed incidence of co-infectivity of RSV and influenza was significantly less than the expected incidence even when both were co-circulating. In light of these data, it may be reasonable to forgo rapid influenza testing or empiric antiviral treatment for children whom rapid RSV testing is positive and who are at low risk of influenza-related complications, especially in times of antiviral therapy shortages.
呼吸道合胞病毒（RSV）和流感病毒在季节上有不同程度的重叠。
确定RSV和流感病毒合并感染的患病率，并与两种病毒在流行季节单独感染的患病率进行比较。
这是一项回顾性横断面研究，对2010年7月至2013年6月期间因病毒呼吸道感染接受评估的儿童使用多重PCR进行检测。季节性被回顾性定义为每年阳性检测总数>2%的周数，并分别针对甲型流感、乙型流感和RSV进行计算。确定了RSV与甲型流感以及RSV与乙型流感的季节性重叠期。合并感染的预期发病率被建模为各病毒发病率的乘积。
在研究期间共送检了13,664份标本进行PCR检测。在所有3个季节中，RSV分别与甲型流感和乙型流感重叠22周和18周；在2011 - 12年，RSV与甲型流感和乙型流感均无重叠。基于模型分析，观察到的RSV/流感合并感染病例数比预期少6 - 7倍：RSV/甲型流感为77例对12例（p≤0.001）；RSV/乙型流感为76例对11例（p≤0.001）。
即使RSV和流感病毒同时流行，观察到的合并感染发病率仍显著低于预期发病率。鉴于这些数据，对于快速RSV检测呈阳性且流感相关并发症风险较低的儿童，尤其是在抗病毒治疗短缺时期，可能无需进行快速流感检测或经验性抗病毒治疗。
