Matias Gonçalo, Taylor Robert, Haguinet François, Schuck-Paim Cynthia, Lustig Roger, Shinde Vivek
GSK, Wavre, Belgium.
Sage Analytica, Bethesda, MD, USA.
BMC Public Health. 2017 Mar 21;17(1):271. doi: 10.1186/s12889-017-4177-z.
Estimates of influenza and respiratory syncytial virus (RSV) burden must be periodically updated to inform public health strategies. We estimated seasonal influenza- and RSV-attributable hospitalizations in the US from 1997 to 2009 according to age and risk status (NCT01599390).
Multiple linear regression modelling was used to attribute hospitalizations to influenza or RSV using virological surveillance and hospitalization data. Hospitalization data were obtained from the US Nationwide Inpatient Sample and virology data were obtained from FluView (Centers for Disease Control and Prevention). Outcomes included any mention of ICD-coded respiratory disease and cardiorespiratory disease diagnoses. We also explored a broader definition of respiratory disease that included mention of relevant respiratory sign/symptoms and viral infection ("respiratory broad").
Applying the respiratory broad outcome, our model attributed ~300,000 and ~200,000 hospitalizations to influenza and RSV, respectively. Influenza A/H3N2 was the predominant cause of influenza-related hospitalizations in most seasons, except in three seasons when influenza B was dominant; likewise, A/H3N2 caused most influenza-related hospitalizations in all age segments, except in children <18 years where the relative contribution of A/H3N2 and B was similar. Most influenza A- and B-related hospitalizations occurred in seniors while approximately one half and one third of all RSV-related events occurred in children 0-4 years and seniors 65+ years, respectively. High-risk status was associated with higher risk of both influenza- and RSV-attributable hospitalizations in adults, but not in children.
Our study assessed the burden of influenza and RSV, information that is important for both cost effectiveness studies and for prioritization of the development of antivirals and vaccines. For seniors, we found that the burdens of influenza and RSV were both substantial. Among children <18 years, about half of all influenza hospitalizations were due to influenza B, most occurring in children without noted risk conditions. RSV hospitalizations among children were confined to those 0-4 years. Our study also demonstrated the importance of the outcome used to estimate hospitalization burden. Our findings highlight the burden of influenza among children regardless of risk status and underscore the prevalence of RSV infections among both young children and older adults.
必须定期更新流感和呼吸道合胞病毒（RSV）负担的估计值，以便为公共卫生策略提供信息。我们根据年龄和风险状况估算了1997年至2009年美国季节性流感和RSV导致的住院病例（NCT01599390）。
采用多元线性回归模型，利用病毒学监测和住院数据将住院病例归因于流感或RSV。住院数据来自美国全国住院患者样本，病毒学数据来自FluView（疾病控制与预防中心）。结果包括任何提及ICD编码的呼吸系统疾病和心肺疾病诊断。我们还探讨了呼吸系统疾病的更广泛定义，其中包括提及相关的呼吸体征/症状和病毒感染（“广义呼吸系统疾病”）。
应用广义呼吸系统疾病这一结果，我们的模型分别将约30万例和20万例住院病例归因于流感和RSV。甲型H3N2流感是大多数季节中与流感相关住院病例的主要原因，但在乙型流感占主导的三个季节除外；同样，甲型H3N2流感导致了所有年龄组中大多数与流感相关的住院病例，但在18岁以下儿童中，甲型H3N2流感和乙型流感的相对贡献相似。大多数甲型和乙型流感相关的住院病例发生在老年人中，而所有RSV相关病例中分别约有一半和三分之一发生在0至4岁儿童和65岁及以上老年人中。高风险状态与成人中流感和RSV导致的住院风险较高相关，但在儿童中并非如此。
我们的研究评估了流感和RSV的负担，这些信息对于成本效益研究以及抗病毒药物和疫苗研发的优先级确定都很重要。对于老年人，我们发现流感和RSV的负担都很大。在18岁以下儿童中，约一半的流感住院病例是由乙型流感引起的，大多数发生在无明显风险状况的儿童中。儿童中的RSV住院病例仅限于0至4岁的儿童。我们的研究还证明了用于估计住院负担的结果的重要性。我们的研究结果突出了无论风险状况如何儿童中流感的负担，并强调了幼儿和老年人中RSV感染的普遍性。
