Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh.
University of Rochester School of Medicine, New York.
J Infect Dis. 2020 Oct 7;222(Supplement_7):S563-S569. doi: 10.1093/infdis/jiy662.
Acute respiratory tract infections (ARI) constitute a substantial disease burden in adults and elderly individuals. We aimed to identify all case-control studies investigating the potential role of respiratory viruses in the etiology of ARI in older adults aged ≥65 years. We conducted a systematic literature review (across 7 databases) of case-control studies published from 1996 to 2017 that investigated the viral profile of older adults with and those without ARI. We then computed a pooled odds ratio (OR) with a 95% confidence interval and virus-specific attributable fraction among the exposed (AFE) for 8 common viruses: respiratory syncytial virus (RSV), influenza virus (Flu), parainfluenza virus (PIV), human metapneumovirus (HMPV), adenovirus (AdV), rhinovirus (RV), bocavirus (BoV), and coronavirus (CoV). From the 16 studies included, there was strong evidence of possible causal attribution for RSV (OR, 8.5 [95% CI, 3.9-18.5]; AFE, 88%), Flu (OR, 8.3 [95% CI, 4.4-15.9]; AFE, 88%), PIV (OR, not available; AFE, approximately 100%), HMPV (OR, 9.8 [95% CI, 2.3-41.0]; AFE, 90%), AdV (OR, not available; AFE, approximately 100%), RV (OR, 7.1 [95% CI, 3.7-13.6]; AFE, 86%) and CoV (OR, 2.8 [95% CI, 2.0-4.1]; AFE, 65%) in older adults presenting with ARI, compared with those without respiratory symptoms (ie, asymptomatic individuals) or healthy older adults. However, there was no significant difference in the detection of BoV in cases and controls. This review supports RSV, Flu, PIV, HMPV, AdV, RV, and CoV as important causes of ARI in older adults and provides quantitative estimates of the absolute proportion of virus-associated ARI cases to which a viral cause can be attributed. Disease burden estimates should take into account the appropriate AFE estimates (for older adults) that we report.
急性呼吸道感染（ARI）在成年人和老年人中构成了相当大的疾病负担。我们旨在确定所有研究呼吸道病毒在老年人呼吸道感染病因学中潜在作用的病例对照研究。我们对 1996 年至 2017 年间发表的病例对照研究进行了系统的文献回顾（跨越 7 个数据库），这些研究调查了患有和未患有 ARI 的老年人的病毒谱。然后，我们计算了 8 种常见病毒的合并比值比（OR）和 95％置信区间以及暴露人群中的病毒特异性归因分数（AFE）：呼吸道合胞病毒（RSV），流感病毒（Flu），副流感病毒（PIV），人偏肺病毒（HMPV），腺病毒（AdV），鼻病毒（RV），博卡病毒（BoV）和冠状病毒（CoV）。在纳入的 16 项研究中，有强有力的证据表明 RSV（OR，8.5 [95％CI，3.9-18.5]；AFE，88％），Flu（OR，8.3 [95％CI，4.4-15.9]；AFE，88％），PIV（OR，无可用数据；AFE，约 100％），HMPV（OR，9.8 [95％CI，2.3-41.0]；AFE，90％），AdV（OR，无可用数据；AFE，约 100％），RV（OR，7.1 [95％CI，3.7-13.6]；AFE，86％）和 CoV（OR，2.8 [95％CI，2.0-4.1]；AFE，65％）在出现 ARI 的老年人中与无呼吸道症状（即无症状个体）或健康老年人相比，具有潜在的因果关系。然而，在病例和对照中检测到 BoV 没有显着差异。该综述支持 RSV，Flu，PIV，HMPV，AdV，RV 和 CoV 是老年人 ARI 的重要原因，并提供了病毒相关性 ARI 病例中可归因于病毒的绝对比例的定量估计。疾病负担估计应考虑到我们报告的适当 AFE 估计值（针对老年人）。
