Choe Young June, Park Sangshin, Michelow Ian C
Department of Pediatrics, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea.
Clin Microbiol Infect. 2020 Dec;26(12):1690.e5-1690.e8. doi: 10.1016/j.cmi.2020.09.006. Epub 2020 Sep 10.
The aim of this study was to assess the co-seasonality and co-detection of respiratory viral infections and bacteraemia in children since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).
Children <18 years old were eligible for inclusion if they had a respiratory infection and a positive PCR-based assay for respiratory viruses as well as a positive blood culture between 2010 and 2018 at a single referral centre in the United States, regardless of their underlying medical condition or antibiotic treatment history. Monthly incidence rates of respiratory viruses and bacteraemia were analysed with a seasonal-trend decomposition procedure based on loess (STL) and cross-correlation functions using time series regression modelling.
We identified 7415 unique positive respiratory virus tests, including 2278 respiratory syncytial virus (RSV) (31%), 1825 influenza viruses (24%), 1036 parainfluenza viruses (14%), 1017 human metapneumovirus (hMPV) (14%), 677 seasonal coronaviruses (9%), and 582 adenoviruses (8%), together with a total of 11 827 episodes of bacteraemia. Significant co-seasonality was found between all-cause bacteraemia and RSV (OR = 1.76, 95%CI 1.50-2.06, p < 0.001), influenza viruses (OR = 1.38, 95%CI 1.13-1.68, p 0.002), and seasonal coronaviruses (OR = 1.18, 95%CI 1.09-1.28, p < 0.001), respectively. Analysis of linked viral-bacterial infections in individual children indicated that the rate ratio (RR) of bacteraemia associated with hMPV (RR = 2.73, 95%CI 1.12-6.85, p 0.019) and influenza (RR = 2.61, 95%CI 1.21-6.11, p 0.013) were more than double that of RSV. Staphylococcus aureus and Streptococcus pneumoniae were the most commonly identified pathogens causing bacteraemia.
There is a significant association between hMPV and influenza viruses and bacteraemia of all causes in hospitalized children at a single paediatric centre in the United States. Large multicentre studies are needed to confirm these findings and to elucidate the mechanisms by which hMPV potentiates the virulence and invasive capacity of diverse bacteria.
本研究旨在评估自13价肺炎球菌结合疫苗（PCV13）引入以来儿童呼吸道病毒感染与菌血症的共同季节性和共同检出情况。
2010年至2018年期间，在美国一家转诊中心，年龄小于18岁、患有呼吸道感染且基于PCR的呼吸道病毒检测呈阳性以及血培养呈阳性的儿童符合纳入标准，无论其潜在疾病状况或抗生素治疗史如何。使用时间序列回归模型，通过基于局部加权回归散点平滑法（STL）的季节性趋势分解程序和互相关函数分析呼吸道病毒和菌血症的月度发病率。
我们鉴定出7415次独特的呼吸道病毒检测呈阳性，其中包括2278次呼吸道合胞病毒（RSV）（31%）、1825次流感病毒（24%）、1036次副流感病毒（14%）、1017次人偏肺病毒（hMPV）（14%）、677次季节性冠状病毒（9%）和582次腺病毒（8%），以及总共11827次菌血症发作。在全因菌血症与RSV（比值比[OR]=1.76，95%置信区间[CI]1.50 - 2.06，p<0.001）、流感病毒（OR = 1.38，95%CI 1.13 - 1.68，p = 0.002）和季节性冠状病毒（OR = 1.18，95%CI 1.09 - 1.28，p<0.001）之间发现了显著的共同季节性。对个体儿童中相关病毒 - 细菌感染的分析表明，与hMPV相关的菌血症的率比（RR）（RR = 2.73，95%CI 1.12 - 6.85，p = 0.019）和流感（RR = 2.61，95%CI 1.21 - 6.11，p = 0.013）是RSV的两倍多。金黄色葡萄球菌和肺炎链球菌是最常鉴定出的导致菌血症的病原体。
在美国一家儿科中心，住院儿童中hMPV和流感病毒与所有原因的菌血症之间存在显著关联。需要进行大型多中心研究来证实这些发现，并阐明hMPV增强多种细菌毒力和侵袭能力的机制。
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