Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN.
J Pediatr. 2021 Jul;234:164-171.e2. doi: 10.1016/j.jpeds.2021.03.036. Epub 2021 Mar 25.
We aimed to evaluate the distribution, clinical presentations and severity of common acute respiratory infections (ARI) viruses in infants across 3 clinical settings.
In a prospective virus surveillance study, infants under 1 year with fever and/or respiratory symptoms were enrolled from outpatient, emergency department, and inpatient settings from December 16, 2019 through April 30, 2020. Demographic and clinical characteristics were collected through parent/guardian interviews, medical chart abstractions, and follow-up surveys. Nasal swabs were collected and tested for viruses using quantitative reverse-transcription polymerase chain reaction.
We enrolled 366 infants and tested nasal swabs on 360 (98%); median age was 6.3 months, 50% male. In total, 295 (82%) had at least 1 virus detected; rhinovirus/enterovirus (RV/EV; 42%), respiratory syncytial virus (RSV; 34%), and influenza (15%) were the most common. RSV was the most frequently detected virus in the inpatient (63%) and emergency department (37%) settings, and RV/EV was most frequently detected virus in the outpatient setting (54%). RSV-positive infants had a lower median age (4.9 months) and were more likely to have respiratory distress, and RV/EV-positive infants were less likely to have respiratory distress. Influenza-positive infants had a higher median age (8 months) and were more likely to have systemic symptoms. RSV infection and younger age were associated with higher odds of hospitalization in multivariable logistic regression.
Across 3 clinical settings, and combining virologic, patient, and health-system information, our results highlight the burden of viral ARI among infants. Overall, RSV, RV/EV, and influenza were most commonly detected, with RSV having the highest disease severity.
我们旨在评估 3 种临床环境中婴幼儿常见急性呼吸道感染（ARI）病毒的分布、临床表现和严重程度。
在一项前瞻性病毒监测研究中，我们于 2019 年 12 月 16 日至 2020 年 4 月 30 日从门诊、急诊和住院环境中招募了发热和/或有呼吸道症状的 1 岁以下婴儿。通过家长/监护人访谈、病历摘录和随访调查收集人口统计学和临床特征。采集鼻拭子，使用实时定量逆转录聚合酶链反应检测病毒。
我们共纳入了 366 名婴儿，对 360 名（98%）婴儿的鼻拭子进行了检测；中位年龄为 6.3 个月，50%为男性。共有 295 名（82%）至少检测到 1 种病毒；鼻病毒/肠道病毒（RV/EV；42%）、呼吸道合胞病毒（RSV；34%）和流感病毒（15%）最为常见。RSV 是住院（63%）和急诊（37%）环境中最常检测到的病毒，而 RV/EV 是门诊环境中最常检测到的病毒（54%）。RSV 阳性婴儿的中位年龄较低（4.9 个月），更有可能出现呼吸窘迫，而 RV/EV 阳性婴儿出现呼吸窘迫的可能性较小。流感阳性婴儿的中位年龄较大（8 个月），更有可能出现全身症状。RSV 感染和年龄较小与多变量逻辑回归中的住院几率升高相关。
在 3 种临床环境中，结合病毒学、患者和卫生系统信息，我们的研究结果强调了婴幼儿病毒性 ARI 的负担。总体而言，RSV、RV/EV 和流感病毒最为常见，RSV 疾病严重程度最高。
