Centre for Global Health, Usher Institute, Edinburgh Medical School, University of Edinburgh, Scotland, UK.
School of Public Health, Nanjing Medical University, Nanjing, China.
J Infect Dis. 2022 Aug 12;226(Suppl 1):S38-S44. doi: 10.1093/infdis/jiab308.
Early-life severe respiratory syncytial virus (RSV) infection has been associated with subsequent risk of asthma and recurrent wheeze. However, changes in the association over time and the interaction effect of the age at first RSV infection are less well understood. We aimed to assess the time-varying association between RSV and subsequent asthma and wheeze admission and explore how the association was affected by the age at RSV infection.
We retrospectively followed up a cohort of 23 365 children for a median of 6.9 years using Scottish health databases. Children who were born between 2001 and 2013 and had RSV-associated respiratory tract infection (RTI) admissions under 2 years were in the exposed group; those with unintentional accident admissions under 2 years comprised the control group. The Cox proportional-hazards model was used to report adjusted hazard ratios (HRs) of RSV admissions on subsequent asthma and wheeze admissions. We did subgroup analyses by follow-up years. We also explored how this association was affected by the age at first RSV admission.
The association was strongest in the first 2 years of follow-up and decreased over time. The association persisted for 6 years in children whose first RSV-RTI admission occurred at 6-23 months of age, with an adjusted HR of 3.9 (95% confidence interval [CI], 3.1-4.9) for the first 2 years, 2.3 (95% CI, 1.6-3.2) for 2 to <4 years, and 1.9 (95% CI, 1.2-2.9) for 4 to <6 years of follow-up. In contrast, the association was only significant for the first 2 years after first RSV-RTI admissions occurring at 0-5 months.
We found a more persistent association for subsequent asthma and wheeze in children whose first severe RSV infection occurred at 6-23 months compared to those whose first severe RSV infection occurred at 0-6 months. This provides new evidence for further assessment of the association and RSV intervention programs.
早期严重呼吸道合胞病毒（RSV）感染与随后的哮喘和反复喘息风险相关。然而，随着时间的推移，这种关联的变化以及首次 RSV 感染年龄的交互作用影响尚不清楚。我们旨在评估 RSV 与随后的哮喘和喘息入院之间的时变关联，并探讨 RSV 感染年龄如何影响这种关联。
我们使用苏格兰健康数据库对 23365 名儿童进行了中位 6.9 年的回顾性随访。2001 年至 2013 年期间出生且在 2 岁以下因 RSV 相关下呼吸道感染（RTI）入院的儿童为暴露组；2 岁以下因意外伤害入院的儿童为对照组。使用 Cox 比例风险模型报告 RSV 入院与随后哮喘和喘息入院的调整后的危险比（HR）。我们按随访年限进行了亚组分析。我们还探讨了这种关联如何受到首次 RSV 入院年龄的影响。
在随访的头 2 年中，这种关联最强，随着时间的推移而减弱。对于首次 RSV-RTI 发病年龄在 6-23 个月的儿童，这种关联持续了 6 年，在前 2 年的调整 HR 为 3.9（95%置信区间[CI]，3.1-4.9），2-<4 年为 2.3（95% CI，1.6-3.2），4-<6 年为 1.9（95% CI，1.2-2.9）。相比之下，首次 RSV-RTI 发病年龄在 0-5 个月的儿童，这种关联仅在前 2 年显著。
我们发现，与首次严重 RSV 感染发生在 0-6 个月的儿童相比，首次严重 RSV 感染发生在 6-23 个月的儿童，其随后哮喘和喘息的关联更持久。这为进一步评估这种关联和 RSV 干预项目提供了新的证据。
