Rankin Danielle A, Haddadin Zaid, Lipworth Loren, Stahl Anna L, Fryzek Jon, Suh Mina, Shepard Donald S, Varjabedian Rebekkah, Fernandez Kailee N, Salib Seifein, Villarreal Jessica, Bruce Mercedes, McHenry Rendie, Spieker Andrew J, Nelson Christopher B, Halasa Natasha B
Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, 1161 21st Ave South, D7232 MCN, Nashville, TN 37232, USA.
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Ther Adv Infect Dis. 2022 Jul 18;9:20499361221112171. doi: 10.1177/20499361221112171. eCollection 2022 Jan-Dec.
The burden of respiratory syncytial virus (RSV)-associated acute respiratory illnesses among healthy infants (<1 year) in the inpatient setting is well established. The focus on RSV-associated illnesses in the outpatient (OP) and emergency department (ED) settings are however understudied. We sought to determine the spectrum of RSV illnesses in infants at three distinct healthcare settings.
From 16 December 2019 through 30 April 2020, we performed an active, prospective RSV surveillance study among infants seeking medical attention from an inpatient (IP), ED, or OP clinic. Infants were eligible if they presented with fever and/or respiratory symptoms. Demographics, clinical characteristics, and illness histories were collected during parental/guardian interviews, followed by a medical chart review and illness follow-up surveys. Research nasal swabs were collected and tested for respiratory pathogens for all enrolled infants.
Of the 627 infants screened, 475 were confirmed eligible; 360 were enrolled and research tested. Within this final cohort, 101 (28%) were RSV-positive (IP = 37, ED = 18, and OP = 46). Of the RSV-positive infants, the median age was 4.5 months and 57% had ⩾2 healthcare encounters. The majority of RSV-positive infants were not born premature (88%) nor had underlying medical conditions (92%). RSV-positive infants, however, were more likely to have a lower respiratory tract infection than RSV-negative infants (76% 39%, < 0.001). Hospitalized infants with RSV were younger, 65% required supplemental oxygen, were more likely to have lower respiratory tract symptoms, and more often had shortness of breath and rales/rhonchi than RSV-positive infants in the ED and OP setting.
Infants with RSV illnesses seek healthcare for multiple encounters in various settings and have clinical difference across settings. Prevention measures, especially targeted toward healthy, young infants are needed to effectively reduce RSV-associated healthcare visits.
呼吸道合胞病毒（RSV）相关急性呼吸道疾病在住院环境中健康婴儿（<1岁）中的负担已得到充分证实。然而，门诊（OP）和急诊科（ED）环境中与RSV相关疾病的研究较少。我们试图确定三种不同医疗环境中婴儿RSV疾病的范围。
从2019年12月16日至2020年4月30日，我们对在住院部（IP）、急诊科或门诊诊所寻求医疗护理的婴儿进行了一项积极的前瞻性RSV监测研究。出现发热和/或呼吸道症状的婴儿符合入选条件。在家长/监护人访谈期间收集人口统计学、临床特征和疾病史，随后进行病历审查和疾病随访调查。为所有入选婴儿采集研究用鼻拭子并检测呼吸道病原体。
在627名筛查的婴儿中，475名被确认为符合条件；360名入选并进行了研究检测。在这个最终队列中，101名（28%）为RSV阳性（住院部=37名，急诊科=18名，门诊=46名）。在RSV阳性婴儿中，中位年龄为4.5个月，57%有≥2次医疗接触。大多数RSV阳性婴儿并非早产（88%）且无基础疾病（92%）。然而，RSV阳性婴儿比RSV阴性婴儿更易发生下呼吸道感染（76%对39%，P<0.001）。与急诊科和门诊环境中的RSV阳性婴儿相比，住院的RSV婴儿更年幼，65%需要补充氧气，更易出现下呼吸道症状，且更常出现呼吸急促和啰音/鼾音。
患有RSV疾病的婴儿在不同环境中因多次接触而寻求医疗护理，且不同环境下存在临床差异。需要采取预防措施，尤其是针对健康的幼儿，以有效减少与RSV相关的医疗就诊。
