Zuurbier Roy P, Bogaert Debby, de Steenhuijsen Piters Wouter A A, Arp Kayleigh, Chu Mei Ling J N, Sanders Elisabeth A M, van Houten Marlies A
From the Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht.
Spaarne Gasthuis Academy, Hoofddorp and Haarlem, The Netherlands.
Pediatr Infect Dis J. 2023 Jan 1;42(1):59-65. doi: 10.1097/INF.0000000000003732. Epub 2022 Oct 11.
Respiratory tract infections (RTIs) in infants are often caused by viruses. Although respiratory syncytial virus (RSV), influenza virus and human metapneumovirus (hMPV) can be considered the most pathogenic viruses in children, rhinovirus (RV) is often found in asymptomatic infants as well. Little is known about the health consequences of viral presence, especially early in life. We aimed to examine the dynamics of (a)symptomatic viral presence and relate early viral detection to susceptibility to RTIs in infants.
In a prospective birth cohort of 117 infants, we tested 1304 nasopharyngeal samples obtained from 11 consecutive regular sampling moments, and during acute RTIs across the first year of life for 17 respiratory viruses by quantitative PCR. Associations between viral presence, viral (sub)type, viral load, viral co-detection and symptoms were tested by generalized estimating equation (GEE) models.
RV was the most detected virus. RV was negatively associated [GEE: adjusted odds ratio (aOR) 0.41 (95% CI 0.18-0.92)], and hMPV, RSV, parainfluenza 2 and 4 and human coronavirus HKU1 were positively associated with an acute RTI. Asymptomatic RV in early life was, however, associated with increased susceptibility to and recurrence of RTIs later in the first year of life (Kaplan-Meier survival analysis: P = 0.022).
Respiratory viruses, including the seasonal human coronaviruses, are often detected in infants, and are often asymptomatic. Early life RV presence is, though negatively associated with an acute RTI, associated with future susceptibility to and recurrence of RTIs. Further studies on potential ecologic or immunologic mechanisms are needed to understand these observations.
婴儿呼吸道感染（RTIs）通常由病毒引起。虽然呼吸道合胞病毒（RSV）、流感病毒和人偏肺病毒（hMPV）可被认为是儿童中致病性最强的病毒，但鼻病毒（RV）在无症状婴儿中也经常被发现。关于病毒存在的健康后果，尤其是在生命早期，人们知之甚少。我们旨在研究（有/无）症状性病毒存在的动态变化，并将早期病毒检测与婴儿RTIs易感性相关联。
在一个有117名婴儿的前瞻性出生队列中，我们对从11个连续的常规采样时刻获得的1304份鼻咽样本进行检测，并在生命的第一年急性RTIs期间，通过定量PCR检测17种呼吸道病毒。通过广义估计方程（GEE）模型检测病毒存在、病毒（亚）型、病毒载量、病毒共同检测与症状之间的关联。
RV是检测到最多的病毒。RV呈负相关[GEE：调整后的优势比（aOR）为0.41（95%置信区间0.18 - 0.92）]，而hMPV、RSV、副流感病毒2型和4型以及人冠状病毒HKU1与急性RTI呈正相关。然而，生命早期无症状的RV与生命第一年后期RTIs易感性增加和复发相关（Kaplan - Meier生存分析：P = 0.022）。
包括季节性人冠状病毒在内的呼吸道病毒在婴儿中经常被检测到，且通常无症状。生命早期RV的存在虽然与急性RTI呈负相关，但与未来RTIs易感性和复发相关。需要进一步研究潜在的生态或免疫机制来理解这些观察结果。
