Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
Lancet. 2023 May 20;401(10389):1669-1680. doi: 10.1016/S0140-6736(23)00811-5. Epub 2023 Apr 20.
Early-life severe respiratory syncytial virus (RSV) infection has been associated with the onset of childhood wheezing illnesses. However, the relationship between RSV infection during infancy and the development of childhood asthma is unclear. We aimed to assess the association between RSV infection during infancy and childhood asthma.
INSPIRE is a large, population-based, birth cohort of healthy infants with non-low birthweight born at term between June and December, 2012, or between June and December, 2013. Infants were recruited from 11 paediatric practices across middle Tennessee, USA. We ascertained RSV infection status (no infection vs infection) in the first year of life using a combination of passive and active surveillance with viral identification through molecular and serological techniques. Children were then followed up prospectively for the primary outcome of 5-year current asthma, which we analysed in all participants who completed 5-year follow-up. Statistical models, which were done for children with available data, were adjusted for child's sex, race and ethnicity, any breastfeeding, day-care attendance during infancy, exposure to second-hand smoke in utero or during early infancy, and maternal asthma.
Of 1946 eligible children who were enrolled in the study, 1741 (89%) had available data to assess RSV infection status in the first year of life. The proportion of children with RSV infection during infancy was 944 (54%; 95% CI 52-57) of 1741 children. The proportion of children with 5-year current asthma was lower among those without RSV infection during infancy (91 [16%] of 587) than those with RSV infection during infancy (139 [21%] of 670; p=0·016). Not being infected with RSV during infancy was associated with a 26% lower risk of 5-year current asthma than being infected with RSV during infancy (adjusted RR 0·74, 95% CI 0·58-0·94, p=0·014). The estimated proportion of 5-year current asthma cases that could be prevented by avoiding RSV infection during infancy was 15% (95% CI 2·2-26·8).
Among healthy children born at term, not being infected with RSV in the first year of life was associated with a substantially reduced risk of developing childhood asthma. Our findings show an age-dependent association between RSV infection during infancy and childhood asthma. However, to definitively establish causality, the effect of interventions that prevent, delay, or decrease the severity of the initial RSV infection on childhood asthma will need to be studied.
US National Institutes of Health.
婴儿期严重呼吸道合胞病毒（RSV）感染与儿童喘息疾病的发生有关。然而，RSV 感染与儿童哮喘之间的关系尚不清楚。我们旨在评估婴儿期 RSV 感染与儿童哮喘之间的关系。
INSPIRE 是一项大型的基于人群的健康婴儿队列研究，足月出生的非低体重儿于 2012 年 6 月至 12 月或 2013 年 6 月至 12 月间出生于美国田纳西州中部的 11 家儿科诊所。我们使用被动和主动监测相结合的方法，通过分子和血清学技术确定婴儿在第一年的 RSV 感染状况（无感染与感染）。然后，对儿童进行前瞻性随访，以确定 5 年当前哮喘的主要结局，对完成 5 年随访的所有参与者进行分析。对具有可用数据的儿童进行的统计模型调整了儿童的性别、种族和民族、任何母乳喂养、婴儿期日托、宫内或婴儿期接触二手烟、以及母亲的哮喘情况。
在 1946 名符合条件的儿童中，有 1741 名（89%）完成了研究，可用于评估婴儿期 RSV 感染状况。1741 名儿童中有 944 名（54%；95%CI 52-57）在婴儿期感染了 RSV。在无 RSV 感染的婴儿中，5 年当前哮喘的比例较低（587 名儿童中有 91 名[16%]），而在有 RSV 感染的婴儿中，5 年当前哮喘的比例较高（670 名儿童中有 139 名[21%]；p=0·016）。与 RSV 感染相比，婴儿期未感染 RSV 与 5 年当前哮喘的风险降低 26%相关（调整后的 RR 0·74，95%CI 0·58-0·94，p=0·014）。通过避免婴儿期 RSV 感染，估计可预防 5 年当前哮喘病例的比例为 15%（95%CI 2·2-26·8）。
在足月出生的健康儿童中，在第一年不感染 RSV 与儿童哮喘的发生风险显著降低有关。我们的研究结果表明，婴儿期 RSV 感染与儿童哮喘之间存在年龄依赖性关系。然而，为了明确因果关系，需要研究预防、延迟或减轻初始 RSV 感染严重程度的干预措施对儿童哮喘的影响。
美国国立卫生研究院。
