Ortiz Justin R, Laufer Rachel S, Brunwasser Steven M, Coulibaly Flanon, Diallo Fatoumata, Doumbia Moussa, Driscoll Amanda J, Fell Deshayne B, Haidara Fadima C, Hartert Tina V, Keita Adama M, Neuzil Kathleen M, Snyder Brittney M, Sow Samba, Fitzpatrick Meagan C
University of Maryland School of Medicine, Baltimore, Md.
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Md.
J Allergy Clin Immunol Glob. 2023 May;2(2):100092. doi: 10.1016/j.jacig.2023.100092.
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in young children and is associated with subsequent recurrent wheezing illness and asthma (wheeze/asthma). RSV prevention may therefore reduce wheeze/asthma prevalence.
We estimated the contribution of RSV LRTI and the impact of RSV prevention on recurrent wheeze/asthma in Mali.
We simulated 12 consecutive monthly birth cohorts in Mali and estimated RSV LRTI cases through 2 years and recurrent wheeze/asthma prevalence at 6 years under different RSV prevention scenarios: status quo, seasonal birth-dose extended half-life mAb, and seasonal birth-dose extended half-life mAb followed by 2 doses of pediatric vaccine (mAb + vaccine). We used World Health Organization (WHO) Preferred Product Characteristics for RSV prevention, demographic and RSV epidemiologic data from Mali, regional recurrent wheeze/asthma prevalence, and relative risk of recurrent wheeze/asthma given early childhood RSV LRTI.
Among the simulated cohort of 778,680 live births, 10.0% had RSV LRTI by 2 years and 89.6% survived to 6 years. We estimated that 13.4% of all recurrent wheeze/asthma at 6 years was attributable to RSV LRTI. Recurrent wheeze/asthma prevalence at 6 years was 145.0 per 10,000 persons (RSV LRTI attributable) and 1084.2 per 10,000 persons (total). In mAb and mAb + vaccine scenarios, RSV LRTI cases decreased by 11.8% and 44.4%, respectively, and recurrent wheeze/asthma prevalence decreased by 11.8% and 44.4% (RSV LRTI attributable) and 1.6% and 5.9% (total).
In Mali, RSV prevention programs may have a meaningful impact on chronic respiratory disease, strengthening the case for investment in RSV prevention.
呼吸道合胞病毒（RSV）是幼儿下呼吸道感染（LRTI）的主要病因，与随后的反复喘息性疾病和哮喘（喘息/哮喘）相关。因此，预防RSV可能会降低喘息/哮喘的患病率。
我们估计了RSV导致的下呼吸道感染对马里反复喘息/哮喘的影响以及RSV预防措施的作用。
我们模拟了马里连续12个每月出生队列，并在不同的RSV预防方案下估计了2岁前的RSV下呼吸道感染病例以及6岁时反复喘息/哮喘的患病率：现状、季节性出生剂量延长半衰期单克隆抗体，以及季节性出生剂量延长半衰期单克隆抗体后接种2剂儿科疫苗（单克隆抗体+疫苗）。我们使用了世界卫生组织（WHO）关于RSV预防的首选产品特征、来自马里的人口统计学和RSV流行病学数据、区域反复喘息/哮喘患病率，以及儿童早期RSV下呼吸道感染后反复喘息/哮喘的相对风险。
在模拟的778,680例活产队列中，2岁前有10.0%发生RSV下呼吸道感染，89.6%存活至6岁。我们估计，6岁时所有反复喘息/哮喘病例中有13.4%归因于RSV下呼吸道感染。6岁时反复喘息/哮喘的患病率为每10,000人145.0例（归因于RSV下呼吸道感染）和每10,000人1084.2例（总计）。在单克隆抗体和单克隆抗体+疫苗方案中，RSV下呼吸道感染病例分别减少了11.8%和44.4%，反复喘息/哮喘患病率分别降低了11.8%和44.4%（归因于RSV下呼吸道感染）以及1.6%和5.9%（总计）。
在马里，RSV预防计划可能对慢性呼吸道疾病产生有意义的影响，这为投资于RSV预防提供了有力依据。
