Atwell Jessica, Chico Martha, Vaca Maritza, Arévalo-Cortes Andrea, Karron Ruth, Cooper Philip J
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Fundacion Ecuatoriana Para la Investigacion en Salud, Quito, Ecuador.
Clin Transl Allergy. 2023 Aug;13(8):e12291. doi: 10.1002/clt2.12291.
There are limited data from non-industrialized settings on the effects of early life viral respiratory disease on childhood respiratory illness. We followed a birth cohort in tropical Ecuador to understand how early viral respiratory disease, in the context of exposures affecting airway inflammation including ascariasis, affect wheezing illness, asthma, and rhinoconjunctivitis in later childhood.
A surveillance cohort nested within a birth cohort was monitored for respiratory infections during the first 2 years in rural Ecuador and followed for 8 years for the development of wheeze and rhinoconjunctivitis. Nasal swabs were examined for viruses by polymerase chain reaction and respiratory symptom data on recent wheeze and rhinoconjunctivitis were collected by periodic questionnaires at 3, 5, and 8 years. Stools from pregnant mothers and periodically from children aged 2 years were examined microscopically for soil-transmitted helminths. Atopy was measured by allergen skin prick testing at 2 years. Spirometry, fractional exhaled nitric oxide measurement, and nasal washes were performed at 8 years. Associations between clinically significant respiratory disease (CSRD) and wheezing or rhinoconjunctivitis at 3, 5, and 8 years were estimated using multivariable logistic regression.
Four hundred and twenty six children were followed of which 67.7% had at least one CSRD episode; 12% had respiratory syncytial virus (RSV)+CSRD and 36% had rhinovirus (RHV)+CSRD. All-cause CSRD was associated with increased wheeze at 3 (OR 2.33 [95% confidence intervals (CI) 1.23-4.40]) and 5 (OR: 2.12 [95% CI 1.12-4.01]) years. RHV+CSRD was more strongly associated with wheeze at 3 years in STH-infected (STH-infected [OR 13.41, 95% CI 1.56-115.64] vs. uninfected [OR 1.68, 95% CI 0.73-3.84]) and SPT+ (SPT+ [OR 9.42, 95% CI 1.88-47.15] versus SPT- [OR 1.92, 95% CI 0.84-4.38]) children. No associations were observed between CSRD and rhinoconjunctivitis.
CSRD was significantly associated with childhood wheeze with stronger associations observed for RHV+CSRD in SPT+ and STH-infected children.
关于非工业化环境下早期病毒性呼吸道疾病对儿童期呼吸道疾病影响的数据有限。我们追踪了厄瓜多尔热带地区的一个出生队列，以了解在包括蛔虫病在内的影响气道炎症的暴露环境中，早期病毒性呼吸道疾病如何影响儿童后期的喘息性疾病、哮喘和鼻结膜炎。
在厄瓜多尔农村，对一个出生队列中的监测队列在头两年进行呼吸道感染监测，并对喘息和鼻结膜炎的发展情况进行8年的随访。通过聚合酶链反应检测鼻拭子中的病毒，并通过3岁、5岁和8岁时的定期问卷收集近期喘息和鼻结膜炎的呼吸道症状数据。对孕妇以及2岁儿童定期采集的粪便进行显微镜检查，以检测土壤传播的蠕虫。在2岁时通过过敏原皮肤点刺试验测量特应性。在8岁时进行肺活量测定、呼出一氧化氮分数测量和鼻腔冲洗。使用多变量逻辑回归估计3岁、5岁和8岁时具有临床意义的呼吸道疾病（CSRD）与喘息或鼻结膜炎之间的关联。
对426名儿童进行了随访，其中67.7%至少有一次CSRD发作；12%患有呼吸道合胞病毒（RSV）+CSRD，36%患有鼻病毒（RHV）+CSRD。全因CSRD与3岁（比值比[OR]2.33[95%置信区间（CI）1.23 - 4.40]）和5岁（OR：2.12[95%CI 1.12 - 4.01]）时喘息增加相关。在感染土壤传播蠕虫（STH）的儿童（感染STH[OR 13.41，95%CI 1.56 - 115.64]与未感染[OR 1.68，95%CI 0.73 - 3.84]）和皮肤点刺试验阳性（SPT+）的儿童（SPT+[OR 9.42，95%CI 1.88 - 47.15]与SPT- [OR 1.92, 95%CI 0.84 - 4.38]）中，RHV+CSRD与3岁时的喘息关联更强。未观察到CSRD与鼻结膜炎之间的关联。
CSRD与儿童喘息显著相关，在SPT+和感染STH的儿童中，RHV+CSRD的关联更强。
