Department of Paediatrics & Child Health, University of Cape Town, Cape Town, South Africa.
Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
PLoS One. 2023 Sep 14;18(9):e0291433. doi: 10.1371/journal.pone.0291433. eCollection 2023.
Low- and middle-income countries carry the largest burden of Respiratory syncytial virus (RSV) disease, with most deaths occurring in these settings. This study aimed to investigate the burden of RSV disease in South African children hospitalised with lower respiratory tract infection (LRTI), with specific reference to incidence, risk factors, and co-infections.
A database from a previous prospective study containing demographic, laboratory and clinical data on children hospitalised with LRTIs in Cape Town, South Africa, was used. A nasopharyngeal swab (NP) and induced sputum (IS) were tested for RSV PCR. Descriptive statistics were used to characterise the study population, and a multivariable analysis of risk factors and co-infections was done.
RSV was detected in 142 (30.9%; 95% CI 26.7-35.3) of the included 460 study children with LRTI. The median age of RSV-positive children was 4.6 (IQR 2.4-9.7) months compared to RSV-negative children of 10.5 (IQR 4.4-21.3) months, P = <0.001. Most cases occurred in autumn and winter with 126 (89%) cases over this period. IS demonstrated greater sensitivity for RSV diagnosis with 135 cases (95.1%) detected on IS and 57 cases (40.1%) identified on NP; P<0.001. The median length of hospital stay was 3.3 (SD 4.2) days in the RSV positive group and 2.7 (SD 3.3) days in the RSV negative group; P<0.001. The median number of detected viral pathogens was 1 (IQR 0-2) in RSV-positive children (when RSV was excluded from the count) compared to 2 (IQR 2-3) in RSV negative children; P<0.001. The presence of RSV was independently associated with a reduction in the frequency of most viruses tested for on PCR.
RSV is common in children hospitalised with LRTI and mainly affects younger children. There is an urgent need to find an effective vaccine to prevent RSV pneumonia in children worldwide, especially in LMICs that carry the greatest burden of disease.
呼吸道合胞病毒（RSV）疾病在中低收入国家的负担最大，大多数死亡发生在这些国家。本研究旨在调查南非因下呼吸道感染（LRTI）住院的儿童中 RSV 疾病的负担，特别关注发病率、危险因素和合并感染。
使用来自南非开普敦以前前瞻性研究的数据库，该数据库包含 LRTI 住院儿童的人口统计学、实验室和临床数据。对鼻咽拭子（NP）和诱导痰（IS）进行 RSV PCR 检测。使用描述性统计来描述研究人群，并进行多变量分析危险因素和合并感染。
在纳入的 460 例 LRTI 研究儿童中，142 例（30.9%；95%CI 26.7-35.3）检测到 RSV。RSV 阳性儿童的中位年龄为 4.6（IQR 2.4-9.7）个月，而 RSV 阴性儿童的中位年龄为 10.5（IQR 4.4-21.3）个月，P<0.001。大多数病例发生在秋季和冬季，这段时间有 126 例（89%）病例。IS 对 RSV 诊断的敏感性更高，IS 上检测到 135 例（95.1%），NP 上检测到 57 例（40.1%）；P<0.001。RSV 阳性组的中位住院时间为 3.3（SD 4.2）天，RSV 阴性组为 2.7（SD 3.3）天；P<0.001。RSV 阳性儿童中检测到的病毒病原体中位数为 1（IQR 0-2）（当将 RSV 排除在计数之外时），而 RSV 阴性儿童中为 2（IQR 2-3）；P<0.001。RSV 的存在与大多数经 PCR 检测的病毒频率降低独立相关。
RSV 在因 LRTI 住院的儿童中很常见，主要影响年幼的儿童。迫切需要找到一种有效的疫苗来预防全球儿童的 RSV 肺炎，特别是在疾病负担最大的中低收入国家。
