Sarna Mohinder, Gebremedhin Amanuel, Richmond Peter C, Glass Kathryn, Levy Avram, Moore Hannah C
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia.
Open Forum Infect Dis. 2023 Oct 2;10(10):ofad450. doi: 10.1093/ofid/ofad450. eCollection 2023 Oct.
The association between early-life respiratory syncytial virus (RSV) infections and later respiratory morbidity is well established. However, there is limited evidence on factors that influence this risk. We examined sociodemographic and perinatal factors associated with later childhood respiratory morbidity requiring secondary care following exposure to a laboratory-confirmed RSV episode in the first 2 years.
We used a probabilistically linked whole-of-population-based birth cohort including 252 287 children born in Western Australia between 2000 and 2009 with follow-up to the end of 2012. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of the association of various risk factors with the first respiratory episode for asthma, wheezing, and unspecified acute lower respiratory infection beyond the age of 2 years.
The analytic cohort included 4151 children with a confirmed RSV test before age 2 years. The incidence of subsequent respiratory morbidity following early-life RSV infection decreased with child age at outcome (highest incidence in 2-<4-year-olds: 41.8 per 1000 child-years; 95% CI, 37.5-46.6), increased with age at RSV infection (6-<12-month-olds: 23.6/1000 child-years; 95% CI, 19.9-27.8; 12-<24-month-olds: 22.4/1000 child-years; 95% CI, 18.2-22.7) and decreasing gestational age (50.8/1000 child-years; 95% CI, 33.5-77.2 for children born extremely preterm, <28 weeks gestation). Risk factors included age at first RSV episode (6-<12 months: aHR, 1.42; 95% CI, 1.06-1.90), extreme prematurity (<28 weeks: aHR, 2.22; 95% CI, 1.40-3.53), maternal history of asthma (aHR, 1.33; 95% CI, 1.04-1.70), and low socioeconomic index (aHR, 1.76; 95% CI, 1.03-3.00).
Our results suggest that in addition to preterm and young infants, children aged 12-<24 months could also be potential target groups for RSV prevention to reduce the burden of later respiratory morbidities associated with RSV.
儿童早期呼吸道合胞病毒（RSV）感染与后期呼吸道疾病之间的关联已得到充分证实。然而，关于影响这种风险的因素的证据有限。我们研究了社会人口统计学和围产期因素与2岁前实验室确诊的RSV感染发作后需要二级护理的儿童后期呼吸道疾病之间的关系。
我们使用了一个基于概率链接的全人群出生队列，包括2000年至2009年在西澳大利亚出生的252287名儿童，随访至2012年底。Cox比例风险模型估计了各种风险因素与2岁以后哮喘、喘息和未指定的急性下呼吸道感染的首次呼吸道发作之间关联的调整风险比（aHRs）。
分析队列包括4151名2岁前RSV检测确诊的儿童。早期RSV感染后随后呼吸道疾病的发病率随结局时儿童年龄的增加而降低（2至<4岁儿童发病率最高：每1000儿童年41.8例；95%CI，37.5-46.6），随RSV感染时年龄的增加而增加（6至<12个月婴儿：23.6/1000儿童年；95%CI，19.9-27.8；12至<24个月婴儿：22.4/1000儿童年；95%CI，18.2-22.7），并随胎龄降低而增加（孕龄小于28周的极早产儿每1000儿童年50.8例；95%CI，33.5-77.2）。风险因素包括首次RSV发作时的年龄（6至<12个月：aHR，1.42；95%CI，1.06-1.90）、极早产（<28周：aHR，2.22；95%CI，1.40-3.53）、母亲哮喘病史（aHR，1.33；95%CI，1.04-1.70）和低社会经济指数（aHR，1.76；95%CI，1.03-3.00）。
我们的结果表明，除了早产和年幼婴儿外，12至<24个月的儿童也可能是预防RSV以减轻与RSV相关的后期呼吸道疾病负担的潜在目标人群。
