Riccò Matteo, Parisi Salvatore, Corrado Silvia, Marchesi Federico, Bottazzoli Marco, Gori Davide
AUSL-IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy.
Sanofi, Medical Affairs, 20100 Milan, Italy.
Infect Dis Rep. 2024 Mar 29;16(2):317-355. doi: 10.3390/idr16020026.
Human Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infections. Usually associated with infants and children, an increasing amount of evidence suggests that RSV can cause substantial morbidity and mortality in immunocompromised individuals, including recipients of bone marrow transplantation (BMT). The present systematic review was therefore designed in accordance with the PRISMA guidelines to collect available evidence about RSV infections in BMT recipients. Three medical databases (PubMed, Embase, and MedRxiv) were therefore searched for eligible observational studies published up to 30 September 2023 and collected cases were pooled in a random-effects model. Heterogeneity was assessed using I statistics. Reporting bias was assessed by means of funnel plots and regression analysis. Overall, 30 studies were retrieved, including 20,067 BMT cases and 821 RSV infection episodes. Of them, 351 were lower respiratory tract infections, and a total of 78 RSV-related deaths were collected. A pooled attack rate of 5.40% (95% confidence interval [95%CI] 3.81 to 7.60) was identified, with a corresponding incidence rate of 14.77 cases per 1000 person-years (95%CI 9.43 to 20.11), and a case fatality ratio (CFR) of 7.28% (95%CI 4.94 to 10.60). Attack rates were higher in adults (8.49%, 95%CI 5.16 to 13.67) than in children (4.79%, 95%CI 3.05 to 7.45), with similar CFR (5.99%, 95%CI 2.31 to 14.63 vs. 5.85%, 95%CI 3.35 to 10.02). By assuming RSV attack rates as a reference group, influenza (RR 0.518; 95%CI 0.446 to 0.601), adenovirus (RR 0.679, 95%CI 0.553 to 0.830), and human metapneumovirus (RR 0.536, 95%CI 0.438 to 0.655) were associated with a substantially reduced risk for developing corresponding respiratory infection. Despite the heterogeneous settings and the uneven proportion of adult and pediatric cases, our study has identified high attack rates and a substantial CFR of RSV in recipients of BMT, stressing the importance of specifically tailored preventive strategies and the need for effective treatment options.
人呼吸道合胞病毒（RSV）是呼吸道感染的常见病因。通常与婴幼儿相关，但越来越多的证据表明，RSV可导致免疫功能低下个体（包括骨髓移植（BMT）受者）出现严重发病和死亡。因此，本系统评价按照PRISMA指南设计，以收集关于BMT受者RSV感染的现有证据。为此，检索了三个医学数据库（PubMed、Embase和MedRxiv），查找截至2023年9月30日发表的符合条件的观察性研究，并将收集到的病例纳入随机效应模型进行汇总分析。使用I统计量评估异质性。通过漏斗图和回归分析评估报告偏倚。总体而言，共检索到30项研究，包括20,067例BMT病例和821例RSV感染发作。其中，351例为下呼吸道感染，共收集到78例与RSV相关的死亡病例。汇总感染率为5.40%（95%置信区间[95%CI] 3.81至7.60），相应发病率为每1000人年14.77例（95%CI 9.43至20.11），病死率（CFR）为7.28%（95%CI 4.94至10.60）。成人的感染率（8.49%，95%CI 5.16至13.67）高于儿童（4.79%，95%CI 3.05至7.45），CFR相似（分别为5.99%，95%CI 2.31至14.63和5.85%，95%CI 3.35至10.02）。以RSV感染率作为参照组，流感（相对危险度[RR] 0.518；95%CI 0.446至0.601）、腺病毒（RR 0.679，95%CI 0.553至0.830）和人偏肺病毒（RR 0.536，95%CI 0.438至0.655）与发生相应呼吸道感染的风险显著降低相关。尽管研究背景存在异质性，且成人和儿童病例比例不均衡，但我们的研究确定了BMT受者中RSV的高感染率和高病死率，强调了制定针对性预防策略的重要性以及有效治疗方案的必要性。
