Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA.
Clin Infect Dis. 2024 Oct 15;79(4):1039-1045. doi: 10.1093/cid/ciae303.
Data on the true prevalence of respiratory syncytial virus (RSV) among medically attended acute respiratory illnesses (MAARI) has been limited by the lack of regular clinical testing of mild to moderate illnesses. Here we present a prospective evaluation of the epidemiology of RSV-associated MAARI across age groups and multimorbidity status over 3 seasons, which is informative in light of the recommendations for shared decision making for vaccination in older adults.
Ambulatory patients ≥6 months of age meeting a common MAARI case definition were prospectively enrolled in the Michigan Ford Influenza Vaccine Effectiveness (MFIVE) study, a subsite of the US Influenza Vaccine Effectiveness Network. All participants were tested by nasal-throat swab for RSV and influenza, including subtype, independently from clinician-directed testing. Participant illness characteristics and calculated multimorbidity-weighted index (MWI) were collected by in-person survey and electronic medical record review.
Over 3 surveillance seasons (fall 2017 to spring 2020), 9.9% (n = 441) of 4442 participants had RSV detected. RSV-associated MAARI was more prevalent than influenza for participants 6 months to 4 years of age. Adults with RSV-MAARI had higher median MWI scores overall compared to influenza-MAARI and controls with neither virus (1.62, 0.40, and 0.64, respectively).
RSV is a significant, underrecognized cause of MAARI in both children and adults presenting for ambulatory care. Multimorbidity is an important contributor to RSV-associated MAARI in outpatient adults, providing information to support shared clinical decision making for vaccination.
由于对轻度至中度疾病缺乏常规临床检测，因此有关呼吸道合胞病毒（RSV）在有医疗记录的急性呼吸道疾病（MAARI）中实际流行率的数据有限。在此，我们针对 3 个季节内 RSV 相关 MAARI 在各年龄段和多重合并症状态下的流行情况进行了前瞻性评估，鉴于老年人接种疫苗的共享决策建议，该研究结果具有重要意义。
符合常见 MAARI 病例定义的≥6 月龄门诊患者在密歇根州福特流感疫苗有效性（MFIVE）研究中进行前瞻性登记，该研究是美国流感疫苗有效性网络的一个子站点。所有参与者均通过鼻喉拭子进行 RSV 和流感检测，包括亚型，检测独立于临床医生指导的检测。通过面对面调查和电子病历回顾收集参与者的疾病特征和计算出的多重合并症加权指数（MWI）。
在 3 个监测季节（2017 年秋季至 2020 年春季）中，4442 名参与者中有 9.9%（n=441）检测到 RSV。6 个月至 4 岁的参与者中，RSV 相关 MAARI 的发病率高于流感。总体而言，患有 RSV-MAARI 的成年人的 MWI 评分中位数高于流感-MAARI 和无病毒（RSV 和流感）对照组（分别为 1.62、0.40 和 0.64）。
RSV 是导致儿童和成人门诊患者 MAARI 的一个重要且被低估的原因。多重合并症是门诊成年患者 RSV 相关 MAARI 的一个重要致病因素，为支持接种疫苗的共享临床决策提供了信息。
