Madhi Shabir A, Ceballos Ana, Cousin Luis, Domachowske Joseph B, Langley Joanne M, Lu Emily, Puthanakit Thanyawee, Rämet Mika, Tan Amy, Zaman Khalequ, Anspach Bruno, Bueso Agustin, Cinconze Elisa, Colas Jo Ann, D'Andrea Ulises, Dieussaert Ilse, Englund Janet A, Gandhi Sanjay, Jose Lisa, Kim Joon Hyung, Klein Nicola P, Laajalahti Outi, Mithani Runa, Ota Martin O C, Pinto Mauricio, Silas Peter, Stoszek Sonia K, Tangsathapornpong Auchara, Teeratakulpisarn Jamaree, Virta Miia, Cohen Rachel A
From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Pediatr Infect Dis J. 2025 May 1;44(5):379-386. doi: 10.1097/INF.0000000000004447. Epub 2024 Jul 1.
There is limited evidence regarding the proportion of wheeze in young children attributable to respiratory syncytial virus lower respiratory tract infections (RSV-LRTI) occurring early in life. This cohort study prospectively determined the population attributable risk (PAR) and risk percent (PAR%) of wheeze in 2-<6-year-old children previously surveilled in a primary study for RSV-LRTI from birth to their second birthday (RSV-LRTI<2Y).
From 2013 to 2021, 2-year-old children from 8 countries were enrolled in this extension study (NCT01995175) and were followed through quarterly surveillance contacts until their sixth birthday for the occurrence of parent-reported wheeze, medically-attended wheeze or recurrent wheeze episodes (≥4 episodes/year). PAR% was calculated as PAR divided by the cumulative incidence of wheeze in all participants.
Of 1395 children included in the analyses, 126 had documented RSV-LRTI<2Y. Cumulative incidences were higher for reported (38.1% vs. 13.6%), medically-attended (30.2% vs. 11.8%) and recurrent wheeze outcomes (4.0% vs. 0.6%) in participants with RSV-LRTI<2Y than those without RSV-LRTI<2Y. The PARs for all episodes of reported, medically-attended and recurrent wheeze were 22.2, 16.6 and 3.1 per 1000 children, corresponding to PAR% of 14.1%, 12.3% and 35.9%. In univariate analyses, all 3 wheeze outcomes were strongly associated with RSV-LRTI<2Y (all global P < 0.01). Multivariable modeling for medically-attended wheeze showed a strong association with RSV-LRTI after adjustment for covariates (global P < 0.0001).
A substantial amount of wheeze from the second to sixth birthday is potentially attributable to RSV-LRTI<2Y. Prevention of RSV-LRTI<2Y could potentially reduce wheezing episodes in 2-<6-year-old children.
关于生命早期发生的呼吸道合胞病毒下呼吸道感染（RSV-LRTI）所致幼儿喘息的比例，证据有限。这项队列研究前瞻性地确定了在一项针对从出生到2岁的RSV-LRTI的初步研究中接受过监测的2至<6岁儿童喘息的人群归因风险（PAR）和风险百分比（PAR%）。
2013年至2021年，来自8个国家的2岁儿童参加了这项扩展研究（NCT01995175），并通过每季度的监测接触进行随访，直至其6岁生日，以了解家长报告的喘息、就医的喘息或反复喘息发作（≥4次/年）的发生情况。PAR%的计算方法是PAR除以所有参与者中喘息的累积发病率。
在纳入分析的1395名儿童中，126名有记录的RSV-LRTI<2Y。与没有RSV-LRTI<2Y的参与者相比，RSV-LRTI<2Y的参与者中报告的（38.1%对13.6%）、就医的（30.2%对11.8%）和反复喘息结局（4.0%对0.6%）的累积发病率更高。每1000名儿童中，所有报告的、就医的和反复喘息发作的PAR分别为22.2、16.6和3.1，对应的PAR%分别为14.1%、12.3%和35.9%。在单变量分析中，所有3种喘息结局均与RSV-LRTI<2Y密切相关（所有总体P<0.01）。对就医的喘息进行多变量建模显示，在调整协变量后，与RSV-LRTI密切相关（总体P<0.0001）。
2岁至6岁期间大量的喘息可能归因于RSV-LRTI<2Y。预防RSV-LRTI<2Y可能会减少2至<6岁儿童的喘息发作。
