Department of Pediatrics, Faculty of Medicine, Thammasat University, Amphoe Khlong Luang, Pathum Thani, 12120, Thailand.
Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Khlong Luang District, Pathum Thani, 12120, Thailand.
F1000Res. 2024 May 17;13:231. doi: 10.12688/f1000research.146540.2. eCollection 2024.
Respiratory syncytial virus (RSV) is one of the most significant respiratory pathogens that causes acute lower respiratory tract infections (LRTI) early in life. Most children have a history of RSV infection within 24 months of age, and recurrent infections are common throughout life.
Children under five years of age were identified through a review of medical records with a diagnosis of RSV-LRTI between 2016 and 2020. Severe RSV-LRTI was defined as a prolonged length of stay (> 7 days), admission to the intensive care unit, need for mechanical ventilation, non-invasive positive pressure ventilation, or in-hospital mortality. Factors associated with severe RSV-LRTI were investigated using univariate and multivariate analyses.
During the study period, 620 patients were diagnosed with RSV-LRTI and 249 (40.16%) patients had severe RSV-LRTI. In the multivariable logistic regression analysis, the factors for severe RSV-LRTI were being under 3 months (aOR 2.18 CI 1.39-3.43, p0.001), cardiovascular disease (aOR 3.55 CI 1.56-8.06, p0.002), gastrointestinal disease (aOR 5.91 CI 1.90-18.46, p0.002), genetic disease (aOR 7.33 CI 1.43-37.54, p0.017), and pulmonary disease (aOR 9.50, CI 4.56-19.80, p<0.001). Additionally, the presence of ≥ 2 co-morbidities (aOR 6.23 CI 2.81-14.81, p<0.016), experiencing illness for more than 5 days (aOR 3.33 CI 2.19-5.06, p<0.001), co-detection of influenza (aOR 8.62 CI 1.49-38.21, p0.015), and nosocomial RSV infection (aOR 9.13 CI 1.98-41.30, p0.012), markedly increased the risk of severe RSV-LTRI. The severe RSV-LRTI group demonstrated higher hospitalization expenses (median, US $720.77 vs $278.00, respectively; p<0.001), and three infants died in-hospital.
Children at high risk for RSV-LRTI due to underlying genetic and gastrointestinal diseases are at an increased risk for severe RSV-LRTI. Further studies to determine the cost-effectiveness of RSV immunization in these potential co-morbidities should be initiated to prioritize RSV immunization, especially in resource-constrained regions with limited availability of nirsevimab.
呼吸道合胞病毒（RSV）是导致婴幼儿急性下呼吸道感染（LRTI）的最重要的呼吸道病原体之一。大多数儿童在 24 个月龄内都有 RSV 感染史，且终生反复感染较为常见。
通过回顾 2016 年至 2020 年期间的病历，确定五岁以下儿童患有 RSV-LRTI。严重 RSV-LRTI 的定义为住院时间延长（>7 天）、入住重症监护病房、需要机械通气、无创正压通气或院内死亡。使用单变量和多变量分析来研究与严重 RSV-LRTI 相关的因素。
在研究期间，共诊断出 620 例 RSV-LRTI 患儿，其中 249 例（40.16%）患有严重 RSV-LRTI。多变量逻辑回归分析表明，严重 RSV-LRTI 的危险因素为年龄<3 个月（aOR 2.18，95%CI 1.39-3.43，p<0.001）、心血管疾病（aOR 3.55，95%CI 1.56-8.06，p<0.002）、胃肠道疾病（aOR 5.91，95%CI 1.90-18.46，p<0.002）、遗传疾病（aOR 7.33，95%CI 1.43-37.54，p=0.017）和肺部疾病（aOR 9.50，95%CI 4.56-19.80，p<0.001）。此外，存在≥2 种合并症（aOR 6.23，95%CI 2.81-14.81，p<0.016）、患病时间超过 5 天（aOR 3.33，95%CI 2.19-5.06，p<0.001）、合并流感检测阳性（aOR 8.62，95%CI 1.49-38.21，p=0.015）和医院获得性 RSV 感染（aOR 9.13，95%CI 1.98-41.30，p=0.012）都会显著增加严重 RSV-LTRI 的风险。严重 RSV-LRTI 组的住院费用更高（中位数分别为 720.77 美元和 278.00 美元，p<0.001），有 3 名婴儿住院期间死亡。
由于基础遗传和胃肠道疾病而处于 RSV-LRTI 高风险的儿童，发生严重 RSV-LRTI 的风险增加。应开展进一步研究，以确定在这些潜在合并症中 RSV 免疫接种的成本效益，以便优先考虑 RSV 免疫接种，特别是在资源有限、尼姆斯韦马供应有限的地区。
