Sarna Mohinder, Le Huong, Taye Belaynew Wasie, Glass Kathryn, Levy Avram, Richmond Peter, Moore Hannah C
Wesfarmers Centre of Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, Western Australia, Australia
School of Population Health, Curtin University, Perth, Western Australia, Australia.
BMJ Open Respir Res. 2024 Dec 18;11(1):e002613. doi: 10.1136/bmjresp-2024-002613.
Acute lower respiratory infections (ALRIs) are a major contributor to the global infectious disease burden and a common cause of hospitalisation for children under 2 years. We compared clinical severity in children hospitalised with respiratory syncytial virus (RSV), parainfluenza virus (PIV), human metapneumovirus (hMPV) and influenza virus (IFV).
We used a probabilistically linked population cohort born in Western Australia between 2010 and 2020 and hospitalised before the age of 2 years. Outcomes compared included length of hospital stay (LOS), admission to intensive care unit (ICU), need for respiratory support (RS), complex hospital course (RS, death, ICU admission or LOS >75th percentile), 7-day and 30-day mortality, hospital-in-the-home care, 30-day all-cause and ALRI-specific readmissions and emergency department presentations 14 days prior to hospitalisation. Logistic regression was used for binary outcomes, and negative binomial regression was used for discrete count variables. Incidence rates, time to RS and time to readmissions were calculated using survival analysis techniques.
The final cohort included 210 997 hospitalised children under 24 months of age for a total of 315 769 admissions. Infants hospitalised before 6 months had the highest rates for all virus-specific hospitalisations, particularly RSV hospitalisations (50.4 per 1000 child-years (95% CI 48.7 to 52.1)). Infants <6 months had higher odds of an ICU admission (adjusted OR (aOR) 2.39, 95% CI 1.36 to 4.19) and RS (aOR 4.68, 95% CI 2.95 to 7.44) and a complex hospital course (aOR 2.69, 95% CI 2.13 to 3.42) with RSV and four times higher hazards of requiring RS earlier (adjusted HR (aHR) 4.06, 95% CI 2.59 to 6.36). An ALRI-coded 30-day readmission was recorded in 10%-24% of virus-specific hospitalisations.
Young infants have a more severe and complex hospital course with RSV hospitalisation compared with hospitalisation with other respiratory viruses and should be prioritised for prevention measures such as the single-dose monoclonal antibody, nirsevimab.
急性下呼吸道感染（ALRIs）是全球传染病负担的主要促成因素，也是2岁以下儿童住院的常见原因。我们比较了因呼吸道合胞病毒（RSV）、副流感病毒（PIV）、人偏肺病毒（hMPV）和流感病毒（IFV）住院的儿童的临床严重程度。
我们使用了一个概率关联的人群队列，该队列于2010年至2020年在西澳大利亚出生，并在2岁前住院。比较的结果包括住院时间（LOS）、入住重症监护病房（ICU）、呼吸支持需求（RS）、复杂的住院过程（RS、死亡、ICU入院或LOS>第75百分位数）、7天和30天死亡率、家庭医院护理、30天全因再入院和ALRI特异性再入院以及住院前14天的急诊科就诊情况。二元结局使用逻辑回归，离散计数变量使用负二项回归。发病率、RS时间和再入院时间使用生存分析技术计算。
最终队列包括210997名24个月以下住院儿童，共315769次入院。6个月前住院的婴儿所有病毒特异性住院率最高，尤其是RSV住院率（每1000儿童年50.4例（95%CI 48.7至52.1））。6个月以下的婴儿入住ICU（调整后OR（aOR）2.39，95%CI 1.36至4.19）和RS（aOR 4.68，95%CI 2.95至7.44）以及复杂住院过程（aOR 2.69，95%CI 2.13至3.42）的几率更高，且因RSV更早需要RS的风险高四倍（调整后HR（aHR）4.06，95%CI 2.59至6.36）。在10%-24%的病毒特异性住院病例中记录到ALRI编码的30天再入院。
与其他呼吸道病毒住院相比，小婴儿因RSV住院的过程更严重、更复杂，应优先采取预防措施，如单剂量单克隆抗体nirsevimab。
