呼吸道合胞病毒与严重急性呼吸综合征冠状病毒2合并感染对南非索韦托下呼吸道感染住院儿童临床严重程度及预后的影响
Impact of Respiratory Syncytial Virus and Severe Acute Respiratory Syndrome Coronavirus 2 Coinfection on Clinical Severity and Outcomes Among Children Hospitalized With Lower Respiratory Tract Infections in Soweto, South Africa.
作者信息
Mrubata Kitso-Lesedi, Bailie Vicky, Solomon Fatima, Izu Alane, Ncube Musawenkosi, Nunes Marta C, Dangor Ziyaad, Madhi Shabir A, Moore David P, Verwey Charl
机构信息
From the Department of Paediatrics and Child Health, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Pediatr Infect Dis J. 2025 Feb 1;44(2):107-111. doi: 10.1097/INF.0000000000004560. Epub 2024 Oct 2.
BACKGROUND
No data are available regarding the interplay and clinical manifestations of respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) coinfection in African children. We compared clinical characteristics and outcomes between RSV-only, SARS-CoV-2-only and RSV/SARS-CoV-2 coinfection lower respiratory tract infections (LRTI) in hospitalized African children.
METHODS
Prospective surveillance of children (0-59 months) hospitalized with severe LRTI was undertaken between March 1, 2020, and March 31, 2023, in Johannesburg, South Africa. Nasopharyngeal swabs for respiratory viruses and clinical data were collected, and clinical characteristics and outcomes were described and compared. Respiratory index of severity in children (RISC) scores were calculated for HIV-uninfected children, and covariates associated with high RISC scores (≥5) were evaluated.
RESULTS
Seven thousand four hundred fifty-six children [6.1 months (interquartile range, 14.4-18.6); 57.7% male] were enrolled, 1372 (18.4%) testing RSV+/SARS-CoV-2- (RSV only), 223 (3.0%) RSV-/SARS-CoV-2+ (SARS-CoV-2-only) and 28 (0.4%) RSV+/SARS-CoV-2+ (RSV/SARS-CoV-2 coinfection). Children with RSV only and RSV/SARS-CoV-2 coinfection were more likely to present with bronchiolitis than those with SARS-CoV-2-only (673/1372 and 15/28 vs. 46/223; P < 0.001). Children with RSV/SARS-CoV-2 coinfection had more severe disease than those with RSV or SARS-CoV-2-only, as well as a higher RISC score than SARS-CoV-2-only. Weight-for-age Z scores [adjusted risk ratio (aRR): 0.92], room air saturations (aRR: 0.988) and RSV+ status (aRR: 1.40) were independently associated with severe disease.
CONCLUSIONS
Although both RSV and SARS-CoV-2 LRTI occurred commonly, coinfection did not. Children with RSV/SARS-CoV-2 coinfection had a higher prevalence of severe LRTI than those with RSV or SARS-CoV-2-only. These findings reinforce the urgent need for safe and effective RSV and SARS-CoV-2 vaccines, especially in children in low- and middle-income countries, where the burden of disease is the highest and the access to medical resources the lowest.
背景
关于非洲儿童呼吸道合胞病毒（RSV）与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）合并感染的相互作用和临床表现，目前尚无相关数据。我们比较了住院非洲儿童单纯RSV感染、单纯SARS-CoV-2感染以及RSV/SARS-CoV-2合并感染的下呼吸道感染（LRTI）的临床特征和结局。
方法
2020年3月1日至2023年3月31日期间，在南非约翰内斯堡对因严重LRTI住院的儿童（0至59个月）进行前瞻性监测。收集呼吸道病毒的鼻咽拭子和临床数据，并描述和比较临床特征及结局。计算未感染HIV儿童的儿童呼吸严重指数（RISC）评分，并评估与高RISC评分（≥5）相关的协变量。
结果
共纳入7456名儿童[6.1个月（四分位间距，14.4 - 18.6）；57.7%为男性]，1372名（18.4%）检测为RSV+/SARS-CoV-2-（单纯RSV感染），223名（3.0%）为RSV-/SARS-CoV-2+（单纯SARS-CoV-2感染），28名（0.4%）为RSV+/SARS-CoV-2+（RSV/SARS-CoV-2合并感染）。与单纯SARS-CoV-2感染的儿童相比，单纯RSV感染和RSV/SARS-CoV-2合并感染的儿童患细支气管炎的可能性更高（673/1372和15/28 vs. 46/223；P < 0.001）。RSV/SARS-CoV-2合并感染的儿童比单纯RSV或单纯SARS-CoV-2感染的儿童病情更严重，且RISC评分高于单纯SARS-CoV-2感染的儿童。年龄别体重Z评分[调整风险比（aRR）：0.92]、室内空气饱和度（aRR：0.988）和RSV+状态（aRR：1.40）与严重疾病独立相关。
结论
尽管RSV和SARS-CoV-2的LRTI都很常见，但合并感染并不常见。RSV/SARS-CoV-2合并感染的儿童严重LRTI的患病率高于单纯RSV或单纯SARS-CoV-2感染的儿童。这些发现凸显了迫切需要安全有效的RSV和SARS-CoV-2疫苗，尤其是在疾病负担最高且获得医疗资源最少的低收入和中等收入国家的儿童中。
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