2016 - 2024年住院青少年新冠病毒、流感和呼吸道合胞病毒的临床检测

Clinical Testing for COVID-19, Influenza, and RSV in Hospitalized Youths, 2016-2024.

作者信息

Toepfer Ariana P, Rutkowski Rachel E, Sahni Leila C, Weinberg Geoffrey A, Michaels Marian G, Selvarangan Rangaraj, Staat Mary Allen, Halasa Natasha, Englund Janet A, Boom Julie A, Szilagyi Peter G, Schuster Jennifer E, Schlaudecker Elizabeth P, Stewart Laura S, Klein Eileen J, Olson Samantha M, Ellington Sascha, McMorrow Meredith L, Moline Heidi L, Dawood Fatimah S

机构信息

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Texas Children's Hospital, Houston.

出版信息

JAMA Netw Open. 2025 Sep 2;8(9):e2531499. doi: 10.1001/jamanetworkopen.2025.31499.

DOI:10.1001/jamanetworkopen.2025.31499

PMID:40952744

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12439058/

Abstract

IMPORTANCE

Studies of COVID-19, influenza, and respiratory syncytial virus (RSV) disease clinical epidemiology, disease burden, and vaccine effectiveness often rely on clinical testing to identify cases, particularly with increasing use of electronic health record data. However, few data are available describing clinical testing practices to inform interpretation of these studies.

OBJECTIVE

To characterize clinical testing frequency for SARS-CoV-2, influenza, and RSV among children and adolescents hospitalized with acute respiratory illness during the 2016 to 2024 respiratory illness seasons by age, intensive care unit admission, and time period (2016-2020 and each season in 2020-2024); estimate the case fraction missed by clinical testing alone; and identify patient characteristics associated with clinical testing.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data collected through prospective surveillance with systematic molecular testing (surveillance testing) for SARS-CoV-2, influenza viruses, and RSV among children and adolescents younger than 18 years hospitalized with acute respiratory illness at 6 US medical centers during the winter respiratory illness seasons of 2016 to 2024. In-hospital clinical molecular testing data were abstracted from the medical record.

MAIN OUTCOMES AND MEASURES

The proportion of children and adolescents with clinical molecular testing for SARS-CoV-2, influenza viruses, and RSV.

RESULTS

During 2016 to 2024, a total of 26 073 hospitalized youths were enrolled (14 459 aged <2 years [55.5%]; 14 833 male [56.9%]), including 12 090 youths during 2016 to 2020 combined. Overall, 10 450 youths (40.1%) had an underlying medical condition. The proportion of youths with clinical testing decreased for SARS-CoV-2 from 3965 of 4388 youths (90.4%) during 2020 to 2021 to 2802 of 3685 youths (76.0%) during 2023 to 2024 (P < .001). In contrast, clinical testing increased from the 2016 to 2020 seasons to the 2023 to 2024 season for influenza viruses (5384 of 12 090 youths [44.5%] to 2740 of 3685 youths [74.4%]; P < .001) and RSV (5072 youths [42.0%] to 2638 youths [71.6%]; P < .001). During the 2023 to 2024 season, the proportion of youths identified as positive for each virus by surveillance testing alone (ie, without clinical testing) was 23 of 112 youths (20.5%) for SARS-CoV-2, 78 of 286 youths (27.3%) for influenza, and 290 of 979 youths (29.6%) for RSV; youths were more likely to receive clinical testing if they were admitted to the intensive care unit (eg, SARS-CoV-2: adjusted odds ratio [aOR], 2.62; 95% CI, 2.06-3.33) or had underlying conditions (eg, any vs no underlying condition for SARS-CoV-2: aOR, 1.56; 95% CI, 1.33-1.84).

CONCLUSIONS AND RELEVANCE

In this study, SARS-CoV-2 clinical testing decreased between 2020 to 2021 and 2023 to 2024 seasons, whereas influenza and RSV testing increased significantly between 2016 to 2020 and 2023 to 2024 seasons; approximately three-quarters of children and adolescents were tested for the 3 viruses in 2023 to 2024.

摘要

重要性

对新冠病毒、流感和呼吸道合胞病毒（RSV）疾病的临床流行病学、疾病负担及疫苗效力的研究，常常依赖临床检测来识别病例，尤其是随着电子健康记录数据使用的增加。然而，关于临床检测实践以指导这些研究解读的数据却很少。

目的

描述2016年至2024年呼吸道疾病季节期间，因急性呼吸道疾病住院的儿童和青少年中，按年龄、重症监护病房收治情况和时间段（2016 - 2020年以及2020 - 2024年的每个季节）对新冠病毒、流感和RSV进行临床检测的频率；估计仅通过临床检测遗漏的病例比例；并确定与临床检测相关的患者特征。

设计、背景和参与者：这项横断面研究分析了通过前瞻性监测收集的数据，该监测对2016年至2024年冬季呼吸道疾病季节期间在美国6家医疗中心因急性呼吸道疾病住院的18岁以下儿童和青少年进行了针对新冠病毒、流感病毒和RSV的系统分子检测（监测检测）。医院内临床分子检测数据从病历中提取。

主要结局和测量指标

对新冠病毒、流感病毒和RSV进行临床分子检测的儿童和青少年比例。

结果

2016年至2024年期间，共纳入26073名住院青少年（14459名年龄<2岁[55.5%]；14833名男性[56.9%]），其中2016年至2020年期间共有12090名青少年。总体而言，10450名青少年（40.1%）有基础疾病。新冠病毒临床检测的青少年比例从2020年至2021年期间4388名青少年中的3965名（90.4%）降至2023年至2024年期间3685名青少年中的2802名（76.0%）（P < 0.001）。相比之下，流感病毒的临床检测从2016年至2020年季节到2023年至2024年季节有所增加（12090名青少年中的5384名[44.5%]到3685名青少年中的2740名[74.4%]；P < 0.001），RSV检测也如此（5072名青少年[42.0%]到2638名青少年[71.6%]；P < 0.001）。在2023年至2024年季节，仅通过监测检测（即无临床检测）确定为每种病毒阳性的青少年比例，新冠病毒为112名青少年中的23名（20.5%），流感为286名青少年中的78名（27.3%），RSV为979名青少年中的290名（29.6%）；如果青少年入住重症监护病房（如新冠病毒：调整优势比[aOR]，2.62；95%置信区间，2.06 - 3.33）或有基础疾病（如新冠病毒有基础疾病与无基础疾病相比：aOR，1.56；95%置信区间，1.33 - 1.84），则更有可能接受临床检测。