英国爱丁堡大学Harish Nair团队研究了2019年全球、地区和国家5岁以下儿童因呼吸道合胞病毒引发急性下呼吸道感染的疾病负担。2022年5月19日，《柳叶刀》杂志发表了这一成果。

呼吸道合胞病毒（RSV）是幼儿急性下呼吸道感染的最常见原因。研究组此前估计，2015年0-60个月的儿童发生3310万次RSV相关的急性下呼吸道感染，导致全世界118200人死亡。自那时以来进行了几项社区监测研究，以便更准确地估计RSV相关的社区死亡人数。该研究旨在更新2019年全球、地区和国家各级0-60个月儿童RSV相关急性下呼吸道感染发病率和死亡率，重点关注RSV预防药物针对的总体死亡率和较窄的婴儿年龄组。

在这项系统分析中，研究组扩展了他们的全球RSV疾病负担数据集，从MEDLINE、Embase、global Health、CINAHL、科学引文索引、LILACS、OpenGrey、CNKI、万方和维普等大型数据库对2017年1月1日至2020年12月31日发表的论文的最新检索中获得新数据。

研究组还纳入了来自RSV GEN合作者的未发布数据。符合条件的研究报告了0-60个月龄RSV儿童的数据，这些儿童在社区环境中的原发感染为急性下呼吸道感染，或需要住院治疗的急性下呼吸道感染；至少连续12个月的报告数据，但住院病死率（CFR）或RSV季节性定义明确的情况除外；报告急性下呼吸道感染的发生率、住院率、住院RSV阳性率或院内CFR。

如果病例定义不明确或应用不一致，RSV感染未经实验室确认或仅基于血清学，或如果报告包括不到50例急性下呼吸道感染，则排除研究。研究组应用广义线性混合效应模型（GLMM）估算了2019年全球和地区（按国家发展状况和世界银行收入分类）RSV相关的急性下呼吸道感染发病率、入院率和住院死亡率。

通过基于风险因素的模型估计了国家级RSV相关急性下呼吸道感染的发病率。研究组通过GLMM开发了新模型，纳入了最新的RSV社区死亡率数据，用于估计RSV总体死亡率。

除之前审查中包括的317项研究外，研究组还确定并包括了来自51项研究的113项新的合格研究和未公布的数据，共计481项研究。估计2019年全球0-60个月的儿童中，共有3300万起RSV相关性急性下呼吸道感染事件，360万起RSV相关性急性下呼吸道感染住院，26300例RSV相关性急性下呼吸道感染住院死亡和101400例可归因于RSV的总死亡人数。

在0-6个月的婴儿中，研究组估计有660万起RSV相关性急性下呼吸道感染发作，140万起RSV相关性急性下呼吸道感染住院，13300例RSV相关急性下呼吸道感染住院死亡和45700例可归因于RSV的总死亡人数。

0-60个月儿童死亡中有2.0%，28天-6个月儿童死亡中有3.6%归因于RSV。超过95%的RSV相关急性下呼吸道感染发作和全年龄段超过97%的RSV归因死亡发生在低收入和中等收入国家（LMICs）。

研究结果表明，RSV在全球范围内大大增加了0-60个月儿童的发病率和死亡负担，尤其是在出生后的前6个月和中低收入国家。研究组强调了全世界RSV疾病的惊人总体死亡负担，0-60个月的儿童每50人中就有一人死亡，28天到6个月的婴儿每28人中就有一人死于RSV。

研究组估计，每1例与RSV相关的急性下呼吸道感染住院死亡，对应社区中3例RSV相关死亡。针对生命最初6个月进行保护的RSV被动免疫计划可能对减少RSV疾病负担产生重大影响，尽管当实施这些计划时，需要更多的数据来了解RSV疾病负担高峰对老年人潜在年龄转移的影响。

附：英文原文

Title: Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis

Author: You Li, Xin Wang, Dianna M Blau, Mauricio T Caballero, Daniel R Feikin, Christopher J Gill, Shabir A Madhi, Saad B Omer, Eric A F Simes, Harry Campbell, Ana Bermejo Pariente, Darmaa Bardach, Quique Bassat, Jean-Sebastien Casalegno, Giorgi Chakhunashvili, Nigel Crawford, Daria Danilenko, Lien Anh Ha Do, Marcela Echavarria, Angela Gentile, Aubree Gordon, Terho Heikkinen, Q Sue Huang, Sophie Jullien, Anand Krishnan, Eduardo Luis Lopez, Joko Marki, Ainara Mira-Iglesias, Hannah C Moore, Jocelyn Moyes, Lawrence Mwananyanda, D James Nokes, Faseeha Noordeen, Evangeline Obodai, Nandhini Palani, Candice Romero, Vahid Salimi, Ashish Satav, Euri Seo, Zakhar Shchomak, Rosalyn Singleton, Kirill Stolyarov, Sonia K Stoszek, Anne von Gottberg, Danielle Wurzel, Lay-Myint Yoshida, Chee Fu Yung, Heather J Zar, Michael Abram, Jeroen Aerssens, Annette Alafaci, Angel Balmaseda, Teresa Bandeira, Ian Barr, Ena Batinovi, Philippe Beutels, Jinal Bhiman, Christopher C Blyth, Louis Bont, Sara S Bressler, Cheryl Cohen, Rachel Cohen, Anna-Maria Costa, Rowena Crow, Andrew Daley, Duc-Anh Dang, Clarisse Demont, Christine Desnoyers, Javier Díez-Domingo, Maduja Divarathna, Mignon du Plessis, Madeleine Edgoose, Fausto Martín Ferolla, Thea K Fischer, Amanuel Gebremedhin, Carlo Giaquinto, Yves Gillet, Roger Hernandez, Come Horvat, Etienne Javouhey, Irakli Karseladze, John Kubale, Rakesh Kumar, Bruno Lina

Issue&Volume: 2022-05-19

Abstract:

Background

Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infection in young children. We previously estimated that in 2015, 33·1 million episodes of RSV-associated acute lower respiratory infection occurred in children aged 0–60 months, resulting in a total of 118200 deaths worldwide. Since then, several community surveillance studies have been done to obtain a more precise estimation of RSV associated community deaths. We aimed to update RSV-associated acute lower respiratory infection morbidity and mortality at global, regional, and national levels in children aged 0–60 months for 2019, with focus on overall mortality and narrower infant age groups that are targeted by RSV prophylactics in development.

Methods

In this systematic analysis, we expanded our global RSV disease burden dataset by obtaining new data from an updated search for papers published between Jan 1, 2017, and Dec 31, 2020, from MEDLINE, Embase, Global Health, CINAHL, Web of Science, LILACS, OpenGrey, CNKI, Wanfang, and ChongqingVIP. We also included unpublished data from RSV GEN collaborators. Eligible studies reported data for children aged 0–60 months with RSV as primary infection with acute lower respiratory infection in community settings, or acute lower respiratory infection necessitating hospital admission; reported data for at least 12 consecutive months, except for in-hospital case fatality ratio (CFR) or for where RSV seasonality is well-defined; and reported incidence rate, hospital admission rate, RSV positive proportion in acute lower respiratory infection hospital admission, or in-hospital CFR. Studies were excluded if case definition was not clearly defined or not consistently applied, RSV infection was not laboratory confirmed or based on serology alone, or if the report included fewer than 50 cases of acute lower respiratory infection. We applied a generalised linear mixed-effects model (GLMM) to estimate RSV-associated acute lower respiratory infection incidence, hospital admission, and in-hospital mortality both globally and regionally (by country development status and by World Bank Income Classification) in 2019. We estimated country-level RSV-associated acute lower respiratory infection incidence through a risk-factor based model. We developed new models (through GLMM) that incorporated the latest RSV community mortality data for estimating overall RSV mortality. This review was registered in PROSPERO (CRD42021252400).

Findings

In addition to 317 studies included in our previous review, we identified and included 113 new eligible studies and unpublished data from 51 studies, for a total of 481 studies. We estimated that globally in 2019, there were 33·0 million RSV-associated acute lower respiratory infection episodes (uncertainty range [UR] 25·4–44·6 million), 3·6 million RSV-associated acute lower respiratory infection hospital admissions (2·9–4·6 million), 26300 RSV-associated acute lower respiratory infection in-hospital deaths (15100–49100), and 101400 RSV-attributable overall deaths (84500–125200) in children aged 0–60 months. In infants aged 0–6 months, we estimated that there were 6·6 million RSV-associated acute lower respiratory infection episodes (4·6–9·7 million), 1·4 million RSV-associated acute lower respiratory infection hospital admissions (1·0–2·0 million), 13300 RSV-associated acute lower respiratory infection in-hospital deaths (6800–28100), and 45700 RSV-attributable overall deaths (38400–55900). 2·0% of deaths in children aged 0–60 months (UR 1·6–2·4) and 3·6% of deaths in children aged 28 days to 6 months (3·0–4·4) were attributable to RSV. More than 95% of RSV-associated acute lower respiratory infection episodes and more than 97% of RSV-attributable deaths across all age bands were in low-income and middle-income countries (LMICs).

Interpretation

RSV contributes substantially to morbidity and mortality burden globally in children aged 0–60 months, especially during the first 6 months of life and in LMICs. We highlight the striking overall mortality burden of RSV disease worldwide, with one in every 50 deaths in children aged 0–60 months and one in every 28 deaths in children aged 28 days to 6 months attributable to RSV. For every RSV-associated acute lower respiratory infection in-hospital death, we estimate approximately three more deaths attributable to RSV in the community. RSV passive immunisation programmes targeting protection during the first 6 months of life could have a substantial effect on reducing RSV disease burden, although more data are needed to understand the implications of the potential age-shifts in peak RSV burden to older age when these are implemented.

DOI: 10.1016/S0140-6736(22)00478-0

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00478-0/fulltext