探讨成人门诊患者呼吸道合胞病毒的病例定义和自然史：第一季的呼吸器-50研究结果

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-01-03 DOI:10.1016/j.jiph.2025.102653

Alexander Domnich , Francesco Lapi , Andrea Orsi , Piero Luigi Lai , Luca Pestarino , Pier Claudio Brasesco , Marta Vicentini , Anna Puggina , Alen Marijam , Carlo-Simone Trombetta , Giada Garzillo , Giulia Guarona , Federica Stefanelli , Valentina Ricucci , Donatella Panatto , Giancarlo Icardi

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引用次数: 0

摘要

背景：成人门诊患者社区获得性RSV的自然病史资料有限。目前还不清楚基于流感样疾病（ILI）病例定义的现有流感监测平台对呼吸道合胞病毒是否有效。两季的呼吸器-50研究于2023年建立，旨在确定最佳RSV病例定义并探索RSV的自然历史。在这里，报告了第一季的结果。方法：研究于2023/2024 RSV流行季在意大利热那亚进行。24名全科医生以1:1的比例随机分组，分别纳入年龄≥ 50岁、因急性呼吸道感染（ARI）或ILI就诊的成年人。这两种综合征都是根据欧洲标准定义的。所有受试者均采用实时聚合酶链反应（RT-PCR）检测RSV和其他病原体。对rsv阳性的成年人进行了长达30天的随访。结果：纳入的517名受试者中，7.0 %[95 %可信区间（CI）： 4.9-9.5 %)]检测出RSV阳性。急性呼吸道感染组RSV患病率(8.0 %；95 % CI: 5.0-12.1 %)高于ILI组(6.0 %；95 % CI: 3.5-9.5 %)，优势比为1.36（95 % CI: 0.69-2.70）。相反，ARI组的流感（10.4 % vs 12.4 %）和SARS-CoV-2（12.4 % vs 16.9 %）的阳性率较低，相应的or分别为0.82（95 % CI: 0.48-1.42）和0.70（95 % CI: 0.43-1.15）。RSV发作的平均持续时间为18.8 ± 8.0天，三分之二的个体使用抗生素。共有33.3% %（95 % CI: 18.6 ~ 51.0% %）的rsv阳性个体出现并发症，其中以支气管炎（13.9 %）和肺炎（8.3 %）最为常见。结论：与ARI相比，基于ili的监测可能低估了≥ 50岁社区居住成年人RSV的负担。rsv阳性的成人门诊患者出现并发症的比例很高，这导致大量的资源消耗。

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Exploring case definitions and the natural history of respiratory syncytial virus in adult outpatients: First-season results of the RESPIRA-50 study

Background

Data on the natural history of the community-acquired RSV in adult outpatients are limited. It is also unclear whether the existing influenza surveillance platforms based on influenza-like illness (ILI) case definitions are efficient for RSV. The two-season RESPIRA-50 study was established in 2023 to identify an optimal RSV case definition and to explore the natural history of RSV. Here, the first-season results are reported.

Methods

The study was conducted in Genoa (Italy) during the 2023/2024 RSV season. Twenty-four general practitioners were randomized 1:1 to enroll adults aged ≥ 50 years seeking care for acute respiratory infection (ARI) or ILI, respectively. Both syndromes were defined according to the European criteria. All subjects were tested by real-time polymerase chain reaction (RT-PCR) for RSV and other pathogens. RSV-positive adults were followed for up to 30 days.

Results

Of 517 subjects included, 7.0 % [95 % confidence interval (CI): 4.9–9.5 %)] tested positive for RSV. RSV prevalence in the ARI group (8.0 %; 95 % CI: 5.0–12.1 %) was higher than in the ILI group (6.0 %; 95 % CI: 3.5–9.5 %) with an odds ratio of 1.36 (95 % CI: 0.69–2.70). Conversely, positivity for influenza (10.4 % vs 12.4 %) and SARS-CoV-2 (12.4 % vs 16.9 %) were lower in the ARI group and the corresponding ORs were 0.82 (95 % CI: 0.48–1.42) and 0.70 (95 % CI: 0.43–1.15), respectively. The mean duration of an RSV episode was 18.8 ± 8.0 days and two thirds of individuals were prescribed antibiotics. A total of 33.3 % (95 % CI: 18.6–51.0 %) of RSV-positive individuals developed complications, of which bronchitis (13.9 %) and pneumonia (8.3 %) were the most frequent.

Conclusions

Compared with ARI, ILI-based surveillance may underestimate the burden of RSV in community-dwelling adults aged ≥ 50 years. A high proportion of RSV-positive adult outpatients develops complications, which lead to substantial resource consumption.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.