Abstract

Background

Respiratory syncytial virus (RSV)–related acute lower respiratory infection is an important cause of death in infants and young children. However, little is known about the risk period for RSV-related deaths after presentation to health services with an RSV illness.

Methods

Using the Scottish national mortality database, we identified deaths from respiratory/circulatory causes (hereafter “respiratory/circulatory deaths”) in young children aged <5 years during 2009–2016, whose medical history and records of laboratory-confirmed RSV infections were obtained by linking the mortality database to the national surveillance data set and the Scottish Morbidity Record. We used a self-controlled case series (SCCS) design to evaluate the relative incidence of deaths with respiratory/circulatory deaths in the first year after an RSV episode. We defined the risk interval as the first year after the RSV episode, and the control interval as the period before and after the risk interval until 5 years after birth. Age-adjusted incidence ratio and attributable fraction were generated using the R software package SCCS.

Results

We included 162 respiratory/circulatory deaths, of which 36 occurred in children with a history of laboratory-confirmed RSV infection. We found that the mortality risk decreased with time after the RSV episode and that the risk was statistically significant for the month after RSV illness. More than 90% of respiratory/circulatory deaths occurring within 1 week after the RSV episode were attributable to RSV (attributable fraction, 93.9%; 95% confidence interval, 77.6%–98.4%), compared with about 80% of those occurring 1 week to 1 month after RSV illness (80.3%; 28.5%–94.6%).

Conclusions

We found an increased risk of death in the first month after an RSV illness episode leading to healthcare attendance. This provides a practical cutoff time window for community-based surveillance studies estimating RSV-related mortality risk. Further studies are warranted to assess the mortality risk beyond the first month after RSV illness episode.

中文翻译：

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使用自控病例系列设计，揭示幼儿呼吸道合胞病毒疾病后死亡的风险期。

摘要

背景

与呼吸道合胞病毒（RSV）相关的急性下呼吸道感染是婴幼儿死亡的重要原因。但是，对于出现RSV疾病的医疗服务后，与RSV相关的死亡风险期知之甚少。

方法

使用苏格兰国家死亡率数据库，我们确定了2009-2016年间<5岁的5岁以下儿童因呼吸道/循环系统原因造成的死亡（以下称“呼吸道/循环系统死亡”），他们的病史和实验室确诊的RSV感染记录是通过将死亡率数据库与国家监测数据集和苏格兰发病记录联系起来。我们使用自控病例系列（SCCS）设计来评估RSV发作后第一年死亡与呼吸系统疾病/循环系统死亡的相对发生率。我们将风险间隔定义为RSV发作后的第一年，而控制间隔定义为风险间隔前后至出生后5年之间的时间段。使用R软件包SCCS生成了年龄调整后的发病率和归因分数。

结果

我们纳入了162例呼吸道/循环系统死亡，其中36例发生在有实验室确诊的RSV感染史的儿童中。我们发现，RSV发作后，死亡风险随时间降低，并且在RSV发病后的一个月中，该风险具有统计学意义。在RSV发作后1周内发生的呼吸/循环系统死亡中，有90％以上归因于RSV（归因分数，93.9％； 95％置信区间，77.6％–98.4％），而在1周内发生的死亡中约有80％至RSV患病后1个月（80.3％； 28.5％–94.6％）。

结论

我们发现，在RSV疾病发作导致就医后的第一个月，死亡风险增加。这为基于社区的监视研究估计RSV相关的死亡风险提供了一个实际的截止时间窗口。有必要进行进一步的研究以评估RSV疾病发作后第一个月后的死亡风险。