Early-life severe respiratory syncytial virus (RSV) infection has been associated with the onset of childhood wheezing illnesses. However, the relationship between RSV infection during infancy and the development of childhood asthma is unclear. We aimed to assess the association between RSV infection during infancy and childhood asthma. INSPIRE is a large, population-based, birth cohort of healthy infants with non-low birthweight born at term between June and December, 2012, or between June and December, 2013. Infants were recruited from 11 paediatric practices across middle Tennessee, USA. We ascertained RSV infection status (no infection infection) in the first year of life using a combination of passive and active surveillance with viral identification through molecular and serological techniques. Children were then followed up prospectively for the primary outcome of 5-year current asthma, which we analysed in all participants who completed 5-year follow-up. Statistical models, which were done for children with available data, were adjusted for child's sex, race and ethnicity, any breastfeeding, day-care attendance during infancy, exposure to second-hand smoke in utero or during early infancy, and maternal asthma. Of 1946 eligible children who were enrolled in the study, 1741 (89%) had available data to assess RSV infection status in the first year of life. The proportion of children with RSV infection during infancy was 944 (54%; 95% CI 52–57) of 1741 children. The proportion of children with 5-year current asthma was lower among those without RSV infection during infancy (91 [16%] of 587) than those with RSV infection during infancy (139 [21%] of 670; p=0·016). Not being infected with RSV during infancy was associated with a 26% lower risk of 5-year current asthma than being infected with RSV during infancy (adjusted RR 0·74, 95% CI 0·58–0·94, p=0·014). The estimated proportion of 5-year current asthma cases that could be prevented by avoiding RSV infection during infancy was 15% (95% CI 2·2–26·8). Among healthy children born at term, not being infected with RSV in the first year of life was associated with a substantially reduced risk of developing childhood asthma. Our findings show an age-dependent association between RSV infection during infancy and childhood asthma. However, to definitively establish causality, the effect of interventions that prevent, delay, or decrease the severity of the initial RSV infection on childhood asthma will need to be studied. US National Institutes of Health.

中文翻译：

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美国婴儿期呼吸道合胞病毒感染和儿童期哮喘 (INSPIRE)：一项基于人群的前瞻性出生队列研究


生命早期严重呼吸道合胞病毒（RSV）感染与儿童喘息疾病的发病有关。然而，婴儿期 RSV 感染与儿童哮喘发展之间的关系尚不清楚。我们的目的是评估婴儿期 RSV 感染与儿童哮喘之间的关联。 INSPIRE 是一个基于人口的大型出生队列，由 2012 年 6 月至 12 月或 2013 年 6 月至 12 月期间出生的非低出生体重的健康婴儿组成。婴儿是从美国田纳西州中部的 11 个儿科诊所招募的。我们通过分子和血清学技术将被动和主动监测与病毒鉴定相结合，确定了出生后第一年的 RSV 感染状态（无感染）。然后对儿童进行前瞻性随访，了解 5 年当前哮喘的主要结局，我们对所有完成 5 年随访的参与者进行了分析。统计模型是针对现有数据的儿童进行的，并根据儿童的性别、种族和民族、母乳喂养、婴儿期日托出勤情况、子宫内或婴儿早期接触二手烟以及孕产妇哮喘等因素进行了调整。在参加该研究的 1946 名符合条件的儿童中，1741 名（89%）有可用数据来评估生命第一年的 RSV 感染状况。 1741 名儿童中，婴儿期感染 RSV 的儿童比例为 944 名（54%；95% CI 52-57）。婴儿期未感染 RSV 的儿童（587 名中的 91 名 [16%]）中当前患有 5 年哮喘的儿童比例低于婴儿期感染 RSV 的儿童（670 名中的 139 名 [21%]；p=0·016） 。 与婴儿期感染 RSV 相比，婴儿期未感染 RSV 的 5 年哮喘风险降低 26%（调整后 RR 0·74，95% CI 0·58–0·94，p=0· 014）。通过在婴儿期避免 RSV 感染可以预防 5 年现有哮喘病例的估计比例为 15% (95% CI 2·2–26·8)。在足月出生的健康儿童中，在生命的第一年没有感染 RSV 与患儿童哮喘的风险大大降低有关。我们的研究结果表明，婴儿期 RSV 感染与儿童哮喘之间存在年龄依赖性关联。然而，为了明确确定因果关系，需要研究预防、延迟或降低初始 RSV 感染严重程度的干预措施对儿童哮喘的影响。美国国立卫生研究院。