背景:呼吸道合胞病毒(RSV)是全球儿童急性下呼吸道感染的最常见原因。严重疾病的发病率最高的是在生命的前6个月,早产儿严重RSV感染的风险最大。在欧洲获得新的RSV疗法(长效单克隆抗体和母体疫苗)的许可,美国,英国和最近的澳大利亚,推动了实施RSV免疫计划的战略决策的需要。数据驱动的方法,考虑到当地的RSV流行病学,对于建议最佳使用这些疗法以有效控制RSV至关重要。
方法:我们开发了一个RSV传播的动态隔室模型,该模型适用于基于个体相关人群的实验室,2000-2012年来自西澳大利亚州(WA)的围产期和住院数据,按年龄和先前暴露分层。我们考虑了足月和早产儿(定义为<37周妊娠)中RSV住院的不同风险。我们制定了一个关于年龄的函数,RSV暴露史,和早产状态与感染后RSV住院风险的关系。
结果:年龄-风险函数显示住院风险,鉴于RSV感染,所有婴儿在生命的前12个月内迅速下降,早产是足月婴儿的2.6倍。住院风险,鉴于感染,足月婴儿到7月龄时下降到<10%,早产儿到9月龄时下降到<10%。
结论:动态模型,使用年龄风险函数,表征西澳大都市的RSV流行病学,现在可以扩展到预测预防措施的影响。通过早产状态模型的分层将使得能够相对于所有人群方法在针对该RSV风险组的扩展模型中对潜在策略进行比较评估。此外,这项工作中开发的年龄-风险函数与RSV的流行病学特征具有更广泛的相关性.
BACKGROUND: Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory infections in children worldwide. The highest incidence of severe disease is in the first 6 months of life, with infants born preterm at greatest risk for severe RSV infections. The licensure of new RSV therapeutics (a long-acting monoclonal antibody and a maternal vaccine) in Europe, USA, UK and most recently in Australia, has driven the need for strategic decision making on the implementation of RSV immunisation programs. Data driven approaches, considering the local RSV epidemiology, are critical to advise on the optimal use of these therapeutics for effective RSV control.
METHODS: We developed a dynamic compartmental model of RSV transmission fitted to individually-linked population-based laboratory, perinatal and hospitalisation data for 2000-2012 from metropolitan Western Australia (WA), stratified by age and prior exposure. We account for the differential risk of RSV-hospitalisation in full-term and preterm infants (defined as < 37 weeks gestation). We formulated a function relating age, RSV exposure history, and preterm status to the risk of RSV-hospitalisation given infection.
RESULTS: The age-to-risk function shows that risk of hospitalisation, given RSV infection, declines quickly in the first 12 months of life for all infants and is 2.6 times higher in preterm compared with term infants. The hospitalisation risk, given infection, declines to < 10% of the risk at birth by age 7 months for term infants and by 9 months for preterm infants.
CONCLUSIONS: The dynamic model, using the age-to-risk function, characterises RSV epidemiology for metropolitan WA and can now be extended to predict the impact of prevention measures. The stratification of the model by preterm status will enable the comparative assessment of potential strategies in the extended model that target this RSV risk group relative to all-population approaches. Furthermore, the age-to-risk function developed in this work has wider relevance to the epidemiological characterisation of RSV.