TY - JOUR
T1 - The burden of respiratory syncytial virus (RSV) associated acute lower respiratory infections in children with Down syndrome
T2 - A systematic review and meta-analysis
AU - Respiratory Syncytial Virus Network (ReSViNET)
AU - Chan, Markus
AU - Park, John J.
AU - Shi, Ting
AU - Torres, Federico Martinón
AU - Bont, Louis
AU - Nair, Harish
AU - Grobbee, Diederick E.
AU - Greenough, Anne
AU - Manzoni, Paolo
AU - Papadopoulos, Nikolaos
AU - Baraldi, Eugenio
AU - Falsey, Ann R.
AU - Heikkinen, Terho
AU - Mejías, Asunción
AU - Polack, Fernando P.
AU - Sharland, Mike
AU - Ramilo, Octavio
AU - Stein, Renato T.
AU - Martinón-Torres, Federico
AU - Sly, Peter D.
AU - Nunes, Marta
N1 - Funding Information:
rope (RESCEU). RESCEU has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 116019. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.
Funding Information:
FM–T’s institution has received both funding for investigator initiated studies from Astra, MSD and Pfizer and trials fees from Regeneron, Medimmune, Pfizer, MSD, Sanofi Pasteur, Novartis, GSK, Ablynx, Janssen and Novavax. FM–T has received speaker and/or consultancy honoraria from Pfizer, MSD, Sanofi Pasteur, Novartis and GSK. FM–T research activities have been supported by grants from Consellería de Sanidade, Xunta de Galicia (RHI07/2–intensificación actividad investigadora, PS09749 and 10PXIB918184PR), Insti-tuto de Salud Carlos III (Intensificación de la actividad investigadora 2007–2017), Fondo de Investigación Sanitaria (FIS; PI070069/PI1000540/PI1601569) del plan nacional de I + D + I and ‘fondos FEDER’ and 2016–PG071 Consolidación e Estructuración REDES 2016GI–1344 G3VIP (Grupo Gallego de Genética Va-cunas Infecciones y Pediatría, ED341D R2016/021). FM–T reports funding from Ablynx, Jansen, GSK, Re-generon, and Medimmune outside the submitted work.
Funding Information:
HN reports grants from Innovative Medicines Initiative, grants and personal fees from BMGF, grants from
PY - 2017/12/4
Y1 - 2017/12/4
N2 - Background Acute lower respiratory tract infections (ALRIs) caused by respiratory syncytial virus (RSV) are a leading cause of hospitalization in infants. Numerous risk factors have been identified in the aetiology of severe RSV-associated ALRI necessitating hospitalisation, including prematurity and congenital heart disease. Down syndrome (DS), a common genetic disorder associated with congenital and dysmorphic features, has recently been identified as an independent risk factor for RSV-associated ALRI requiring hospitalisation; however, the disease burden of RSV-associated ALRI in this population has not yet been established. Similarly, the impact of DS as an independent risk factor has not yet been quantified. We aimed therefore to estimate the incidence of admissions in children with DS, and by comparing this with unaffected children, to quantify the risk of DS independent of other risk factors. Methods A systematic review of the existing literature published between 1995 and March 1, 2017 was performed to quantify the incidence of hospitalisation due to RSV-associated ALRI in children with DS. Meta-analyses were performed on extracted data using STATA statistical software, and hospitalisation rates for children with and without DS under the age of 2 were calculated. Findings 5 articles were ultimately deemed eligible for analyses. Analyses were limited to children under the age of 2 years. We calculated the hospitalisation rate for children with DS in this age group to be 117.6 per 1000 child-years (95% CI 67.4-205.2), vs a rate of 15.2 per 1000 child-years (95% CI 8.3-27.6) in unaffected children. This indicates DS contributes to a 6.8 (95% CI 5.5-8.4) fold increase in the relative risk of hospitalisation for RSV-associated ALRI. Interpretation Though limited by a small number of articles, this review found sufficient evidence to conclude DS was a significant independent risk factor for the development of severe RSV-associated ALRI requiring hospitalisation. Further studies are needed to define the impact of DS in conjunction with other comorbidities on the risk of severe RSV infection. Determining benefits of immunoprophylaxis or future vaccines against RSV in this at-risk population is warranted.
AB - Background Acute lower respiratory tract infections (ALRIs) caused by respiratory syncytial virus (RSV) are a leading cause of hospitalization in infants. Numerous risk factors have been identified in the aetiology of severe RSV-associated ALRI necessitating hospitalisation, including prematurity and congenital heart disease. Down syndrome (DS), a common genetic disorder associated with congenital and dysmorphic features, has recently been identified as an independent risk factor for RSV-associated ALRI requiring hospitalisation; however, the disease burden of RSV-associated ALRI in this population has not yet been established. Similarly, the impact of DS as an independent risk factor has not yet been quantified. We aimed therefore to estimate the incidence of admissions in children with DS, and by comparing this with unaffected children, to quantify the risk of DS independent of other risk factors. Methods A systematic review of the existing literature published between 1995 and March 1, 2017 was performed to quantify the incidence of hospitalisation due to RSV-associated ALRI in children with DS. Meta-analyses were performed on extracted data using STATA statistical software, and hospitalisation rates for children with and without DS under the age of 2 were calculated. Findings 5 articles were ultimately deemed eligible for analyses. Analyses were limited to children under the age of 2 years. We calculated the hospitalisation rate for children with DS in this age group to be 117.6 per 1000 child-years (95% CI 67.4-205.2), vs a rate of 15.2 per 1000 child-years (95% CI 8.3-27.6) in unaffected children. This indicates DS contributes to a 6.8 (95% CI 5.5-8.4) fold increase in the relative risk of hospitalisation for RSV-associated ALRI. Interpretation Though limited by a small number of articles, this review found sufficient evidence to conclude DS was a significant independent risk factor for the development of severe RSV-associated ALRI requiring hospitalisation. Further studies are needed to define the impact of DS in conjunction with other comorbidities on the risk of severe RSV infection. Determining benefits of immunoprophylaxis or future vaccines against RSV in this at-risk population is warranted.
UR - http://www.scopus.com/inward/record.url?scp=85039044364&partnerID=8YFLogxK
U2 - 10.7189/jogh.07.020413
DO - 10.7189/jogh.07.020413
M3 - Article
C2 - 29302319
AN - SCOPUS:85039044364
SN - 2047-2978
VL - 7
JO - Journal of Global Health
JF - Journal of Global Health
IS - 2
M1 - 020413
ER -