北京地区60岁及以上老年人呼吸道合胞病毒感染流行病学和临床特征研究

Epidemiological and clinical characteristics of respiratory syncytial virus infection among people aged 60 and above in Beijing City

目的了解2015—2023年北京地区≥60岁老年人呼吸道合胞病毒(RSV)流行情况与临床特征。方法依托北京市呼吸道病原监测系统,从北京市16个区28家哨点医院收集2015年1月至2023年12月≥60岁老年人急性上呼吸道感染病例、肺炎病例和重症肺炎病例标本。急性上呼吸道感染病例在发病1周内采集咽拭子标本,肺炎及重症肺炎病例采集下呼吸道标本,同时收集患者人口学资料、流行病学资料等。对标本检测包括RSV在内的多种呼吸道病原体。结果 2015年1月至2023年12月,共纳入20 349例≥60岁急性呼吸道感染病例,RSV感染总阳性率为1.54%(313/20 349,95%CI:1.39%~1.68%)。其中,COVID-19流行前期、流行期和流行后期老年人RSV感染总阳性率分别为1.59%(207/13 006,95%CI:1.38%~1.81%)、0.82%(38/4 650,95%CI:0.56%~1.08%)、2.53%(68/2 693,95%CI:1.93%~3.12%),RSV阳性率差异有统计学意义(P<0.001)。基于病例采样时间,北京地区老年人RSV流行季为10月至次年3月,高峰期在12月或次年1月。COVID-19流行后期,2023年4—6月老年人RSV阳性病例检出极少,仅在5月和6月各检出1例阳性病例,10—12月老年人RSV阳性率明显增加,12月阳性率达到11.75%(51/383)。263例老年人RSV感染病例中,RSV-A型占43.35%(114/263),RSV-B型占29.28%(77/263),未分型占27.38%(72/263);自2020年出现型别转换,以RSV-B为主。197例具有完整临床资料老年人RSV感染病例中,主要症状为咳嗽(86.8%,171/197)、咳痰(80.2%,158/197)、发热(73.60%,145/197);24.87%(49/197)的老年病例发生并发症;入院死亡率为4.57%(9/197)、住院率为78.68%(155/197)、ICU入住率为1.99%(36/197)、机械通气使用率为13.32%(33/197),住院天数M(Q1,Q3)为12(9,16)d。结论北京地区≥60岁老年人RSV感染率在COVID-19流行期较低,COVID-19流行较高;2023年老人RSV感染未出现反季节流行;老年人RSV感染病例的并发症多、疾病严重、预后较差。

Objective To investigate the epidemiological and clinical characteristics of RSV among patients aged≥60 years in Beijing from 2015 to 2023.Methods Based on the respiratory pathogen surveillance system,samples of upper respiratory tract infections(URTI),non-severe community-acquired pneumonia(nsCAP)and severe community-acquired pneumonia(sCAP)among people aged≥60 years were collected from 28 sentinel hospitals in 16 districts of Beijing from January 2015 to December 2023.Swab samples were collected from URTI within one week,and lower respiratory tract samples from nsCAP and sCAP were collected.Demographic and epidemiological data were also collected.Various respiratory pathogens including RSV were detected.Results From January 2015 to December 2023,a total of 20349 cases of acute respiratory infections aged≥60 years were included,with the RSV-positive rate of 1.54%(313/20349,95%CI:1.39%-1.68%).Among them,the total RSV-positive rates of older people during the pre-pandemic,pandemic,and post-pandemic periods of COVID-19 were 1.59%(207/13006,95%CI:1.38%-1.81%),0.82%(38/4650,95%CI:0.56%-1.08%)and 2.53%(68/2693,95%CI:1.93%-3.12%),respectively.The difference in RSV-positive rate was statistically significant(P<0.001).Based on the sampling time of cases,the RSV epidemic season for older people in Beijing was from October to March of the following year,with a peak period in December or January of the following year.In the post COVID-19 pandemic,there were very few RSV-positive cases detected in the elderly from April to June 2023,with only one positive case detected in May and one in June.The RSV-positive rate of older people increased significantly from October to December,reaching 11.75%(51/383)in December.Among 263 RSV-positive cases in the elderly,RSV-A,RSV-B and unclassified type accounted for 43.35%(114/263),29.28%(77/263)and 27.38%(72/263),respectively.Since 2020,there has been a subtype conversion,with RSV-B being the main focus.Among 197 elderly cases that have complete clinical data,the main symptoms were cough(86.8%,171/197),sputum(80.2%,158/197)and fever(73.60%,145/197).About 24.87%(49/197)of elderly cases experienced complications.The hospitalization mortality rate was 4.57%(9/197),and the hospitalization rate was 78.68%(155/197).The ICU occupancy rate was 1.99%(36/197).The mechanical ventilation usage rate was 13.32%(33/197),and the length of hospital stay[M(Q1,Q3)]was 12(9,16)days.Conclusion In Beijing,the RSV infection rate is relatively low during the COVID-19 pandemic,and the prevalence of COVID-19 is relatively high.In 2023,there was no out-of-season outbreak of RSV infection among the elderly.Elderly RSV infection cases have multiple complications,severe diseases,and poor prognosis.