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フィリピンにおけるウイルス性下気道呼吸器感染症の出生コホート研究

大谷 可菜子 東北大学

2020.03.25

概要

<背景> 下気道感染症(Lower respiratory tract infection, LRTI)は、世界の 5 歳未満児の死亡・入院の最も大きな原因である。しかしながら、LRTI を引き起こすウイルスや、年齢別の発症率、重症化との関連性について解明されていない部分は多く、特に、LRTI による影響を最も強く受けている低・中所得国での疫学研究は限られている。また、生後早期では LRTI が重症化するリスクが高いと考えられており、その後の成長や健康にも影響を及ぼしている可能性もある。現在、RSウイルスに対するワクチンの臨床試験が進められているが、呼吸器疾患起因ウイルスに対するワクチンで実用化されているものは生後 6 カ月以降を対象としたインフルエンザワクチンのみである。本研究では、2歳未満での LRTI 発症率や関連するウイルス、危険因子、乳幼児期での LRTI発症による健康への長期的影響の有無を明らかにすることを目的とした。

<方法> フィリピン共和国ビリラン島において、2014 年 3 月から 2016 年 6 月に、5 歳未満児を対象とした小児呼吸器感染症のコホート研究を行った。その参加児のうち、生後 28 日以内に研究に参加した小児のみを出生コホートとして、解析の対象とした。呼吸器症状で医療機関を受診した際に、世界保健機関の専門家会議で提唱された経皮血中酸素飽和濃度を反映した指標を用いて LRTI の診断と重症度判定を行い、鼻咽頭ぬぐい液検体を採取し 7 種類の呼吸器ウイルスを検出した。2019 年には、身体測定と喘息に関する追加調査を行なった。年齢層、重症度、ウイルス別での LRTI 発症率と LRTI 累積発症割合、危険因子、生後 6 カ月または 12 カ月未満での LRTI 発症とその後の LRTI 発症率、3–4 歳時点での喘息疑い診断の有無、低体重・低身長との関連について解析を行った。

<結果> 419 人から 350 症例の LRTI が観察された。LRTI 発症率は、0–5 カ月齢、6–11 カ月齢、12– 23 カ月齢でそれぞれ 70.8、70.7、80.8/100 child-years であった。生後 12 カ月までに 45%の小児が少なくとも1回の LRTI を発症すると推定された。ライノウイルに関連する LRTI の発症率はすべての年齢層において最も高かった(14.4–22.3/100 child-years)。RS ウイルスは特に重症例で多く検出された(22.1%)。インフルエンザウイルスに関連する LRTI 発症は 0–5 カ月齢での検出は少なかった(3.4/100 child-years)。LRTI 発症に関与する危険因子は、発症の年齢層によって異なっていた。生後 6 カ月未満で LRTI を発症した小児は、LRTI を発症しなかった小児に比べ、6 カ月から 23 カ月での LRTI 発症率が高くなり、3–4 歳時点では低体重・低身長である割合が高かった。

<結論> 年齢層別の LRTI 発症率や重症割合はウイルスごとに異なっており、1 歳以降も高い LRTI 発症率が観察された。ワクチンも含めた LRTI の対策では、これらの特徴を考慮する必要がある。また、乳幼児期での LRTI 発症による長期的な健康への影響も示唆された。

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