Infección por virus sincicial respiratorio en poblaciones vulnerables: riesgo biológico contra riesgo social
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Rev. bol. ped.
Abstract
Introducción. Los prematuros con displasia broncopulmonar y sin ella tienen alto riesgo de hospitalización por infección por virus sincicial respiratorio. En Argentina no existen suficientes datos epidemiológicos que permitan extrapolar las recomendaciones establecidas para el empleo de palivizumab para la profilaxis pasiva de este virus en poblaciones vulnerables. Además del riesgo biológico, pocos estudios han explorado el impacto del contexto socioambiental. El objetivo de este estudio fue analizar los factores biológicos y socioambientales asociados con la ocurrencia de formas graves de infección respiratoria por virus sincicial respiratorio en prematuros con displasia broncopulmonar o sin ella. Población, material y métodos. El diseño del estudio fue de casos y controles. Se incluyeron todos los niños atendidos en el programa de seguimiento entre los meses de mayo a septiembre de los años 1998 a 2002, que cumplían con los criterios para profilaxis con palivizumab que recomienda la Academia Estadounidense de Pediatría. Se exploraron retrospectivamente variables de riesgo biológico y de riesgo social. Resultados. De los 121 pacientes analizados, 30 (25%) requirieron internación (casos). No requirieron internación 91 pacientes (controles). Entre las variables de riesgo biológico analizadas, los casos tuvieron peso al nacer y edad gestacional mayores que los controles (PN: 1.329 g ± 450 contra 1.145 g ± 393). No se hallaron diferencias significativas en otras variables de riesgo biológico. El análisis de las variables de riesgo social sólo mostró diferencias al comparar la presencia de hermanos o convivientes en edad escolar y el nivel de educación materna menor a primario completo (OR 5,4 IC 95% 1,7-16; OR 5,8 IC95% 2,2-15,4). Conclusiones. Nuestros resultados muestran que el peso de nacimiento y la edad gestacional podrían ser insuficientes para determinar la probabilidad de internación por virus sincicial respiratorio. La presencia de convivientes menores de 10 años y la educación materna se asociaron con riesgo de infección.
Introduction. Preterm infants and those carrying bronchopulmonary dysplasia have a higher risk of hospitalization because of respiratory syneytial virus infection. Palivizumab is an expensive drug that has been approved in Argentina. The lack of epidemiological data about respiratory syneytial virus infection hospitalizations in high-risk populations precludes extrapolation of the American Academy of Pediatrics guidelines to the Argentine population. Few studies have explored social risk in the biologically vulnerable groups for this severe infection. Objective. To explore the association between biologic and socio-economic factors, and severe forms of respiratory syneytial virus infection in preterm babies with or without bronchopulmonary dysplasia. Population, material and methods. The study design is a case-control study. Inclusion criteria: children who attended to the neonatal high-risk clinic followup program and met the criteria of the American Academy of Pediatrics guidelines during a five year period (May to September 1998-2002). Biological and social risk variables were investigated. Results. Of the 121 patients who fulfilled the inclusion criteria; 30 patients (25%) required hospitalization (cases) and 91 did not require hospitalization (controls). For the analyzed biological variables of risk, the cases had birth weights and gestational ages greater than controls (329 g ± 450 versus 1,145 g ± 393). There were not significant differences in their variables of biological risk. Only siblings or other children in the household younger than ten years of age and mothers with incomplete primary school were associated with increased risk of hospitalization (OR 5.4, CI 95% 1.7-16; OR 5.8 CI 95% 2.2-15.4). Conclusions. We conclude that the biological risk factors currently used in developed countries are inadequate to define the risk for respiratory syncitial virus infection hospitalization in low socioeconomic groups in developing countries, and that social factors (i.e.: maternal education and the number of siblings) were strongly associated to serious infection by respiratory syneytial virus.
Introduction. Preterm infants and those carrying bronchopulmonary dysplasia have a higher risk of hospitalization because of respiratory syneytial virus infection. Palivizumab is an expensive drug that has been approved in Argentina. The lack of epidemiological data about respiratory syneytial virus infection hospitalizations in high-risk populations precludes extrapolation of the American Academy of Pediatrics guidelines to the Argentine population. Few studies have explored social risk in the biologically vulnerable groups for this severe infection. Objective. To explore the association between biologic and socio-economic factors, and severe forms of respiratory syneytial virus infection in preterm babies with or without bronchopulmonary dysplasia. Population, material and methods. The study design is a case-control study. Inclusion criteria: children who attended to the neonatal high-risk clinic followup program and met the criteria of the American Academy of Pediatrics guidelines during a five year period (May to September 1998-2002). Biological and social risk variables were investigated. Results. Of the 121 patients who fulfilled the inclusion criteria; 30 patients (25%) required hospitalization (cases) and 91 did not require hospitalization (controls). For the analyzed biological variables of risk, the cases had birth weights and gestational ages greater than controls (329 g ± 450 versus 1,145 g ± 393). There were not significant differences in their variables of biological risk. Only siblings or other children in the household younger than ten years of age and mothers with incomplete primary school were associated with increased risk of hospitalization (OR 5.4, CI 95% 1.7-16; OR 5.8 CI 95% 2.2-15.4). Conclusions. We conclude that the biological risk factors currently used in developed countries are inadequate to define the risk for respiratory syncitial virus infection hospitalization in low socioeconomic groups in developing countries, and that social factors (i.e.: maternal education and the number of siblings) were strongly associated to serious infection by respiratory syneytial virus.
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Vol. 46, No. 1