2023+中国专家共识:儿童呼吸道合胞病毒感染的诊断、治疗和预防(英文版).pdf
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1、Vol.:(0123456789)1 3World Journal of Pediatrics https:/doi.org/10.1007/s12519-023-00777-9REVIEW ARTICLEExpert consensus onthediagnosis,treatment,andprevention ofrespiratory syncytial virus infections inchildrenXianLiZhang1 XiZhang2 WangHua1 ZhengDeXie3 HanMinLiu4 HaiLinZhang5 BiQuanChen6 YuanChen7 X
2、inSun8 YiXu9 SaiNanShu10 ShunYingZhao11 YunXiaoShang12 LingCao13 YanHuiJia1 LuoNaLin1 JiongLi14 ChuangLiHao15 XiaoYanDong16 DaoJiongLin17 HongMeiXu18 DeYuZhao19 MeiZeng20 ZhiMinChen21 LiSuHuang1Received:29 August 2023/Accepted:26 October 2023 The Author(s)2023AbstractBackground Respiratory syncytial
3、 virus(RSV)is the leading global cause of respiratory infections and is responsible for about 3 million hospitalizations and more than 100,000 deaths annually in children younger than 5years,representing a major global healthcare burden.There is a great unmet need for new agents and universal strate
4、gies to prevent RSV infections in early life.A multidisciplinary consensus development group comprising experts in epidemiology,infectious diseases,respiratory medicine,and methodology aims to develop the current consensus to address clinical issues of RSV infections in children.Data sources The evi
5、dence searches and reviews were conducted using electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Library,using variations in terms for“respiratory syncytial virus”,“RSV”,“lower respira-tory tract infection”,“bronchiolitis”,“acute”,“viral pneumonia”,“neonatal”,“infant”“chi
6、ldren”,and“pediatric”.Results Evidence-based recommendations regarding diagnosis,treatment,and prevention were proposed with a high degree of consensus.Although supportive care remains the cornerstone for the management of RSV infections,new monoclonal antibodies,vaccines,drug therapies,and viral su
7、rveillance techniques are being rolled out.Conclusions This consensus,based on international and national scientific evidence,reinforces the current recommenda-tions and integrates the recent advances for optimal care and prevention of RSV infections.Further improvements in the management of RSV inf
8、ections will require generating the highest quality of evidence through rigorously designed studies that possess little bias and sufficient capacity to identify clinically meaningful end points.Keywords Consensusprevention Respiratory syncytial virus TreatmentIntroductionIn the past decade,the subst
9、antial burden of respiratory syn-cytial virus(RSV)has attracted global attention.RSV is associated with about 33 million cases of lower respiratory tract infections(LRTIs),three million hospitalizations,and over 100,000 deaths in children younger than 5years each year globally,and no decline in morb
10、idity,hospitalization,or mortality has been observed over time 1,2.Infants in the first 6months of life are particularly vulnerable,with a mor-tality rate of 3.6%attributable to RSV 1.RSV is the most common reason for infant hospitalization in high-income countries,and it causes a disproportionate n
11、umber of deaths in low-and middle-income countries 1.There is,however,a scarcity of consensus or guidelines for the management and prevention of RSV infections in children globally.Pre-vious guidelines focused on bronchiolitis have helped clini-cians manage RSV infections to some extent.Nevertheless
12、,there are emerging evidences of distinct mechanistic path-ways employed by various viruses causing bronchiolitis,and these differences can be responsible for some of the hetero-geneities observed in therapeutic interventions.Therapeutic management tailored to a virological diagnosis is an area for
13、further study.Furthermore,despite two decades of evidence suggesting that less treatment is preferable and advising sup-portive rather than interventional therapy,the elimination of interventional care has not been achieved globally and Extended author information available on the last page of the a
14、rticle World Journal of Pediatrics1 3remains a major challenge.With advancements in virology,significant progress has been made in the epidemiology,diagnosis,treatment,and prevention of RSV infections.To date,dramatic alternations in the epidemiologic profile of RSV have been reported as a result of
15、 the severe acute res-piratory syndrome coronavirus 2(SARS-CoV-2)pandemic 37.The introduction of nonpharmaceutical interventions(NPIs)led first to a sharp decline in global mortality from RSV infections and second to a resurgence of RSV when NPIs had been lifted,which ultimately disrupted the routin
16、e and historical seasonality and subsequently caused peaks in atypical periods of the year,thus leading to a consid-erable impact on global healthcare systems.In addition to palivizumab and nirsevimab,several candidate monoclo-nal antibodies targeting RSV are currently in the pipeline.Moreover,break
17、throughs have been made in RSV vaccines.Therefore,experts in epidemiology,infectious diseases,respiratory medicine,and methodology jointly developed the present consensus,synthesizing the available evidence to better guide clinical practice.The consensus applies to children younger than 5years,focus
18、ing on the most recent research advancements in the epidemiology,clinical mani-festations,diagnosis,treatment,and prevention of RSV infections.MethodsIn January 2023,a steering committee meticulously assem-bled a consensus development group,including 25 special-ists with clinical and/or research exp
19、ertise in epidemiology,infectious diseases,respiratory medicine,and methodology.The composition of the 25 members was carefully designed to ensure representation from various geographic regionsof China,including Beijing,Shanghai,Guangdong,Chong-qing,Hebei,Liaoning,Jiangsu,Zhejiang,Anhui,Hubei,Hainan
20、,Sichuan,and Shanxi.All members were free of financial or intellectual conflicts of interest and were granted unrestricted involvement.The evidence searches and reviews were conducted in January 2023 using electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Library.On these
21、websites,we searched for articles without date restrictions,using variations in terms for“respiratory syncytial virus”,“RSV”,“lower respiratory tract infection”,“bronchiolitis”,“acute”,“viral pneumonia”,“neonatal”,“infant”“children”,and“pediatric”.Furthermore,a comprehensive search was conducted to
22、uncover additional pertinent literature by exam-ining the references of the selected publications.References were regularly updated during the drafting of the consensus.Reviewers collaborated in pairs,independently performed reference screening and data extraction,and resolved any disagreements thro
23、ugh discussion or consultation with a third reviewer.A draft version of the document underwent a thorough evaluation process by consensus development group members.The resulting comments were reviewed by consensus development group members and subsequently integrated into the final draft as appropri
24、ate.A Delphi method was adopted to develop a consensus of pertinent statements.The consensus development group members were requested to vote on each statement of the Delphi questionnaire according to a five-point Likert scale(strongly agree/agree/neither agree nor disagree/disagree/strongly disagre
25、e)and provide open text comments,as appropriate.Consensus agreement was defined as an agree-ment by a minimum of 75%of the participants(i.e.,75%agree or strongly agree).The Delphi questionnaire was completed by all 25 experts via an online survey in July 2023,and final drafted recommendations were f
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