Evidence of a Causal Role of Winter Virus Infection during Infancy in Early Childhood Asthma
Pingsheng Wu1,2,3,
William D. Dupont3,6,
Marie R. Griffin2,4,5,6,
Kecia N. Carroll7,
Edward F. Mitchel6,
Tebeb Gebretsadik3 and
Tina V. Hartert1,2,4,5
1 Division of Allergy, Pulmonary and Critical Care Medicine, 2 Department of Medicine, 3 Department of Biostatistics, 4 Center for Health Services Research, 5 Institute for Medicine and Public Health, 6 Department of Preventive Medicine, 7 Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
Correspondence and requests for reprints should be addressed to Tina V. Hartert, M.D., M.P.H., 6107 Medical Center East, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-8300. E-mail: tina.hartert{at}vanderbilt.edu
Rationale: Bronchiolitis during infancy is associated with anincreased risk of childhood asthma. Whether winter viral infectionscause asthma or are a manifestation of a predisposition to asthmadevelopment is unknown.
Objectives: To study the relationship of winter virus infectionduring infancy and the development of childhood asthma.
Methods: We studied over 95,000 infants born between 1995 and2000 and followed through 2005 who were enrolled in the TennesseeMedicaid program from birth through early childhood to determinewhether infant birth in relationship to the winter virus peakalters the risk of developing early childhood asthma.
Measurements and Main Results: Among 95,310 children studiedduring five winter virus seasons from birth through early childhood,the risk of developing asthma tracked with the timing of infantbirth in relationship to the winter virus peak. Infant birthapproximately 4 months before the winter virus peak carriedthe highest risk, with a 29% increase in odds of developingasthma compared with birth 12 months before the peak (adjustedodds ratio, 1.29; 95% confidence interval, 1.19–1.40).Infant age at the winter virus peak was comparable to or greaterthan other known risk factors for asthma.
Conclusions: Timing of birth in relationship to winter virusseason confers a differential and definable risk of developingearly childhood asthma, establishing winter virus seasonalityas a causal factor in asthma development. Delay of exposureor prevention of winter viral infection during early infancycould prevent asthma.
Scientific Knowledge on the Subject
Bronchiolitis during infancyis associated with an increased risk of childhood asthma. Whethercommon respiratory viruses, which infect all infants, causeasthma or whether infection is a marker of those predisposedto developing asthma is unknown.
What This Study Adds to theField
Timing of birth in relationship to the annual wintervirus peak predicts an infant's likelihood of developing childhoodasthma. This study provides strong evidence for a causal relationshipof winter viruses with early childhood asthma.
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