Respiratory viruses in acute respiratory infections among hospitalized children in Macau

Abstract

Background: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality worldwide. Children are the most susceptible group. The epidemiological profile of respiratory viruses in local region is necessary for the management of ARI. However, limited data are available in Macau._ Furthermore, the frequent incidences of multiple viral infection and the difficulties in establishing precise viral etiology of coinfection pose a challenge to medical treatment, control and prevention.

Objectives: The aim of the study is to explore the viral etiology, seasonality, susceptible groups and to assess disease severity of viral coinfection of ARI among hospitalized children in Macau, to provide a scientific basis for diagnosis, treatment, control and prevention.

Methods: A 3 years retrospective analysis of medical records carried out in Kiang Wu Hospital, Macau. Children aged under 14 years, hospitalized for acute respiratory infection (ICD9 460-466, ICD: International Classification of Diseases, version 9) and its subcategory influenza and pneumonia (ICD 480-478) were recruited. In additional, their laboratory diagnostic test results of detected respiratory virus infection using multiplex PCR were collected.

Results and conclusion: In this study, among the 1388 hospitalized children with ARI in Macau Kiang Wu Hospital from 2012 to 2014, 923 cases (66.5%) of children were positive for at least one viral pathogens, 804 (87.1%) were <5 years old. The most prevalent respiratory viruses were human rhinovirus/enterovirus (HRV/ENT, 24.4%), adenovirus (ADV, 17.5%), respiratory syncytial virus (RSV, 8.9%), parainfluenza viruses (PIVs, 8.9%) and influenza viruses (Flu, 6.7%). Respiratory viral pathogens were detected throughout the years, but it can be concluded that there was an overall winter–spring and autumn–winter seasonality. Although of a lower detection rate, the newly identified viruses: human metapneumovirus (hMPV, 4.4%) and human bocavirus (HBoV, 3.5%) were likely to induce severe disease and prolong hospitalization. Coinfection was common (131 cases, 14.2%), HRV/ENT, ADV, RSV-A, PIVs were the most frequently involved in multiple infection. In linear regression, children admitted with RSV coinfected with other viral pathogens had a significant 33% longer hospitalization duration compared to those admitted with RSV-A single viral infection (exp(_)=1.33, 95% CI=1.04, 1.69; P=0.023). In multi-variable logistic regression, children coinfected with influenza virus and other viral pathogens presented a higher rate of pneumonia and respiratory tract failure (OR=8, 95%CI 1.01, 63.23; P=0.049). However, children with HBoV coinfection were identified with marginal significant to decrease disease severity as presented a lower rate of pneumonia and respiratory tract failure compared to those infected with single HBoV pathogen. (OR=0.14, 95% CI 0.03, 0.61; P=0.090). HBoV was the viral pathogen involved in coinfection most frequently with coinfection rate of up to 54.2%.

In this study, provided a better understanding of the local epidemiological profile, which could help to provide a scientific basis to diagnosis, treatment, prevent and control of ARI. In addition, as the association between multiple viral infection and disease severity was clarified in this study. It could help to assess clinical outcome, disease severity and relative treatment of multiple viral infection in clinical practice.