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Ten years' experience with year-round active surveillance of up to 19 respiratory pathogens in children
Josef A I Weigl1, Wolfram Puppe, Claudius U Meyer
1Pediatric Infectious Diseases, Children's Hospital Kiel, Schwanenweg 20, Kiel, Germany. weigl@pediatrics.uni-kiel.de
Insights
Active surveillance for acute respiratory infections (ARI) in children is more effective than passive systems. Comprehensive, pathogen-specific, and population-based surveillance provides superior data for understanding pediatric respiratory illnesses.
Area of Science:
- Pediatric infectious diseases
- Respiratory virology
- Public health surveillance
Background:
- Current acute respiratory infection (ARI) surveillance in children often has limitations in pathogen scope, age range, or seasonality.
- Existing systems may be syndromic or restricted to winter months, potentially missing key etiological data.
Purpose of the Study:
- To establish and evaluate an active, year-round, population-based surveillance system for ARI in children.
- To comprehensively identify a wide range of respiratory pathogens in pediatric populations.
Main Methods:
- Implemented an active, year-round surveillance network (PID-ARI.net) across three German regions.
- Included children aged 0-16 years, collecting samples for multiplex RT-PCR testing of up to 19 noncolonizing airway pathogens.
Main Results:
- Over 10 years (1996-2006), 18,899 samples were analyzed, with positive detection rates reaching 72.9% with an expanded pathogen panel.
- Picornaviruses, paramyxoviruses, and orthomyxoviruses were the most prevalent pathogens.
- Certain viruses exhibited distinct seasonal patterns, and the age distribution of infections varied by pathogen.
Conclusions:
- Active, pathogen-specific, and comprehensive surveillance systems are superior to passive methods for ARI in children.
- Population-based, multilevel surveillance is crucial for minimizing bias.
- The role of atypical bacteria in pediatric ARI may have been overestimated in previous studies.
Introduction:
Surveillance systems for acute respiratory infections (ARI) in children currently are often limited in terms of the panel of pathogens and the age range investigated or are only syndromic and at times only active in the winter season.
Methods:
Within PID-ARI.net, a research network for ARI in children in Germany, an active, year-round surveillance system was formed in three regions from north to south for population-based analysis. Children from birth to 16 years of age were included and up to 19 noncolonizing airway pathogens were tested for with multiplex RT-PCR.
Results:
In the 10-year period from July 1996 to June 2006, a total of 18,899 samples were tested. The positive rate increased with the size of the test panel to up to 72.9%. Picornaviruses (35-39%), paramyxoviruses (23-28%) and orthomyxoviruses (5.8-12.5%) comprised the highest fraction. Reoviruses and Legionella pneumophila were not found at all and Chlamydia pneumoniae and Bordetella parapertussis only rarely. Respiratory syncytial virus and parainfluenza virus (PIV) type 3 were anticyclical in rhythmicity with metapneumovirus and PIV1 and PIV2. The age medians per pathogen depended predominantly upon the attack rate and interepidemic intervals.
Conclusion:
Active surveillance systems for ARI are superior to passive systems. They should be pathogen-specific and comprehensive for viruses and bacteria and age ranges. They should be population-based and multilevel to avoid bias. The impact of atypical bacteria in children was highly overestimated in earlier studies.
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