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Published on: January 30, 2017
Viral Etiology and the Impact of Codetection in Young Children Presenting With Influenza-Like Illness
Faye J Lim1, Zoe V Wake2,3, Avram Levy4,5
1Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, West Perth.
Insights
Virus-virus codetection in children with acute respiratory tract infections generally has minimal impact on illness severity. However, specific viral combinations, like influenza and RSV, may increase hospitalization risks.
Area of Science:
- Pediatric infectious diseases
- Virology
- Epidemiology
Background:
- Acute respiratory tract infections (ARTI) in children often involve multiple viruses, but their clinical significance is unclear.
- Investigating virus-virus codetection in pediatric ARTI is crucial for understanding disease impact.
Purpose of the Study:
- To examine the virology of ARTI in children.
- To determine the clinical impact of virus-virus codetection on ARTI severity.
Main Methods:
- Prospective cohort study of children (6-59 months) with influenza-like illness.
- Respiratory virus identification using culture and PCR.
- Comparison of clinical outcomes between single-virus and multi-virus infections using logistic regression.
Main Results:
- Virus detection in 69.2% of 2356 children; rhinovirus, influenza, and RSV were most common.
- 25% of infected children had virus-virus codetection.
- Codetection was associated with increased odds of cough and rhinorrhea; influenza and RSV coinfection showed highest hospitalization probability (55%).
Conclusions:
- Virus-virus codetection has limited overall impact on ARTI clinical severity in children.
- Specific viral pairs, such as influenza and RSV, may be linked to more severe outcomes.
- Routine diagnostics should focus on common pathogens.
Background:
Children with acute respiratory tract infection (ARTI) frequently exhibit virus-virus codetection, yet the clinical significance of ARTI remains contentious. Using data from a prospective cohort of children with influenza-like illness, we examined the virology of ARTI and determined the clinical impact of virus-virus codetection.
Methods:
Children aged 6 to 59 months who presented to a tertiary pediatric hospital between influenza seasons 2008 and 2012 with fever and acute respiratory symptoms were enrolled, and nasal samples were collected. Respiratory viruses were identified by culture and polymerase chain reaction. We compared demographics, presenting symptoms, and clinical outcomes of children with a single-virus infection and those in whom 2 or more viruses were detected (virus-virus codetection). We used logistic regression models and estimated marginal means to calculate the adjusted odds ratios and probabilities of symptom presentation, prescription of antibiotics, and hospitalization.
Results:
Of 2356 children, a virus was detected in 1630 (69.2%) of them; rhinovirus (40.8%), influenza (29.5%), and respiratory syncytial virus (26.4%) were detected most commonly. Two or more viruses were detected in 25% of these children. After we adjusted for demographic factors, children with virus-virus codetection had greater odds of presenting with cough (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2-3.1) and rhinorrhea (aOR, 1.8; 95% CI, 1.1-2.9) than those with a single-virus infection, although both symptoms were common. Children with influenza and respiratory syncytial virus combined had the highest probability of hospitalization (55%; 95% CI, 35%-73%), which was significantly greater than for those with influenza infection alone (22%; 95% CI, 16%-29%).
Conclusions:
Overall, virus-virus codetection has limited impact on clinical severity among children with influenza-like illness. However, infection with specific pathogen pairs might be associated with more severe outcomes. Routine diagnostics to identify specific viruses should be restricted to common pathogens.
