Co-seasonality and co-detection of respiratory viruses and bacteraemia in children: a retrospective analysis
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Published on: August 7, 2017
Young June Choe1, Sangshin Park2, Ian C Michelow3
1Department of Pediatrics, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
Insights
Human metapneumovirus (hMPV) and influenza infections in children are linked to increased bacteraemia risk. Further research is needed to understand how these viruses enhance bacterial infections.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Virology
- Bacteriology
Background:
- The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced to reduce bacterial infections in children.
- Understanding the interplay between viral respiratory infections and bacteraemia is crucial for public health.
Purpose of the Study:
- To assess the co-seasonality and co-detection of respiratory viruses and bacteraemia in children post-PCV13 introduction.
- To identify specific respiratory viruses associated with an increased risk of bacteraemia.
Main Methods:
- Retrospective analysis of pediatric cases (2010-2018) with respiratory infections and positive blood cultures.
- Utilized PCR for viral detection and blood cultures for bacterial identification.
- Employed time series analysis (STL, cross-correlation) to examine seasonal trends and associations.
Main Results:
- Significant co-seasonality observed between bacteraemia and respiratory syncytial virus (RSV), influenza, and seasonal coronaviruses.
- Human metapneumovirus (hMPV) and influenza infections showed a more than doubled rate ratio for bacteraemia compared to RSV.
- Staphylococcus aureus and Streptococcus pneumoniae were the predominant bacteraemia pathogens.
Conclusions:
- A significant association exists between hMPV, influenza, and all-cause bacteraemia in hospitalized children.
- Further multicenter studies are required to confirm these findings and investigate the mechanisms of viral potentiation of bacterial infections.
Objectives:
The aim of this study was to assess the co-seasonality and co-detection of respiratory viral infections and bacteraemia in children since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).
Methods:
Children <18 years old were eligible for inclusion if they had a respiratory infection and a positive PCR-based assay for respiratory viruses as well as a positive blood culture between 2010 and 2018 at a single referral centre in the United States, regardless of their underlying medical condition or antibiotic treatment history. Monthly incidence rates of respiratory viruses and bacteraemia were analysed with a seasonal-trend decomposition procedure based on loess (STL) and cross-correlation functions using time series regression modelling.
Results:
We identified 7415 unique positive respiratory virus tests, including 2278 respiratory syncytial virus (RSV) (31%), 1825 influenza viruses (24%), 1036 parainfluenza viruses (14%), 1017 human metapneumovirus (hMPV) (14%), 677 seasonal coronaviruses (9%), and 582 adenoviruses (8%), together with a total of 11 827 episodes of bacteraemia. Significant co-seasonality was found between all-cause bacteraemia and RSV (OR = 1.76, 95%CI 1.50-2.06, p < 0.001), influenza viruses (OR = 1.38, 95%CI 1.13-1.68, p 0.002), and seasonal coronaviruses (OR = 1.18, 95%CI 1.09-1.28, p < 0.001), respectively. Analysis of linked viral-bacterial infections in individual children indicated that the rate ratio (RR) of bacteraemia associated with hMPV (RR = 2.73, 95%CI 1.12-6.85, p 0.019) and influenza (RR = 2.61, 95%CI 1.21-6.11, p 0.013) were more than double that of RSV. Staphylococcus aureus and Streptococcus pneumoniae were the most commonly identified pathogens causing bacteraemia.
Conclusions:
There is a significant association between hMPV and influenza viruses and bacteraemia of all causes in hospitalized children at a single paediatric centre in the United States. Large multicentre studies are needed to confirm these findings and to elucidate the mechanisms by which hMPV potentiates the virulence and invasive capacity of diverse bacteria.
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