WHO respiratory disease survey in children: a serological study

This paper is a report on the first (serological) phase of a study organized by WHO in collaboration with the WHO International Reference Centre for Respiratory Virus Diseases other than Influenza in Bethesda, Md., USA, to define the viral etiology of severe respiratory infections in children, particularly in tropical areas. Paired sera from 528 children up to 5 years old admitted to hospital with severe respiratory illness of probable viral etiology were collected in 10 countries and sent frozen to the International Reference Centre, where standard complement-fixation tests were made for the following agents: parainfluenza virus types 1, 2 and 3, influenza virus types A and B, adenoviruses, respiratory syncytial virus, Mycoplasma pneumoniae, Coxiella burneti and psittacosis-ornithosis.Some 41% of paired sera showed rising antibody titres for one or more of these agents, multiple infections being observed in 8%. In most of the countries the pattern of infection was similar. RS virus was the most important respiratory tract pathogen of early life, particularly in the first year of life and in cases of bronchiolitis and pneumonia; the parainfluenza viruses were next in importance, particularly in cases of croup, but, in contra-distinction to RS virus infections, they were commoner in older children. Influenza, adenoviruses, and M. pneumoniae were of moderate importance, and C. burneti and the psittacosis-ornithosis agents were relatively rare. This pattern is similar to that which has been observed in temperate climates.