Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Pediatric Infect Dis Soc. 2024 Mar 19;13(3):189-195. doi: 10.1093/jpids/piae009.
Respiratory viral shedding is incompletely characterized by existing studies due to the lack of longitudinal nasal sampling and limited inclusion of healthy/asymptomatic children. We describe characteristics associated with prolonged virus detection by polymerase chain reaction (PCR) in a community-based birth cohort.
Children were followed from birth to 2 years of age in the PREVAIL cohort. Weekly nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel. Weekly text surveys were administered to ascertain the presence of acute respiratory illnesses defined as fever and/or cough. Maternal reports and medical chart abstractions identified healthcare utilization. Prolonged virus detection was defined as a persistently positive test lasting ≥4 weeks. Factors associated with prolonged virus detection were assessed using mixed effects multivariable logistic regression.
From a sub-cohort of 101 children with ≥70% weekly swabs collected, a total of 1489 viral infections were detected. Prolonged virus detection was found in 23.4% of viral infections overall, 39% of bocavirus infections, 33% of rhinovirus/enterovirus infections, 14% of respiratory syncytial virus (RSV) A infections, and 7% of RSV B infections. No prolonged detection was found for influenza virus A or B, coronavirus 229E or HKU1, and parainfluenza virus 2 or 4 infections. First-lifetime infection with each virus, and co-detection of another respiratory virus were significantly associated with prolonged detection, while symptom status, child sex, and child age were not.
Prolonged virus detection was observed in 1 in 4 viral infections in this cohort of healthy children and varied by pathogen, occurring most often for bocavirus and rhinovirus/enterovirus. Evaluating the immunological basis of how viral co-detections and recurrent viral infections impact duration of virus detection by PCR is needed to better understand the dynamics of prolonged viral shedding.
由于缺乏纵向鼻腔采样和对健康/无症状儿童的限制纳入，现有研究未能充分描述呼吸道病毒脱落的特征。我们描述了与社区为基础的出生队列中聚合酶链反应（PCR）检测到的病毒持续时间延长相关的特征。
PREVAIL 队列从儿童出生到 2 岁进行随访。每周采集鼻拭子并使用 Luminex 呼吸道病原体面板进行检测。每周进行文本调查以确定急性呼吸道疾病的存在，定义为发热和/或咳嗽。母亲报告和病历摘录确定了医疗保健的利用情况。将持续阳性检测持续时间≥4 周定义为病毒持续检测。使用混合效应多变量逻辑回归评估与病毒持续检测相关的因素。
从收集了≥70%每周拭子的 101 名儿童的子队列中，共检测到 1489 种病毒感染。总体上，23.4%的病毒感染持续病毒检测，39%的 bocavirus 感染，33%的 rhinovirus/enterovirus 感染，14%的 RSV A 感染和 7%的 RSV B 感染。未发现流感病毒 A 或 B、冠状病毒 229E 或 HKU1 以及副流感病毒 2 或 4 的持续检测。每种病毒的首次感染以及另一种呼吸道病毒的共同检测与持续检测显著相关，而症状状态、儿童性别和儿童年龄则没有。
在本队列中，健康儿童的 1/4 病毒感染中观察到持续病毒检测，病原体各不相同，bocavirus 和 rhinovirus/enterovirus 最常见。评估病毒共同检测和复发性病毒感染如何影响 PCR 检测到的病毒持续时间的免疫基础，对于更好地了解持续病毒脱落的动态是必要的。
