Kalawati Saran Children's Hospital & Lady Hardinge Medical College, New Delhi, India.
Influenza Program, US Centers for Disease Control and Prevention - Delhi office, New Delhi, India.
J Glob Health. 2024 Nov 8;14:04230. doi: 10.7189/jogh.14.04230.
With the increased availability of licensed vaccines for respiratory viruses such as severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus (RSV), and influenza virus, a better understanding of the viral aetiology of severe acute respiratory infections (SARI) among children could help in optimising the use of these vaccines. We conducted a study among children aged <5 years hospitalised with SARI at a tertiary care children's hospital in north India and tested for common respiratory pathogens.
We randomly enrolled eligible SARI cases aged <5 years from August 2013 to July 2015. SARI cases were defined as either <7-day history of fever with cough or in children aged eight days to three months, a physician diagnosis of acute lower respiratory infection requiring hospitalisation. We also enrolled an age-group matched control without any acute illness in a 2:1 ratio from the outpatient clinic within 24 hours of case enrolment. Nasopharyngeal and/or oropharyngeal swabs were collected and tested using TaqMan Array Cards, a real-time reverse transcription polymerase chain reaction-based multi-pathogen testing platform for selected respiratory viruses among the enrolled cases and controls. We compared the prevalence of each pathogen among cases and controls using the χ (χ) or Fisher exact test (P < 0.05). We used logistic regression to estimate adjusted odds ratios (aORs) which were then used to calculate aetiologic fractions (EFs).
We enrolled 840 cases and 419 outpatient controls. Almost half of the individuals in the whole sample were aged <6 months (n = 521, 41.4%). Females made up 33.7% of cases and 37.2% of controls. Viral detections were more common among cases (69%, 95% confidence interval (CI) = 66, 73) compared to controls (33%; 95% CI = 29, 38) (P < 0.01). RSV (n = 257, 31%; 95% CI = 28, 34%) was the most common virus detected among cases. Influenza A was detected among 24 (3%; 95% CI = 2, 4%), and influenza B among 5 (1%; 95% CI = 0, 1%) cases. The association between the virus and SARI was strongest for RSV (aOR = 23; 95% CI = 12, 47; EF = 96%). Antivirals were administered to 1% of SARI cases while 78% received antibiotics.
Using a multi-pathogen molecular detection method, we detected respiratory viruses among more than two-thirds of children aged <5 years admitted with SARI in the Delhi tertiary care children's hospital. The guidelines for preventing and managing SARI cases among children could be optimised further with the improved availability of antivirals and vaccines.
随着针对严重急性呼吸道综合征冠状病毒 2、呼吸道合胞病毒（RSV）和流感病毒等呼吸道病毒的许可疫苗的供应增加，更好地了解儿童严重急性呼吸道感染（SARI）的病毒病因学，有助于优化这些疫苗的使用。我们在印度北部的一家三级儿童保健医院对因 SARI 住院的<5 岁儿童进行了一项研究，并对常见呼吸道病原体进行了检测。
我们随机招募了 2013 年 8 月至 2015 年 7 月期间<5 岁的符合条件的 SARI 病例。SARI 病例的定义为<7 天发热伴咳嗽或 8 天至 3 个月大的儿童，医生诊断为需要住院治疗的急性下呼吸道感染。我们还从病例入组后 24 小时内的门诊以 2:1 的比例招募了一名年龄匹配的无急性疾病的对照组。对纳入病例和对照组的鼻咽和/或口咽拭子进行采集，并使用 TaqMan 阵列卡进行检测，这是一种基于实时逆转录聚合酶链反应的多病原体检测平台，用于检测所选呼吸道病毒。我们使用卡方检验（χ 2 检验）（P<0.05）比较了病例和对照组中每种病原体的流行率。我们使用逻辑回归估计调整后的优势比（aOR），然后使用这些 aOR 计算病因分数（EF）。
我们共招募了 840 例病例和 419 名门诊对照组。整个样本中几乎一半的个体年龄<6 个月（n=521，41.4%）。女性占病例的 33.7%，对照组的 37.2%。与对照组（33%；95%CI=29，38）相比，病毒检测在病例中更为常见（69%；95%CI=66，73）（P<0.01）。RSV（n=257，31%；95%CI=28，34%）是病例中最常见的病毒。甲型流感病毒在 24 例（3%；95%CI=2，4%）中被检测到，乙型流感病毒在 5 例（1%；95%CI=0，1%）中被检测到。病毒与 SARI 之间的关联最强的是 RSV（aOR=23；95%CI=12，47；EF=96%）。1%的 SARI 病例接受了抗病毒药物治疗，而 78%的病例接受了抗生素治疗。
使用多病原体分子检测方法，我们在德里三级儿童保健医院因 SARI 住院的<5 岁儿童中检测到了呼吸道病毒。随着抗病毒药物和疫苗的供应增加，预防和管理儿童 SARI 病例的指南可以进一步优化。
