Khan Tila, Das Ranjan Saurav, Jaiswal Abhishek, Halder Sayantan, Majhi Rina Maity, Mahato Arabinda, Ghosh Tarapada, Satpathi Parthasarathi, Bhattacharya Sangeeta Das
School of Medical Science & Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302, India.
Viral Research and Diagnostic Laboratory, Department of Microbiology, Midnapore Medical College & Hospital, Midnapore, India.
BMC Infect Dis. 2025 Aug 20;25(1):1047. doi: 10.1186/s12879-025-11421-4.
Evaluating the burden of respiratory syncytial virus (RSV) and influenza among young children in LMICs is crucial to inform implementation policies, given the importance of maternal influenza and RSV vaccination, which may not yet be widely available.
This study established a one-year surveillance of severe acute respiratory infection (SARI) from June 2022-2023 in hospitalized children 1-24 months from rural West Bengal India. We tested nasopharyngeal swabs collected from children admitted with SARI using multiplex real-time PCR for influenza, RSV, SARS-CoV-2, with a subset (N = 81) tested for additional respiratory pathogens and analyzed clinical features, factors influencing infections, and hospitalization duration.
Of 1842 children admitted with SARI, 77% (1419) were between 1 and 24 months. Of 191 sampled, 21 required intensive care, and 3 died. The majority of mothers (83.7%) were vaccinated against COVID-19, but none against influenza, pertussis, or RSV. Viruses were detected in 44% (84/191), with RSV being the most common 60/190 (31.6%), followed by influenza 12/190 (6.3%), and SARS-CoV-2 2/191 (1%). Influenza subtypes included influenza A/H3 (6/16), A/H1N1pdm (5/16), Influenza B (4/16), and Influenza C (1/16). RSV peaked during autumn, influenza during winter and monsoon. Influenza was more common in infants < 6 months (13.4%, p = 0.03). RSV affected both infants under 6 months and over similarly (34% vs. 29.6%, p = 0.5). Infants < 6 months frequently required oxygen support (p = 0.02), though ICU admissions were similar (p = 0.98). RSV was associated with 19% of ICU admissions and influenza with 14%. Additional pathogens included Haemophilus influenzae (23.45%), Streptococcus pneumoniae (22%), rhinovirus (13.6%), parainfluenza virus group (6.1%), Staphylococcus aureus (8.6%), Moraxella catarrhalis (5%), bocavirus (3.7%), adenovirus (3.7%), Chlamydia pneumoniae (1%), and Bordetella (1%). Viral-bacterial co-detection occurred in 34%, especially in infants < 6 months. Children with RSV had increased risk of having S. pneumoniae [Odds Ratio OR 6.2, 95% CI 1.8-21.3]. Rhinovirus cases were associated with ICU admission, mechanical ventilation, and longer length of stay, regardless of age.
RSV and influenza were the key contributors to SARI in children under-2. Findings highlight the need for diagnostics to guide vaccination, reduce antibiotic use, and improve indoor air quality for alleviating the SARI burden in rural settings.
鉴于母体流感和呼吸道合胞病毒（RSV）疫苗接种的重要性（而这两种疫苗在低收入和中等收入国家可能尚未广泛普及），评估低收入和中等收入国家幼儿中呼吸道合胞病毒（RSV）和流感的负担对于制定实施政策至关重要。
本研究于2022年6月至2023年对印度西孟加拉邦农村地区1至24个月大的住院儿童进行了为期一年的严重急性呼吸道感染（SARI）监测。我们使用多重实时聚合酶链反应（PCR）对因SARI入院儿童采集的鼻咽拭子进行检测，以检测流感、RSV、严重急性呼吸综合征冠状病毒2（SARS-CoV-2），并对一部分样本（N = 81）检测其他呼吸道病原体，同时分析临床特征、影响感染的因素以及住院时长。
在1842例因SARI入院的儿童中，77%（1419例）年龄在1至24个月之间。在191例采样儿童中，21例需要重症监护，3例死亡。大多数母亲（83.7%）接种了新冠病毒疫苗，但无人接种流感、百日咳或RSV疫苗。在44%（84/191）的样本中检测到病毒，其中RSV最为常见，为60/190（31.6%），其次是流感12/190（6.3%），SARS-CoV-2为2/191（1%）。流感亚型包括甲型H3流感（6/16）、甲型H1N1pdm流感（5/16）、乙型流感（4/16）和丙型流感（1/16）。RSV在秋季达到高峰，流感在冬季和季风季节达到高峰。流感在6个月以下婴儿中更为常见（13.4%；p = 0.03）。RSV对6个月以下和6个月以上婴儿的影响相似（34%对29.6%；p = 0.5）。6个月以下婴儿经常需要氧气支持（p = 0.02），不过入住重症监护病房的情况相似（p = 0.98）。RSV与19%的重症监护病房入院病例相关，流感与14%相关。其他病原体包括流感嗜血杆菌（23.45%）、肺炎链球菌（22%）、鼻病毒（13.6%）、副流感病毒组（6.1%）、金黄色葡萄球菌（8.6%）、卡他莫拉菌（5%）、博卡病毒（3.7%）、腺病毒（3.7%）、肺炎衣原体（1%）和博德特氏菌（1%）。病毒-细菌合并检测率为34%，尤其在6个月以下婴儿中。感染RSV的儿童感染肺炎链球菌的风险增加[比值比（OR）6.2，95%置信区间（CI）1.8 - 21.3]。无论年龄大小，鼻病毒感染病例均与入住重症监护病房、机械通气及住院时间延长相关。
RSV和流感是2岁以下儿童SARI的主要病因。研究结果凸显了进行诊断以指导疫苗接种、减少抗生素使用以及改善室内空气质量以减轻农村地区SARI负担的必要性。
