1507. Clinical Characteristics of Common Respiratory Viruses Detected in Infants Across Different Clinical Settings

Abstract

Background Viral acute respiratory infections (ARI) continues to be a significant cause of healthcare visits in young children. We evaluated the clinical presentation and disease severity of common respiratory viruses associated with medically attended ARI in infants. Methods We conducted a prospective viral surveillance study in Davidson County, TN. Infants under one year with fever and/or respiratory symptoms were enrolled from the outpatient (OP), emergency department (ED), or inpatient (IP) settings from 12/16/2019 through 4/30/2020. Nasal swabs were collected and tested for common viral pathogens using Luminex® NxTAG Respiratory Pathogen Panel. Demographic and clinical characteristics were collected through parent/guardian interviews and medical chart abstractions. Results In total, 364 participants were enrolled, and 361 (99%) had nasal swabs collected and tested. Overall, mean age was 6±3.3 months, 50% were female, 45% White, and 27% Hispanic. Of the 295 (82%) virus-positive specimens; the three most common viruses were rhinovirus/enterovirus (RV/EV), respiratory syncytial virus (RSV), and influenza (flu) [124, 101, and 44, respectively]. Compared to virus-negative infants, virus-positive infants were more likely to have more severe ARI symptoms and to be admitted to the intensive care unit (Table 1). Compared to other virus-positive infants: RV/EV-positive infants were more likely to be White, attend daycare, but less likely to present with respiratory distress, or require oxygen or admission; flu-positive infants were older and more likely to have systemic symptoms rather than ARI symptoms, and RSV-positive infants were more likely to present with respiratory distress, receive oxygen and be hospitalized (Table 1). Table 1. Demographic and Clinical Characteristics of Study Subjects Conclusion The majority of ARI in infants are due to respiratory viruses, with RSV, RV/EV, and flu accounting for over three-quarters of these viruses. The clinical presentations and disease severity differed across the clinical settings and the three main viruses, with RSV being most severe. To decrease the burden of medically attended viral ARI, preventive measures (i.e., developing new vaccines and antivirals), refining current vaccination strategies, and infection control measures are needed. Disclosures Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) Danielle A. Rankin, MPH, CIC, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Donald S. Shepard, PhD, Sanofi Pasteur (Grant/Research Support) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)

Systematic literature review of the signs and symptoms of respiratory syncytial virus

“…Twenty‐five studies reported on RSV S&S in the target pediatric population. In addition, 13 studies reported symptom duration, 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 including nine studies that also presented RSV S&S. Hospital LOS was extracted from 13 of the included studies in this review. 19 , 21 , 25 , 26 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 …”

“…Studies on S&S of RSV in the pediatric population (25 studies) took place in both community and clinical settings, and S&S were reported by both caregivers (six studies) 19 , 20 , 21 , 39 , 40 , 41 and clinicians (22 studies) 19 , 20 , 21 , 26 , 27 , 28 , 29 , 34 , 35 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ; we analyzed and present these two sets separately. In addition, two publications presented clinician‐reported S&S in the intensive care unit (ICU).…”

“…Nasal discharge, nasal congestion, cough, shortness of breath, feeding abnormalities, and fever were the most commonly reported S&S by both clinicians and caregivers, occurring in at least 40% of children across multiple studies and treatment settings (Tables S1 to S3 ). 19 , 21 , 28 , 29 , 31 , 34 , 35 , 39 , 40 , 41 , 42 , 43 , 46 , 47 , 49 , 50 , 52 …”

“…In the hospital setting (not including patients in the ICU 24 , 51 ), there were 12 studies of clinician‐reported RSV S&S in children aged 0 to 5 years (Figure 2 and Table S4 ). 19 , 26 , 28 , 34 , 35 , 37 , 39 , 40 , 43 , 44 , 46 , 48 Studies in the ICU setting are summarized separately below. The most common S&S (≥40% of patients) reported by clinicians in the hospitalized pediatric population were cough, nasal discharge or congestion, dyspnea, and feeding abnormalities.…”

“…The most common S&S (≥40% of patients) reported by clinicians in the hospitalized pediatric population were cough, nasal discharge or congestion, dyspnea, and feeding abnormalities. 28 , 34 , 35 , 37 , 43 , 46 , 48 …”