Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe—results from the PED-MERMAIDS multicentre case–control study

Abstract

BackgroundBoth pathogenic bacteria and viruses are frequently detected in the nasopharynx (NP) of children in the absence of acute respiratory infection (ARI) symptoms. The aim of this study was to estimate the aetiological fractions for ARI hospitalisation in children for respiratory syncytial virus (RSV) and influenza virus and to determine whether detection of specific respiratory pathogens on NP samples was associated with ARI hospitalisation.Methods349 children up to 5 years of age hospitalised for ARI (following a symptom-based case definition) and 306 hospital controls were prospectively enrolled in 16 centres across seven European Union countries between 2016 and 2019. Admission day NP swabs were analysed by multiplex PCR for 25 targets.ResultsRSV was the leading single cause of ARI hospitalisations, with an overall population attributable fraction (PAF) of 33.4% and high seasonality as well as preponderance in younger children. Detection of RSV on NP swabs was strongly associated with ARI hospitalisation (OR adjusted for age and season: 20.6, 95% CI: 9.4 to 45.3). Detection of three other viral pathogens showed strong associations with ARI hospitalisation: influenza viruses had an adjusted OR of 6.1 (95% CI: 2.5 to 14.9), parainfluenza viruses (PIVs) an adjusted OR of 4.6 (95% CI: 1.8 to 11.3) and metapneumoviruses an adjusted OR of 4.5 (95% CI: 1.3 to 16.1). Influenza viruses had a PAF of 7.9%, PIVs of 6.5% and metapneumoviruses of 3.0%. In contrast, most other pathogens were found in similar proportions in cases and controls, including Streptococcus pneumoniae, which was weakly associated with case status, and endemic coronaviruses.ConclusionRSV is the predominant cause of ARI hospitalisations in young children in Europe and its detection, as well as detection of influenza virus, PIV or metapneumovirus, on NP swabs can establish aetiology with high probability. PAFs for RSV and influenza virus are highly seasonal and age dependent.

Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children

“… 1 The detection of a respiratory virus does not always explain the acute symptoms since the finding may be coindicental. 32 We enrolled acutely ill children with an assumed respiratory infection on their arrival at the ED. In selected cohorts, the impact of multiplex PCR testing for respiratory pathogens may be different.…”

Pathogen Profile of Children Hospitalised with Severe Acute Respiratory Infections during COVID-19 Pandemic in the Free State Province, South Africa

“…Globally, viral aetiology of SARI varies between 2 and 80% [ 14 , 37 , 38 , 39 , 40 , 41 , 42 ]. In this study, the QIAstat-Dx Respiratory SARS-CoV-2 Panel (Qiagen Hilden, Germany), which has been critically evaluated [ 32 , 33 , 36 , 43 ], was used for respiratory pathogen detection.…”

Profiling of humoral immune responses to norovirus in children across Europe

“…To study genotype-specific seroprevalence in children, we tested a cohort of 287 children’s sera. The cohort included sera of children aged <1 month to 5.5 years and was collected between 2016 and 2019 from 16 sites in seven European countries and is further described in (37). Sera were tested on the protein array and titers above 40 were considered positive for an antigen.…”

“…To study genotype-specific seroprevalence in children, we used sera of 287 children that were collected as part of the Multi-centre EuRopean study of MAjor Infectious Disease Syndromes (MERMAIDS) across seven European countries (Table 3) (37). At the time of sera collection, no gastrointestinal symptoms were reported.…”