Respiratory syncytial virus, adenoviruses, and mixed acute lower respiratory infections in children in a developing country

Abstract

There is growing evidence suggesting greater severity and worse outcomes in children with mixed as compared to single respiratory virus infections. However, studies that assess the risk factors that may predispose a child to a mixture of respiratory syncytial virus (RSV) and adenoviral infections, are scarce. In a retrospective cohort study, the study investigated the epidemiology of RSV and adenovirus infections and predictors of mixed RSV-adenoviral infections in young children hospitalized with acute lower respiratory infection in Bogota, Colombia, South America, over a 2-year period 2009–2011. Of a total of 5,539 children admitted with a diagnosis of acute lower respiratory infection, 2,267 (40.9%) who were positive for RSV and/or adenovirus were selected. Out the total number of cases, 1,416 (62.5%) infections occurred during the 3-month period from March to May, the first rainy season of Bogota, Colombia. After controlling for gender, month when the nasopharyngeal sample was taken, and other pre-existing conditions, it was found that an age greater than 6 months (OR:1.74; CI 95%:1.05–2.89; P = 0.030) and malnutrition as a comorbidity (OR:9.92; CI 95%:1.01–100.9; P = 0.049) were independent predictors of mixed RSV-adenoviral infections in the sample of patients. In conclusion, RSV and adenovirus are significant causes of acute lower respiratory infection in infants and young children in Bogota, Colombia, especially during the first rainy season. The identified predictors of mixed RSV-adenoviral infections should be taken into account when planning intervention, in order to reduce the burden of acute lower respiratory infection in young children living in the country.

Clinical Impact of Mixed Respiratory Viral Infection in Children with Adenoviral Infection

“…Most studies reported a higher frequency of respiratory viral coinfection in younger children than in older children and adults [12142728]. This presumably was caused by immature immune systems, the lack of protective immunity arising from prior exposures to viruses, and prolonged excretion of respiratory viruses in younger children compared with older children and adults [142128]. Although respiratory viral coinfection increased the rate and duration of hospitalization [141727], it eventually did not cause a poorer prognosis such as oxygen supplementation and ICU admission, compared with single viral infection [1727].…”

“…Furthermore, even as ADV infection occurs steadily all year round in Korea, the clinical impact of respiratory viral coinfection on childhood ADV infection has rarely been reported [19]. In addition, previous studies on ADV coinfections included only children younger than 1 or 3 years of age, or children with lower respiratory tract infections [182021]. This retrospective study was performed to investigate the clinical impact of respiratory viral coinfections in Korean children with ADV infection.…”

Prevalencia y periodicidad del virus sincitial respiratorio en Colombia

“…En el análisis bivariado se encontró una correlación entre el número de infecciones mensuales por VSR y las variables de temperatura y precipitación (Spearman: p=0,730, p<0,01) durante el periodo de tres meses (marzo a mayo), primera época de lluvias del año en Bogotá, y evidenció un aumento en los casos positivos de VSR durante el periodo de estudio (2009 a 2011). Las otras variables no tuvieron correlación alguna con las infecciones por VSR (Rodríguez, et al, 2015).…”

“…Con respecto a la gravedad de la enfermedad respiratoria, 488 (21,5 %) niños fueron ingresados en la unidad de cuidados intensivos pediátricos. Del total de 2.267 pacientes incluidos en el estudio, 2.110 (93,1 %) necesitaron administración de oxígeno suplementario, 106 (4,7 %), intubación endotraqueal, 596 (26,3 %), antibióticos, y 1.008 (44,5 %), oxígeno domiciliaria; a tasa mortalidad observada fue de 1,3 % durante el periodo de estudio (Rodríguez-Martínez, et al, 2015).…”

“…Aunque no es completamente clara la asociación entre la frecuencia de los casos por VSR y los factores meterológicos como la temperatura, la humedad o la lluvia, las temporadas de lluvias y las temperaturas cálidas favorecen la replicación, la estabilidad y la transmisión del virus todo el año (Rodríguez, et al, 2015). En los estudios realizados en el país tanto de cohorte como descriptivos el aumento en la frecuencia de casos por VSR concidió con el inicio de las lluvias en la región andina, en la cual la primera temporada de lluvias ocurre entre marzo y mayo y la segunda entre septiembre y noviembre (Barbosa-Ramírez, et al, 2014;Gamba-Sánchez, et al, 2016).…”