Viral burden in acute respiratory tract infections in hospitalized children in the wet and dry zones of Sri Lanka

Jayaweera, Jayaweera Arachchige Asela Sampath; Noordeen, F.; Morel, A. J.; Pitchai, N.; Kothalawala, Sukitha; Abeykoon, A. M. S. B.; Peiris, Jsm

doi:10.1016/j.ijid.2016.02.980

Cited by 12 publications

(18 citation statements)

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“…Among children aged £ 5 years hospitalized with respiratory illness in the Central and North Central provinces, > 40% had respiratory viruses detected, with RSV being most common and PIV, adenovirus, influenza, and hMPV also being present. 24 Among children aged £ 3 years hospitalized with respiratory illness in the Sabaragamuwa Province, 32% had respiratory virus, with 90% being RSV and the remainder being PIV and influenza. 25 Interestingly, in our study in the southern province, influenza was the most common respiratory virus identified, even among children aged < 5 years.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka

Tillekeratne

Bodinayake

Simmons³

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ³ 1 year of age admitted to a tertiary care hospital in southern Sri Lanka, June 2012-October 2014. We collected epidemiologic/clinical data and a nasal or nasopharyngeal sample that was tested using polymerase chain reaction (Luminex NxTAG, Austin, TX). We determined associations between weather data and respiratory viral activity using the Spearman correlation and assessed respiratory virus seasonality using a Program for Appropriate Technology definition. Bivariable and multivariable regression analyses were conducted to identify features associated with respiratory virus detection. Among 964 patients, median age was 26.2 years (interquartile range 14.6-39.9) and 646 (67.0%) were male. One-fifth (203, 21.1%) had respiratory virus detected: 13.9% influenza, 1.4% human enterovirus/ rhinovirus, 1.4% parainfluenza virus, 1.1% respiratory syncytial virus, and 1.1% human metapneumovirus. Patients with respiratory virus identified were younger (median 9.8 versus 27.7 years, P < 0.001) and more likely to have respiratory signs and symptoms. Influenza A and respiratory viral activity peaked in February-June each year. Maximum daily temperature was associated with influenza and respiratory viral activity (P = 0.03 each). Patients with respiratory virus were as likely as others to be prescribed antibiotics (55.2% versus 52.6%, P = 0.51), and none reported prior influenza vaccination. Respiratory viral infection was a common cause of AFI. Improved access to vaccines and respiratory diagnostics may help reduce disease burden and inappropriate antibiotic use.

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Section: Discussionmentioning

confidence: 99%

Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka

Tillekeratne

Bodinayake

Simmons³

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…Among hospitalized children £ 5 years of age in two regions of Sri Lanka, RSV accounted for > 50% of disease, with peak activity during May-July in the dry zone and during December-January and in April in the wet zone. 21 Our study was conducted in a wet region in the country, but peak RSV activity was during May-July. The reason for variation in seasonality within the country is not clear, but underscores the need for further studies on respiratory virus epidemiology in tropical and subtropical settings.…”

Section: Discussionmentioning

confidence: 99%

Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka

Shapiro

Bodinayake

Nagahawatte

et al. 2017

The American Society of Tropical Medicine and Hygiene

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In tropical and subtropical settings, the epidemiology of viral acute respiratory tract infections varies widely between countries. We determined the etiology, seasonality, and clinical presentation of viral acute respiratory tract infections among outpatients in southern Sri Lanka. From March 2013 to January 2015, we enrolled outpatients presenting with influenza-like illness (ILI). Nasal/nasopharyngeal samples were tested in duplicate using antigen-based rapid influenza testing and multiplex polymerase chain reaction (PCR) for respiratory viruses. Monthly proportion positive was calculated for each virus. Bivariable and multivariable logistic regression were used to identify associations between sociodemographic/clinical information and viral detection. Of 571 subjects, most (470, 82.3%) were ≥ 5 years of age and 53.1% were male. A respiratory virus was detected by PCR in 63.6% ( = 363). Common viral etiologies included influenza (223, 39%), human enterovirus/rhinovirus (HEV/HRV, 14.5%), respiratory syncytial virus (RSV, 4.2%), and human metapneumovirus (hMPV, 3.9%). Both ILI and influenza showed clear seasonal variation, with peaks from March to June each year. RSV and hMPV activity peaked from May to July, whereas HEV/HRV was seen year-round. Patients with respiratory viruses detected were more likely to report pain with breathing (odds ratio [OR] = 2.60, = 0.003), anorexia (OR = 2.29, < 0.001), and fatigue (OR = 2.00, = 0.002) compared with patients with no respiratory viruses detected. ILI showed clear seasonal variation in southern Sri Lanka, with most activity during March to June; peak activity was largely due to influenza. Targeted infection prevention activities such as influenza vaccination in January-February may have a large public health impact in this region.

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“…Viral infections of the respiratory tract are often treated with antibiotics due to the absence of viral diagnostics to identify the viral aetiology. Thus, a proper diagnosis is crucial prior to initiating antibiotic treatment for bacterial ARTI or pneumonia [9, 15]. In developing countries, a lack of availability of diagnostic facilities contributes to the use of antibiotics and thus to development of antimicrobial resistance [9, 10].…”

Section: Discussionmentioning

confidence: 99%

“…RSV is the most common respiratory viral pathogen causing hospitalization of thousands of children each year [2, 15]. Many of the affected children do not require hospitalization and some with severe respiratory disease are hospitalized or even managed in the intensive care unit (ICU).…”

Section: Discussionmentioning

confidence: 99%

“…Multivariable analyses were performed using a step wise logistic regression analysis to assess the risk factors for the development of RSV and RSV/hMPV co-infection. The risk factors included in the study were age at hospitalization, duration of the disease, gender of the child, ethnicity, weight for the given age (as a measure of acute malnutrition), height for the given age (as a measure of chronic malnutrition) and Hb%, gestational age to assess the maturity of the mother, mode of delivery and presence of concurrent medical conditions (congenital heart disease (CHD), chronic lung disease (CLD), asthma, cystic fibrosis, immunodeficiencies and epilepsy) and genetic disorders like Down’s syndrome-trisomy 21, neuromuscular disorders and pre-existing respiratory tract morbidity, parental passive smoking (father or any other family member regularly smoking cigarettes in the vicinity of the child), having house hold pets, presence of indoor (cooking using firewood) and outdoor air pollution (construction activities in the vicinity of the child), overcrowding (living area of the child is < 24 m 2 and living > 2 people in that area [15]), day care attendance (child regularly attending to daycare), parent/guardian’s educational level (< grade 8, up to advanced level and graduates), experience of the caregiver (first child or having cared for > 1 child) and parent/guardian’s occupation. For the risk factor analysis, stepwise logistic regression and when appropriate chi-squired test was also used.…”

Section: Methodsmentioning

confidence: 99%

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A case series on common cold to severe bronchiolitis and pneumonia in children following human metapneumovirus infection in Sri Lanka

et al. 2018

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ObjectivesThe prevalence of hMPV infections in Sri Lanka has not been reported and here we report a case series of hMPV infection in children less than 5 years. Patients with ARTI were included from Teaching Hospital, Anuradhapura from March 2013 to August 2014. Indirect fluorescence assay was performed on nasopharyngeal aspirates for the identification of respiratory viruses [respiratory syncytial virus (RSV), parainfluenza virus 1, 2 and 3, influenza A and B and hMPV]. Moreover, reverse transcriptase-polymerase chain reaction was done to further confirm the hMPV infection.ResultsIn this case series, hMPV infection showed a range of respiratory symptoms from common cold to life threatening lower respiratory tract infections with varying severity. In some cases, the clinical presentation of hMPV infection was similar to the ARTI caused by RSV. hMPV co-infections with of RSV have also been seen in some cases of ARTI. A child delivered through cesarean section and birth order > 3 has an Odds ratio of 3.5 and 4.3 (95% CI) for developing co-infection with RSV compared to hMPV mono-infections. Lack of diagnostic facilities to identify the viral aetiology has contributed to the use of antibiotics indicating the need for establishing viral diagnostic facilities in the country.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3239-3) contains supplementary material, which is available to authorized users.

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Viral burden in acute respiratory tract infections in hospitalized children in the wet and dry zones of Sri Lanka

Cited by 12 publications

References 0 publications

Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka

Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka

Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka

A case series on common cold to severe bronchiolitis and pneumonia in children following human metapneumovirus infection in Sri Lanka

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