Abstract
BackgroundRespiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting.MethodsThe clinical presentation, patient and phylogenetic characteristicsof laboratory-confirmed cases of RSV, as well as risk factors for nosocomial infectionat Red Cross War Memorial Children’s Hospital in Cape Town were analysed. A multiplex PCR assay that detects 7 respiratory viruses was used to identify RSV nucleic acid on respiratory specimens.ResultsA total of 226 children were studied, ages ranging between 1 week and 92.5 months (median: 2.8 months, IQR: 1.3–6.3 months) and 51.8 % were males. The median duration of symptoms prior to diagnosis was 2 days (IQR: 1–4 days). Nosocomial infections wereidentified in 22 (9.7 %) children. There were pre-existing medical conditions in 113 (50.0 %) excluding HIV, most commonly prematurity (n = 58, 50.0 %) and congenital heart disease (n = 34, 29.3 %). The commonest presenting symptoms were cough (196, 86.7 %), difficulty in breathing (115, 50.9 %) and fever (91, 41.6 %).A case fatality rate of 0.9 % was recorded. RSV group A predominated (n = 181, 80.1 %) while group B accounted for only 45 (19.9 %) of the infections. The prevalent genotypes were NA1 (n = 127,70.1 %), ON1 (n = 45,24.9 %) and NA2 (n = 9,5.0 %) for group A while the only circulating RSV B genotype was BA4. There was no significant difference in the genotype distribution between the nosocomial and community-acquired RSV infections. Age ≥ 6 months was independently associated with nosocomial infection.ConclusionsA large percentage of children with RSV infection had pre-existing conditions. Approximately one tenth of the infections were nosocomial with age 6 months or older being a risk factor. Though both RSV groups co-circulated during the season, group A was predominant and included the novel ON1 genotype. Continued surveillance is necessary to identify prevalent and newly emerging genotypes ahead of vaccine development and efficacy studies.
Highlights
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting
The aims of the study were to determine the proportion of RSV nosocomial infections among children testing positive for RSV, describe clinical characteristics of patients with the infection, phylogenetically classify the genotypes causing nosocomial and community-acquired infection, and determine risk factors associated with nosocomial infection in children with acute lower respiratory tract infection (LRTI), hospitalised at Red Cross War Memorial Children’s Hospital (RCWMCH), Cape Town
There was no significant difference in the genotype distribution between the nosocomial and community-acquired RSV infections (Table 4)
Summary
Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting. Respiratory syncytial virus (RSV) is an important cause of bronchiolitis and pneumonia in infants and young children [1]. It is estimated that RSV causes over 30 million new acute lower respiratory tract infection (LRTI) episodes annually, resulting in more than 3.4 million hospital admissions and199000 deaths in children younger than 5 years of age [1]. Nosocomial outbreaks of RSV, which usually coincide with seasonal outbreaks, are a major hazard in paediatric wards, especially in those individuals with increased risk of RSV infection. Nosocomial outbreaks are associated with prolonged hospitalisation and increased mortality compared to community-acquired illness [5,6,7]. HIVinfected children experience prolonged shedding of RSV [6]
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