Environmental Factors But Not Viral Etiologies Affect the Outcome of Hospitalized Children with Pneumonia, 2009-2018

Abstract

Background: A comprehensive analysis on meteorological, clinical and epidemiological features of respiratory viruses has been rarely described. Here we aimed to analyze the impact of demographic, viral etiological, and meteorological effects on clinical outcome of hospitalized children with acute respiratory tract infections (ARTIs). Methods: A surveillance of hospitalized children with ARTIs was conducted in one sentinel hospital from 2009 to 2018 in Chongqing, China. Respiratory specimens were collected and tested for the presence of eight common respiratory viruses. Host related factors, clinical information, meteorological factors were used for the random forest (RF) algorithm and linear regression model analysis to determine the factors that might affect the development and severity of pneumonia. Findings Altogether 7533 children with ARTIs were enrolled, with 6580 developing pneumonia, including 990 with severe pneumonia. Altogether 70.35% (5269/7490) children were positive for at least one virus, 1411 with two kinds of viruses and 375 with ≥three kinds of viruses. Children were more likely to develop severe pneumonia when the infections occurred under meteorological factors with lower temperature, larger temperature difference, higher wind speed, precipitation, SO2, PM10, NO2 and PM2.5. These metrological variables, together with the host related factor (age < 15 months old, lower body weight, longer delay in admission), can attain a good accuracy (AUC, 0.92) in predicting the disease severity, while viral infection status contributed with less effect in the model. Interpretation The meteorological factors had remarkable impacts on the development of severity pneumonia, which was less affected by the respiratory viral etiologies. Funding Statement: This study was supported by the China Mega-Project for Infectious Diseases grant (2018ZX10713002, 2018ZX10101003-002, 2017ZX10103004), the Natural Science Foundation of China (81825019, 81621005) and the Fundamental Research Funds for the Central Universities & Peking University Medicine Seed Fund for Interdisciplinary Research (BMU2018MX009). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Declaration of Interests: The authors declare no competing interest. Ethics approval number: The study was reviewed and approved by the ethical review committees of CHCMU.