Role of Human Metapneumovirus, Influenza A Virus and Respiratory Syncytial Virus in Causing WHO-Defined Severe Pneumonia in Children in a Developing Country

Asad Ali,Sultan Mustafa,Maaman Zahoor Bashir,Anita Zaidi,Fatima Aziz,Asif Raza Khowaja,Malcolm Gracie Semple

doi:10.1371/journal.pone.0074756

Asad Ali, Sultan Mustafa + Show 5 more

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https://doi.org/10.1371/journal.pone.0074756

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Journal: PloS one	Publication Date: Sep 18, 2013
Citations: 34	License type: CC BY 4.0

Affiliation: Aga Khan University, Abbasi Shaheed Hospital

Abstract

ObjectiveThe role of respiratory viruses in causing severe, life threatening pneumonia in children in developing countries is not well established. Our study aims to determine the role of human metapneumovirus (HMPV), influenza A virus and respiratory syncytial virus (RSV) in children, aged 6 weeks to 2 years, hospitalized with WHO defined severe pneumonia (tachypnea plus any general danger sign or chest in-drawing) at a public sector hospital in Karachi, Pakistan.MethodsThis study was conducted from November 2010 to September 2011 at Abbassi Shaheed Hospital, a large public tertiary care hospital in Karachi, Pakistan. Children admitted with WHO-defined severe pneumonia were enrolled and throat swabs were obtained to detect respiratory viruses using real time RT-PCR. Chest x-rays of all subjects were obtained and independently interpreted by two radiologists to diagnose radiologic pneumonia.Results169 children were enrolled. HMPV was detected in 24 (14.2%), influenza A virus in 9 (5.3%) and RSV in 30 (17.8%) children admitted with severe pneumonia. Of 9 patients with influenza A, 8 tested positive for H1N1. Viral etiology was found in 18% of radiologically confirmed pneumonia. HMPV infections peaked in February and April, influenza A was prevalent in January, June and November and RSV infections were most prevalent from June to September.ConclusionHMPV, influenza A and RSV are common causes of WHO-defined severe pneumonia in hospitalized children in Karachi. Knowledge regarding the viral etiology of pediatric pneumonia and individual viral seasonality can help in the recommendation and implementation of appropriate management strategies.

Highlights

Pneumonia is the second leading cause of childhood mortality worldwide, with estimated 1.25 million deaths per year [1]
To determine the etiology of severe, potentially fatal pneumonia in developing countries, studies need to be conducted in health care facilities which cater to the lower income population, which is at the highest risk for adverse health outcomes
This study is the first to describe the viral etiology of WHO defined severe pneumonia in hospitalized children in Pakistan using real time RT-PCR assays

Summary

Introduction

Pneumonia is the second leading cause of childhood mortality worldwide, with estimated 1.25 million deaths per year [1]. While the role of respiratory viruses including HMPV, influenza A and RSV is well established in causing selflimiting upper respiratory tract infections or mild pneumonia, their contribution in causing severe and radiologically proven pneumonia in developing countries is less clear [3]. This knowledge is critical to guide the development of preventive and therapeutic interventions against these viruses, and to make a case for the use of existing interventions like the influenza vaccine [4]. We conducted a longitudinal surveillance study at a busy public sector hospital in Karachi to determine the role of respiratory viruses in WHOdefined severe pneumonia, including radiologically proven pneumonia, in children 6 weeks to 2 years of age

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