Abstract
Background: Respiratory viruses are primary agents of respiratory tract diseases. Knowledge on the types and frequency of respiratory viruses affecting school-children is important in determining the role of schools in transmission in the community and identifying targets for interventions. Methods: We conducted a one-year (term-time) surveillance of respiratory viruses in a rural primary school in Kilifi County, coastal Kenya between May 2017 and April 2018. A sample of 60 students with symptoms of ARI were targeted for nasopharyngeal swab (NPS) collection weekly. Swabs were screened for 15 respiratory virus targets using real time PCR diagnostics. Data from respiratory virus surveillance at the local primary healthcare facility was used for comparison. Results: Overall, 469 students aged 2-19 years were followed up for 220 days. A total of 1726 samples were collected from 325 symptomatic students; median age of 7 years (IQR 5-11). At least one virus target was detected in 384 (22%) of the samples with a frequency of 288 (16.7%) for rhinovirus, 47 (2.7%) parainfluenza virus, 35 (2.0%) coronavirus, 15 (0.9%) adenovirus, 11 (0.6%) respiratory syncytial virus (RSV) and 5 (0.3%) influenza virus. The proportion of virus positive samples was higher among lower grades compared to upper grades (25.9% vs 17.5% respectively; χ 2 = 17.2, P -value <0.001). Individual virus target frequencies did not differ by age, sex, grade, school term or class size. Rhinovirus was predominant in both the school and outpatient setting. Conclusion: Multiple respiratory viruses circulated in this rural school population. Rhinovirus was dominant in both the school and outpatient setting and RSV was of notably low frequency in the school. The role of school children in transmitting viruses to the household setting is still unclear and further studies linking molecular data to contact patterns between the school children and their households are required.
Highlights
Acute respiratory infections (ARI) pose a globally important disease burden and are a major contributor both to morbidity and mortality notably attributed to pneumonia[1,2].Bacterial pathogens are important disease agents of the respiratory tract
Studies conducted in a number of African countries consistently show that one or more respiratory viruses are responsible for the majority of the ARI cases reported yearly[1,8,11,12,13,14,15]
The Kilifi Health and Demographic Surveillance System (KHDSS) area was established by the KEMRI Wellcome Trust Research Programme (KWTRP) in 200023 to monitor births, deaths, in-migration and out-migration in a population of approximately 296,000 residents (2016 census-unpublished data, data is available on request from KEMRI) over an area of 891km[2]
Summary
Acute respiratory infections (ARI) pose a globally important disease burden and are a major contributor both to morbidity and mortality notably attributed to pneumonia[1,2].Bacterial pathogens are important disease agents of the respiratory tract. Respiratory viruses have been identified as the primary agents of mild disease of the upper respiratory tract[8,9,10]. ARIs in school children are most times mild and affect the upper respiratory tract often presenting as the common cold, a self-limiting viral infection involving the nose, sinuses, pharynx and larynx[16]. Respiratory viruses are primary agents of respiratory tract diseases. Knowledge on the types and frequency of respiratory viruses affecting school-children is important in determining the role of schools in transmission in the community and identifying targets for interventions. Methods: We conducted a one-year (term-time) surveillance of respiratory viruses in a rural primary school in Kilifi County, coastal Kenya between May 2017 and April 2018. Individual virus target frequencies did not differ by age, sex, grade, school term or class size. Rhinovirus was dominant in both the school and outpatient setting and RSV was of notably low frequency in the school
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