Viral Etiologies of Acute Respiratory Infections among Hospitalized Vietnamese Children in Ho Chi Minh City, 2004–2008

Anh Ha Lien Do,Jeremy Farrar,Quang Ha Do,Thanh Hang Thi Hoang,Minh Hien Vo,Tan Le Van,Menno D De Jong,Cong Khanh Vo,Tinh Hien Tran,Juliet E Bryant,Bridget Wills,Minh Dung Nguyen,My Ngoc Nghiem,H Rogier Van Doorn,Vinh Chau Van Nguyen,Tan Thanh Tran,Dong-Yan Jin

doi:10.1371/journal.pone.0018176

Abstract

BackgroundThe dominant viral etiologies responsible for acute respiratory infections (ARIs) are poorly understood, particularly among hospitalized children in resource-limited tropical countries where morbidity and mortality caused by ARIs are highest. Improved etiological insight is needed to improve clinical management and prevention.ObjectivesWe conducted a three-year prospective descriptive study of severe respiratory illness among children from 2 months to 13 years of age within the largest referral hospital for infectious diseases in southern Vietnam.MethodsMolecular detection for 15 viral species and subtypes was performed on three types of respiratory specimens (nose, throat swabs and nasopharyngeal aspirates) using a multiplex RT-PCR kit (Seeplex™ RV detection, Seegene) and additional monoplex real-time RT-PCRs.ResultsA total of 309 children were enrolled from November 2004 to January 2008. Viruses were identified in 72% (222/309) of cases, including respiratory syncytial virus (24%), influenza virus A and B (17%), human bocavirus (16%), enterovirus (9%), human coronavirus (8%), human metapneumovirus (7%), parainfluenza virus 1–3 (6%), adenovirus (5%), and human rhinovirus A (4%). Co-infections with multiple viruses were detected in 20% (62/309) of patients. When combined, diagnostic yields in nose and throat swabs were similar to nasopharyngeal aspirates.ConclusionSimilar to other parts in the world, RSV and influenza were the predominant viral pathogens detected in Vietnamese hospitalized children. Combined nasal and throat swabs are the specimens of choice for sensitive molecular detection of a broad panel of viral agents. Further research is required to better understand the clinical significance of single versus multiple viral coinfections and to address the role of bacterial (co-)infections involved in severe respiratory illness.

Highlights

Acute respiratory illnesses (ARIs) are a leading cause of infectious disease-related morbidity, hospitalization, and mortality among children worldwide, in developing countries and in young children [1]
Similar to other parts in the world, respiratory syncytial virus (RSV) and influenza were the predominant viral pathogens detected in Vietnamese hospitalized children
Combined nasal and throat swabs are the specimens of choice for sensitive molecular detection of a broad panel of viral agents

Summary

Introduction

Acute respiratory illnesses (ARIs) are a leading cause of infectious disease-related morbidity, hospitalization, and mortality among children worldwide, in developing countries and in young children (age , 5 years) [1]. Regardless of geographic location, the most common etiologic agents of ARIs in children are viruses [2]. Limited resources and laboratory capacity precludes the routine use of molecular diagnostics in tropical lower-income countries such as Vietnam. Insight into the aetiology of ARIs is lowest in regions of the world where morbidity and mortality are highest. The dominant viral etiologies responsible for acute respiratory infections (ARIs) are poorly understood, among hospitalized children in resource-limited tropical countries where morbidity and mortality caused by ARIs are highest. Improved etiological insight is needed to improve clinical management and prevention

Objectives

Methods

Results

Conclusion