Comparative incidence and burden of respiratory viruses associated with hospitalization in adults in New York City

BackgroundAlthough the burden of influenza is well characterized, the burden of community‐onset non‐influenza respiratory viruses has not been systematically assessed. Understanding the severity and seasonality of non‐influenza viruses, including human coronaviruses, will provide a better understanding of the overall disease burden from respiratory viruses that could better inform resource utilization for hospitals and highlight the value of preventative strategies, including vaccines.MethodsFrom October 2017 to September 2019, a retrospective study was performed in a pre‐defined catchment area to estimate the population‐based incidence of community‐onset respiratory viruses associated with hospitalization. Included patients were ≥18 years old, resided in New York City, were hospitalized for ≥24 hours, and had a respiratory virus detected within 3 calendar‐days of admission. Disease burden was measured by hospital length of stay (LOS), intensive care unit (ICU) admissions, and in‐hospital mortality and compared among those with laboratory‐confirmed influenza versus those with laboratory‐confirmed non‐influenza viruses (human coronaviruses, parainfluenza viruses, respiratory syncytial virus, human metapneumovirus, and adenovirus).ResultsDuring the study period, 4232 eligible patients were identified of whom 50.9% were ≥65 years of age. For each virus, the population‐based incidence was highest for those ≥80 years of age. When compared to those with influenza viruses detected, those with non‐influenza respiratory viruses detected (combined) had higher population‐based incidence, significantly more ICU admissions, and higher in‐house mortality.ConclusionsThe burden of non‐influenza respiratory viruses for hospitalized adults is substantial. Prevention and treatment strategies are needed for non‐influenza respiratory viruses, particularly for older adults.     

Changes in virus detection in hospitalized children before and after the severe acute respiratory syndrome coronavirus 2 pandemic

The impact of strengthening preventive measures against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection on the prevalence of respiratory viruses in children was examined. After the SARS‐CoV‐2 pandemic, the rate of multiple virus detection among hospitalized children decreased. Immediately after the SARS‐CoV‐2 pandemic, respiratory syncytial and parainfluenza viruses were rarely detected and subsequently reemerged. Human metapneumovirus and influenza virus were not consistently detected. Non‐enveloped viruses (bocavirus, rhinovirus, and adenovirus) were detected to some extent even after the pandemic. Epidemic‐suppressed infectious diseases may reemerge as susceptibility accumulates in the population and should continue to be monitored.     

Epidemiology and factors associated with the severity of viral acute lower respiratory infection in children hospitalized in Manaus,Amazonas, in 2017–2018: An observational study

To investigate the epidemiology and factors associated with the severity of viral acute lower respiratory infection (ALRI) in children hospitalized in Manaus, Amazonas, in 2017 to 2018.Retrospective cohort study of children hospitalized at the Hospital and Emergency Room Delphina Rinaldi Abdel Aziz, in Manaus, from April 01, 2017 to August 31, 2018, with a clinical diagnosis of ALRI and nasopharyngeal aspirates positive for at least 1 respiratory virus.One hundred forty-six children aged 0.2 to 66 months (median 7 months) were included. Patients were divided into 2 groups according to the disease severity classified by an adapted Walsh et al score: moderate disease, score 0–4, n = 66 (45.2%) and severe disease, score 5–7, n = 80 (54.8%). A greater number of viral ALRI cases were observed in the rainiest months. Respiratory syncytial virus was the most prevalent (n = 103, 70.3%), followed by metapneumovirus (n = 24, 16.4%), influenza virus (n = 17, 11.6%), parainfluenza virus (n = 11, 7.5%), and adenovirus (n = 4, 2.7%). Co-detections of 2 to 3 viruses were found in 12 (8.2%) patients. The presence of viral coinfection was an independent risk factor for disease severity (adjusted relative risk [RR] 1.53; 95% CI 1.10–2.14). Twelve patients (8.2%) died, all with severe disease. Risk factors for death were shock (adjusted RR 10.09; 95% CI 2.31–43.90) and need for vasoactive drugs (adjusted RR 10.63; 95% CI 2.44–46.31).There was a higher incidence of viral ALRI in Manaus in the rainy season. Respiratory syncytial virus was the most prevalent virus. The presence of viral coinfection was an independent risk factor for disease severity.     

114例疑似COVID-19患者呼吸道病毒感染分析

目的 分析114例COVID-19疑似患者呼吸道病毒感染情况, 探讨多种病毒同时检测在疫情防控中的价值。方法 利用Real Time RT-PCR技术检测发热门诊COVID-19疑似患者SARS-CoV-2核酸,利用基因芯片恒温扩增技术检测SARS-CoV-2核酸阴性患者其他常见的18种呼吸道病毒。结果 114例COVID-19疑似患者SARS-CoV-2核酸均为阴性,有21例感染了非其它呼吸道病毒,感染率达18.42%,21例患者中共检测出10种呼吸道病毒,包括冠状病毒NL63/229型、呼吸道合胞病毒、柯萨奇病毒A16型、乙型流感病毒、人副流感病毒1型、人副流感病毒3型、人偏肺病毒、甲型流感病毒、甲型流感病毒季节性H3亚型、肠道病毒/鼻病毒。其中乙型流感病毒感染患者最多,有6例,呼吸道合胞病毒有5例。有3例患者同时感染2种病毒:呼吸道合胞病毒与柯萨奇病毒A16型混合感染、冠状病毒NL63/229型与人副流感病毒1型混合感染、甲型流感病毒与甲型流感病毒季节性H3亚型混合感染。结论 在应对本次SARS-CoV-2疫情中,针对COVID-19疑似患者中,要注意鉴别SARS-CoV-2与其它呼吸道病毒,及时有效地排除疑似病例。     

Human parainfluenza virus type 3 (HPIV 3) community-acquired pneumonia (CAP) mimicking pertussis in an adult: the diagnostic importance of hoarseness and monocytosis

Background

There are relatively few causes of acute community-acquired pneumonias (CAPs) in adults associated with prolonged cough. In adults the most common acute CAPs with a prominent and persistent nonproductive cough are due to Mycoplasma pneumoniae, Chlamydophilia (Chlamydia) pneumoniae, or Bordetella pertussis (pertussis). Pertussis is an underrecognized and underappreciated cause of CAP in adults. Different from classic pertussis in children, pertussis in adults presents with prolonged dry cough, that is, the “100-day cough.” In pertussis, the characteristic nonspecific laboratory findings are leukocytosis and relative lymphocytosis. Dry cough accompanied by hoarseness with CAP in an adult should suggest C. pneumoniae or a respiratory virus (eg, influenza, parainfluenza, respiratory syncytial virus).

Methods

We present the case of a young woman who presented with a prominent and persistent pertussis-like cough with hoarseness. She had no leukocytosis or relative lymphopenia, which argued against the diagnosis of pertussis. Notably, she had persistent monocytosis. Her protracted pertussis-like cough that persisted during her hospitalization was so impressive that the diagnostic impression was pertussis. Direct fluorescent antibody (FA) and throat cultures were negative for pertussis. Furthermore, her hoarseness suggested the possibility of C. pneumoniae, but her C. pneumoniae immunoglobulin-M titer was negative.

Results

Because C. pneumoniae was ruled out, her hoarseness suggested a respiratory viral cause. A respiratory FA viral panel and viral throat cultures were obtained. The respiratory FA viral panel was negative for influenza A/B, respiratory syncytial virus, metapneumovirus, adenovirus, cytomegalovirus, and parainfluenza viruses. However, her viral throat cultures grew parainfluenza virus type 3 (HPIV 3), confirming the diagnosis.

Conclusion

To the best of our knowledge, this is the first case of HPIV 3 CAP presenting with a prominent and persistent pertussoid cough in an adult mimicking pertussis with hoarseness and monocytosis.     

Human bocavirus and human metapneumovirus in hospitalized children with lower respiratory tract illness in Changsha,China

Background

Lower respiratory tract illness is a major cause of morbidity and mortality in children worldwide, however, information about the epidemiological and clinical characteristics of LRTIs caused by HMPV and HBoV in China is limited.

Objectives

Human bocavirus (HBoV) and human metapneumovirus (HMPV) are two important viruses for children with lower respiratory tract infections (LRTI). We aimed to assay the correlation between viral load and clinical characteristics of HBoV and HMPV with LRTI in Changsha, China.

Methods

Nasopharyngeal aspirates (NPAs) from children with LRTI were collected. Real‐time PCR was used to screen HBoV and HMPV. Analyses were performed using SPSS 16.0 software.

Results

Pneumonia was the most frequent diagnosis. There was no significant difference between HBoV‐ and HMPV‐positive patients in age (P = .506) or hospitalization duration (P = .280); 24.1% and 18.2% were positive for HBoV and HMPV. HBoV infections peaked in summer (32.2%), and HMPV infections peaked in winter (28.9%). The HBoV‐positive patients had a shorter hospitalization duration than the HBoV‐negative patients (P = .021), and the HMPV‐positive patients had a higher prevalence of fever than the HMPV‐negative patients (P = .002). The HBoV viral load was significantly higher among patients aged <1 year (P = .006). The mean HBoV and HMPV viral loads were not significantly different between patients with single infections and coinfections. Patients infected with HBoV only were older than those coinfected with HBoV and other respiratory viruses (P = .005). No significant difference was found in the clinical characteristics of patients infected with HMPV only and those coinfected with HMPV and other respiratory viruses.

Conclusion

Pneumonia was the most frequent diagnosis caused by HBoV and HMPV. Neither HBoV nor HMPV viral load was correlated with disease severity.     

Multiple versus single virus respiratory infections: viral load and clinical disease severity in hospitalized children

Please cite this paper as: Martin et al. (2012) Multiple versus single virus respiratory infections: viral load and clinical disease severity in hospitalized children. Influenza and Other Respiratory Viruses 6(1), 71–77. Background Molecular testing for viral pathogens has resulted in increasing detection of multiple viruses in respiratory secretions of ill children. The clinical impact of multiple virus infections on clinical presentation and outcome is unclear. Objectives To compare clinical characteristics and viral load between children with multiple virus versus single virus illnesses. Patients/methods Eight hundred and ninety‐three residual nasal wash samples from children treated for respiratory illness at Children’s Hospital, Seattle, from September 2003 to September 2004 were evaluated by quantitative PCR for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), influenza (Flu), parainfluenza, adenoviruses, and coronaviruses (CoV). Illness severity and patient characteristics were abstracted from medical charts. Results Coinfections were identified in 103 (18%) of 566 virus‐positive samples. Adenovirus was most commonly detected in coinfections (52%), followed by CoV (50%). Illnesses with a single virus had increased risk of oxygen requirement (P = 0·02), extended hospital stays (P = 0·002), and admissions to the inpatient (P = 0·02) or intensive care units (P = 0·04). For Adv and PIV‐1, multiple virus illnesses had a significantly lower viral load (log₁₀ copies/ml) than single virus illnesses (4·2 versus 5·6, P = 0·007 and 4·2 versus 6·9, P < 0·001, respectively). RSV, Flu‐A, PIV‐3, and hMPV viral loads were consistently high whether or not another virus was detected. Conclusions Illnesses with multiple virus detections were correlated with less severe disease. The relationship between viral load and multiple virus infections was virus specific, and this may serve as a way to differentiate viruses in multiple virus infections.     

Duration of shedding of respiratory syncytial virus in a community study of Kenyan children

Background  

Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions.     

Respiratory viral infections among hospitalized adults: experience of a single tertiary healthcare hospital

Background

Following the 2009 H1N1 pandemic, there have been a large number of studies focusing on the epidemiology and outcomes of influenza A infection; however, there have been fewer studies focused on other respiratory viral infections.

Objectives

To define the epidemiology and outcomes of non-influenza respiratory viral infections in hospitalized adults.

Patients/Methods

Data on all patients ≥18 years of age with a positive molecular respiratory viral assay who were hospitalized at a single tertiary healthcare system in Chicago, IL, from retrospectively collected and analyzed.

Results

Over the study period, 503 of 46 024 (1·1%) admitted patients had a positive RVP result. Human rhinovirus was the most commonly detected virus followed by influenza A, human metapneumovirus, respiratory syncytial virus, and parainfluenza virus, adenovirus, and influenza B, respectively. Infection in immunocompromised patients was associated with a higher rate of progression to pneumonia and death.

Conclusions

Non-influenza respiratory viral infections are commonly detected among adults admitted to the hospital and can cause serious illness. The data can inform the prioritization of research into novel antiviral therapies for these infections.     

Relationships between A(H1N1)pdm09 influenza infection and infections with other respiratory viruses

Background

A(H1N1)pdm09, a new influenza pandemic virus emerged in 2009. The A(H1N1)pdm09 infection had several unique characteristics which included rapid transmissibility and high morbidity in obese individuals, pregnant women and individuals suffering from chronic diseases.

Objectives

To study the relationships between A(H1N1)pdm09 influenza infection and infections with other respiratory viruses such as respiratory syncytial virus (RSV), human metapneumo virus (hMPV), adenovirus and seasonal influenza.

Methods

Samples (nasopharyngeal swabs or aspirates) collected between 2007 until 2012 from patients of various ages that were hospitalized due to respiratory virus infections were analyzed for the presence of various respiratory viruses, using qRT-PCR.

Results

In 2009–2010, when the pandemic influenza A(H1N1)pdm09 first appeared, two major infection peaks were noted and individuals of various ages were infected. Following the decline of the A(H1N1)pdm09 virus infection, the percentages of patients infected with adenovirus and hMPV increased, while infection frequency with RSV B and with seasonal influenza virus decreased. Furthermore, RSV infections were delayed and very few percentages of patients were co-infected with more than one virus. Interestingly, the A(H1N1)pdm09 virus lost its dominancy when it reappeared in the winter of 2010–2011, and at this time, only the incidence of RSV infections was affected by the A(H1N1)pdm09 virus.

Conclusions

The A(H1N1)pdm09 virus had distinct effects on other respiratory viruses when it first appeared versus later, when it evolved from being a pandemic to a seasonal virus.     

Role of influenza and other respiratory viruses in admissions of adults to Canadian hospitals

Objective We sought to estimate age‐specific hospitalization rates attributed to influenza and other virus for adults. Methods Admissions from Canada’s national hospitalization database (Canadian Institute of Health Information), from 1994/95 to 1999/2000, were modeled as a function of proxy variables for influenza, respiratory syncytial virus (RSV) and other viral activity, seasonality and trend using a Poisson regression model and stratified by age group. Results The average annual influenza‐attributed hospitalization rate for all adults, 20 years of age or older, over the study period, which included three severe seasons, was an estimated 65/100 000 population (95% CI 63–67). Among persons aged 65 and over, 270–340 admissions per 100 000 population per year were attributed to influenza, while 30–110, 60–90 and 130–350 per 100 000 were attributed to RSV, parainfluenza (PIV) and other respiratory viruses, respectively. Although marked season‐to‐season variation in age‐specific hospitalization rates attributable to influenza was observed in persons 50 years of age and older, increasing risk with age was preserved at all time periods. Conclusions Influenza, RSV, PIV and other respiratory viruses were all associated with morbidity requiring hospitalization, while influenza was responsible for peak respiratory admissions. The burden of health care utilization associated with respiratory viruses is appreciable beginning in the sixth decade and increases significantly with age.     

Influenza and respiratory syncytial virus are the major respiratory viruses detected from prospective testing of pediatric and adult coronial autopsies

Background

To ascertain the full mortality of influenza and other respiratory viruses, the testing of community autopsy specimens is essential.

Methods

Respiratory virus PCR and culture were performed on 2418 fresh unfrozen respiratory samples collected from 1611 coronial cases where the death was either unknown or infection was suspected, from July 2007 to June 2011, to detect the common respiratory viruses in children and adults, using standardized microbiological testing.

Results

The respiratory virus positive rate was 8·3% (134 cases) with a peak of 28% (42 of 151 cases) in children under 10 years of age. Influenza virus was the commonest respiratory virus (50 cases, 3%), followed by respiratory syncytial virus (RSV) (30 cases, 2%). All tested respiratory viruses were found in children, most commonly adenovirus, enterovirus and RSV, and influenza A and RSV predominated in those over 60 years, but coinfection was uncommon. Almost all influenza cases occurred when influenza was widely circulating in the community but few were diagnosed pre‐mortem. Influenza and RSV detection was associated with bronchitis or bronchiolitis in 7 (9%) of the 80 cases and caused pneumonia in 14 (0·8%) deaths overall.

Conclusions

Our prospective review of respiratory viruses using standardized testing found a single lower respiratory tract autopsy specimen for respiratory virus PCR would detect most community infections at the time of death.     

Epidemiology of acute viral respiratory tract infections in Korean children

OBJECTIVE: Viruses are the most common causes of respiratory tract infection in children. We investigated the aetiologies and the epidemiological features of acute viral respiratory tract infections in Korean children. METHODS: We tried to isolate respiratory syncytial virus (RSV) and parainfluenza virus from January 1994, influenza virus from February 1995, and adenovirus from April 1996 through August 1998, and identified the isolated viruses by indirect immunofluorescence (IF) staining in the children hospitalized with acute respiratory tract infections (ARTI). RESULTS: Virus was identified in 360 of 1389 (25.9%) nasopharyngeal aspirates cultured. Of a total of 392 viruses, 164 (41.8%) RSV, 90 (23%) parainfluenza virus, 66 (16.8%) influenza A virus, 54 (13.8%) adenovirus, and 18 (4.6%) influenza B virus were cultured, including cases in mixed viral infections. The male to female ratio of the culture-positive patients was 2:1, and the proportions of the patients aged >6 months, 6-11 months, 1, 2, 3, 4, 5, 6-7, 8-9, and >10 years were 22.5, 29.5, 25.7, 9.5, 3.8, 3.8, 1.7, 1.7, 1.2, and 0.6%, respectively. The major clinical diagnosis was bronchiolitis for RSV, croup for parainfluenza virus, and pneumonia for adenovirus and influenza virus. Infections by RSV, parainfluenza virus, and influenza virus occurred in annual epidemics, and infections by adenovirus occurred annually with or without epidemics. There were somewhat larger epidemics by adenovirus and influenza virus in May to July 1996 and March to June 1997, respectively. CONCLUSIONS: Viral agents are one of the main aetiologies and the main causes of admission in Korean children with ARTI.     

Respiratory virus infection in immunocompromised patients

Seventy-eight immunocompromised patients were prospectively evaluated for infection with respiratory viruses including parainfluenza viruses, respiratory syncytial virus, influenza viruses and adenoviruses beginning before marrow transplant and continuing to 60 days after transplant or discharge from hospital. Patients were studied both on a fixed surveillance schedule and at any time upper or lower respiratory symptoms developed. Fifteen (19%) patients had a respiratory virus detected including parainfluenza 1 in six patients, adenovirus in five, parainfluenza 3 in two, and influenza A and respiratory syncytial virus in one each. Twelve patients had infection before transplant and 11 of these had upper respiratory symptoms. Three patients had virus isolated only after transplant. Both patients with parainfluenza 3 infection developed pneumonia. One patient died with disseminated adenovirus infection. These data suggest that infections with respiratory viruses are frequent and often symptomatic in immunocompromised patients. Since antiviral therapy is available for some of these infections, early specific viral diagnosis is of potential clinical importance in immunocompromised patients with respiratory symptoms.     

Antigen detection in the diagnosis of viral infections

The value of viral antigen detection from nasopharyngeal secretion (NPS) by enzyme immunoassay (EIA) in everyday clinical practice was evaluated in 570 children hospitalized because of infections. NPS-EIA gave a positive result in 32% of all cases. Virus isolation was positive in the NPS in 25%, virus isolation in stool samples in 14%, and virus serology in 28% of the cases. NPS-EIA was superior for detecting adenovirus, respiratory syncytial (RS) and parainfluenza viruses. In a series of 124 patients in whom 3 methods were compared, NPS-EIA was the only positive method in 48% of all findings positive for adenoviruses, in 73% for RSV, and in 58% for parainfluenza viruses. Antigen detection by NPS-EIA markedly increased the diagnostic potential in everyday clinical practice, especially for viral respiratory diseases.     

Parainfluenza type 3 outbreaks in Izmir children, Turkey

The present study was aimed to investigate characteristics of lower respiratory tract infections caused by parainfluenza type 3 viruses. Nasopharyngeal smears were taken from 178 patients with lower respiratory infections for the diagnosis of respiratory syncytial virus, adenovirus, influenza and parainfluenza viruses between December 2004 and April 2005. Parainfluenza type 3 was isolated from the viral specimens of 96 (53.9%) patients and it was noticeable that the parainfluenza type 3 outbreak occurs during winter. Obviously, improving the aetiological diagnosis of viral infections might avoid unnecessary therapy, antibiotics in particular, and would allow for preventive isolation of infected patients.     

Hospitalization Incidence,Mortality, and Seasonality of Common Respiratory Viruses Over a Period of 15 Years in a Developed Subtropical City

Information on respiratory viruses in subtropical region is limited.Incidence, mortality, and seasonality of influenza (Flu) A/B, respiratory syncytial virus (RSV), adenovirus (ADV), and parainfluenza viruses (PIV) 1/2/3 in hospitalized patients were assessed over a 15-year period (1998–2012) in Hong Kong.Male predominance and laterally transversed J-shaped distribution in age-specific incidence was observed. Incidence of Flu A, RSV, and PIV decreased sharply from infants to toddlers; whereas Flu B and ADV increased slowly. RSV conferred higher fatality than Flu, and was the second killer among hospitalized elderly. ADV and PIV were uncommon, but had the highest fatality. RSV, PIV 2/3 admissions increased over the 15 years, whereas ADV had decreased significantly. A “high season,” mainly contributed by Flu, was observed in late-winter/early-spring (February–March). The “medium season” in spring/summer (April–August) was due to Flu and RSV. The “low season” in late autumn/winter (October–December) was due to PIV and ADV. Seasonality varied between viruses, but predictable distinctive pattern for each virus existed, and temperature was the most important associating meteorological variable.Respiratory viruses exhibit strong sex- and age-predilection, and with predictable seasonality allowing strategic preparedness planning. Hospital-based surveillance is crucial for real-time assessment on severity of new variants.     

Community respiratory virus infections following lung transplantation

Abstract: Respiratory infections remain a significant cause of morbidity and mortality after lung transplantation. In addition to cytomegalovirus, the community respiratory viruses such as respiratory syncytial virus (RSV), parainfluenza virus (PIV), influenza virus, and adenovirus, are important causes of infection in transplant recipients, often involve the lower respiratory tract, and may be associated with significant morbidity and mortality. In this review, we summarize the current state of knowledge regarding the epidemiology, clinical manifestations, diagnosis, treatment and outcomes associated with RSV, PIV, influenza virus, and adenovirus infections in lung transplant recipients.