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Respiratory syncytial virus among children hospitalized with severe acute respiratory infection in Kashmir, a temperate region in northern India

JOURNAL OF GLOBAL HEALTH(2022)

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摘要
Background Severe acute respiratory infections (SARI) are a leading cause of hospitalizations in children, especially due to viral pathogens. We studied the prevalence of respiratory viruses among children aged <5 years hospitalized with severe acute respiratory infections (SARI) in Kashmir, India. Methods We conducted a prospective observational study in two tertiary care hospitals from October 2013 to September 2014, systematically enrolling two children aged <5 years with SARI per day. We defined SARI as history of fever or measured fever (>= 38 degrees C) and cough with onset in the last 7 days requiring hospi-talization for children aged 3-59 months and as physician-diagnosed acute lower respiratory infection for children aged <3 months. Trained study staff screened children within 24 hours of hospitalization for SARI and collected clinical data and nasopharyngeal swabs from enrolled participants. We tested for respiratory syncytial virus (RSV) A and B, influenza viruses, rhinoviruses (HRV)/enterovi-ruses, adenovirus (AdV), bocavirus (BoV), human metapneumovirus (hMPV) A and B, coronaviruses (OC43, NL65, C229E), and parainfluenza viruses (PIV) 1, 2, 3 and 4 using standardized duplex real-time polymerase chain reaction. Results Among 4548 respiratory illness admissions screened from October 2013 to September 2014, 1026 met the SARI case definition, and 412 were enrolled (ages = 5 days to 58 months; median = 12 months). Among enrolees, 256 (62%) were positive for any virus; RSV was the most commonly detected (n = 118, 29%) followed by HRV/enteroviruses (n = 88, 21%), PIVs (n = 31, 8%), influenza viruses (n = 18, 4%), BoV (n = 15, 4%), coronaviruses (n = 16, 4%), AdV (n = 14, 3%), and hMPV (n = 9, 2%). Fifty-four children had evidence of virus co-detection. Influenza-associated SARI was more common among children aged 1-5 years (14/18, 78%) while most RSV detections occurred in children <12 months (83/118, 70%). Of the RSV viruses typed (n = 116), the majority were type B (94, 80%). Phylogenetic analysis of G gene of RSV showed circulation of the BA9 genotype with 60bp nucleotide duplication. Conclusions Respiratory viruses, especially RSV, contributed to a substantial proportion of SARI hospitalizations among children <5 years in north India. These data can help guide clinicians on appropriate treatment and prevention strategies. Globally, respiratory viruses account for half of all causes of acute lower respiratory infections, including pneu-monia and bronchiolitis [1,2]. Respiratory viruses have been detected in over half of children hospitalized with respiratory illness in studies from India and the US [3,4]. Among them, the respiratory syncytial virus is the leading cause of acute lower respiratory infection (ALRI) among children <5 years of age, frequently causing bronchiolitis and pneumonia in both high-income countries (HIC) as well as low-and middle-income coun-tries (LMIC) [4-6]. Globally an estimated 33.8 million new episodes of RSV-associated ALRI occurred in 2005 and at least 3.4 million required hospitalisations [7]. High RSV-associated incidence of hospitalisation has been reported especially in LMICs [8,9]. Data from a community-based study in India showed annual incidence rates of 3.2/1000 among children <5 years of age [10]. As several candidate RSV vaccines are being evaluated in clinical trials, it is important to generate more data on RSV burden to inform future policy. This is crucial for India, as many of its states have populations compara-ble to large countries, but with wide variation between the states in terms of lower respiratory disease burden [11]. Various studies in the last decade have reported the prevalence of RSV among children hospitalized with ALRI from different parts of India with tropical climates, but none are reported from Kashmir, a temperate re-gion of north India [12-15]. We present the prevalence of respiratory viruses among children aged <5 years hospitalized with severe acute respiratory infections in Kashmir.
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关键词
respiratory syncytial virus,severe acute respiratory infection,kashmir
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