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

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          Abstract

          Background

          The 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.

          Objectives

          We 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.

          Methods

          Molecular 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.

          Results

          A 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.

          Conclusion

          Similar 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.

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          Human Bocavirus and Acute Wheezing in Children

          Tobias Allander, Tuomas Jartti, Shawon Gupta … (2007)
          Abstract Background . Human bocavirus is a newly discovered parvovirus. It has been detected primarily in children with acute lower respiratory tract infection, but its occurrence, clinical profile, and role as a causative agent of respiratory tract disease are not clear. Methods . We investigated the presence of human bocavirus by quantitative polymerase chain reaction of nasopharyngeal aspirate specimens and selected serum samples obtained from 259 children (median age, 1.6 years) who had been hospitalized for acute expiratory wheezing. The samples were analyzed for 16 respiratory viruses by polymerase chain reaction, virus culture, antigen detection, and serological assays. Results . At least 1 potential etiologic agent was detected in 95% of children, and >1 agent was detected in 34% of children. Human bocavirus was detected in 49 children (19%). A large proportion of the cases were mixed infections with other viruses, but human bocavirus was the only virus detected in 12 children (5%). High viral loads of human bocavirus were noted mainly in the absence of other viral agents, suggesting a causative role for acute wheezing. In addition, infections that had uncertain clinical relevance and low viral loads were prevalent. Human bocavirus DNA was frequently detected in serum specimens obtained from patients with acute wheezing, suggesting systemic infection. Conclusions . Human bocavirus is prevalent among children with acute wheezing and can cause systemic infection. Results suggest a model for bocavirus infection in which high viral loads are potentially associated with respiratory symptoms and low viral loads indicate asymptomatic shedding. Therefore, quantitative polymerase chain reaction analysis may be important for additional studies of human bocavirus.
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            Estimates of world-wide distribution of child deaths from acute respiratory infections.

            Brian Williams, Eleanor Gouws, Cynthia Boschi-Pinto … (2002)
            Acute respiratory infections (ARI) are among the leading causes of childhood mortality. Estimates of the number of children worldwide who die from ARI are needed in setting priorities for health care. To establish a relation between deaths due to ARI and all-cause deaths in children under 5 years we show that the proportion of deaths directly attributable to ARI declines from 23% to 18% and then 15% (95% confidence limits range from +/- 2% to +/- 3%) as under-5 mortality declines from 50 to 20 and then to 10/1000 per year. Much of the variability in estimates of ARI in children is shown to be inherent in the use of verbal autopsies. This analysis suggests that throughout the world 1.9 million (95% CI 1.6-2.2 million) children died from ARI in 2000, 70% of them in Africa and southeast Asia.
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              Influenza and the rates of hospitalization for respiratory disease among infants and young children.

              Hector Izurieta, William W Thompson, Piotr Kramarz … (2000)
              Young children may be at increased risk for serious complications from influenzavirus infection. However, in population-based studies it has been difficult to separate the effects of influenzavirus from those of respiratory syncytial virus. Respiratory syncytial virus often circulates with influenzaviruses and is the most frequent cause of hospitalization for lower respiratory tract infections in infants and young children. We studied the rates of hospitalization for acute respiratory-disease among infants and children during periods when the circulation of influenzaviruses predominated over the circulation of respiratory syncytial virus. For each season from October to May during the period from 1992 to 1997, we used local viral surveillance data to define periods in Washington State and northern California when the circulation of influenzaviruses predominated over that of respiratory syncytial virus. We calculated the rates of hospitalization for acute respiratory disease, excess rates attributable to influenzavirus, and incidence-rate ratios for all infants and children younger than 18 years of age who were enrolled in either the Kaiser Permanente Medical Care Program of Northern California or the Group Health Cooperative of Puget Sound. The rates of hospitalization for acute respiratory disease among children who did not have conditions that put them at high risk for complications of influenza (e.g., asthma, cardiovascular diseases, or premature birth) and who were younger than two years of age were 231 per 100,000 person-months at Northern California Kaiser sites (from 1993 to 1997) and 193 per 100,000 person-months at Group Health Cooperative sites (from 1992 to 1997). These rates were approximately 12 times as high as the rates among children without high-risk conditions who were 5 to 17 years of age (19 per 100,000 person-months at Northern California Kaiser sites and 16 per 100,000 person-months at Group Health Cooperative sites) and approached the rates among children with chronic health conditions who were 5 to 17 years of age (386 per 100,000 person-months and 216 per 100,000 person-months, respectively). Infants and young children without chronic or serious medical conditions are at increased risk for hospitalization during influenza seasons. Routine influenza vaccination should be considered in these children.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2011
                Publication date (Electronic): 24 March 2011
                Volume: 6
                Issue: 3
                Electronic Location Identifier: e18176
                Affiliations
                [1 ]Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Program, Ho Chi Minh City, Vietnam
                [2 ]Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
                [3 ]Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
                [4 ]Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
                University of Hong Kong, Hong Kong
                Author notes

                Conceived and designed the experiments: MDJ THT JF BW. Performed the experiments: MNN. Analyzed the data: AHLD THtH JB HRvD MDJ. Contributed reagents/materials/analysis tools: AHLD QHD TLV TTT VCvN MHV CKV MDN. Wrote the paper: AHLD JB HRvD MDJ.

                Article
                Publisher ID: PONE-D-10-04322
                DOI: 10.1371/journal.pone.0018176
                PMC ID: 3063798
                PubMed ID: 21455313
                SO-VID: 07241ae5-37e0-4184-aa03-ff43d11285ef
                Copyright © Do et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 4 November 2010
                Date accepted : 27 February 2011
                Page count
                Pages: 9
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Microbiology
                Subject: Virology
                Subject: Co-Infections
                Subject: Viral Disease Diagnosis
                Subject: Medicine
                Subject: Diagnostic Medicine
                Subject: Epidemiology
                Subject: Pediatric Epidemiology
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Enterovirus Infection
                Subject: Human Bocavirus Infection
                Subject: Human Metapneumovirus Infection
                Subject: Human Parainfluenza Virus Infection
                Subject: Influenza
                Subject: Respiratory Syncytial Virus Infection
                Subject: Rhinovirus Infection
                Subject: SARS
                Subject: Viral Pneumonia
                Subject: Pediatrics
                Subject: Pediatric Pulmonology
                Subject: Public Health
                Subject: Child Health
                Subject: Pulmonology
                Subject: Respiratory Infections

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