Costs associated with acute respiratory illness and select virus infections in hospitalized children, El Salvador and Panama, 2012–2013

Abstract Background Although antiviral therapy is recommended for hospitalized patients with suspected or confirmed influenza, clinicians often rely on test results to determine management. Rapid influenza diagnostic tests (RIDTs) have suboptimal sensitivity; use of molecular assays may improve care. We evaluated clinical influenza testing and antiviral treatment practices in hospitalized children. Methods Children aged <18 years with acute respiratory illness (ARI) were enrolled through active surveillance at 7 hospitals in the New Vaccine Surveillance Network between November 2015 and June 30, 2016; analysis was restricted to the influenza season. Preliminary data were analyzed for children who had clinical influenza diagnostic testing with a rapid influenza diagnostic test or molecular assay on nasopharyngeal or nasal swabs or nasal washes. Children who had received antivirals prior to hospitalization were excluded. Results Of 2267 children, 1165 (51%) had clinical diagnostic testing on upper respiratory samples: 276 (24%) by RIDT alone, 780 (67%) by molecular testing alone, and 109 (9%) by both. The use of molecular testing alone varied by site, from 10% to 100% of samples tested. Of 116 (10%) children testing positive for influenza, 60 (52%) were treated; by site, treatment of children positive for influenza ranged from 25% to 83%. Antiviral treatment was given to 16/20 (80%) of those admitted ≤2 days from symptom onset vs. 44/96 (46%) children admitted >2 days after onset. Among 94 children tested by one method who were positive, >80% had samples collected in the emergency department or on day of admission, and 47 started treatment (Figure, A): 16/37 (43%) and 31/57 (54%) were treated when tested by RIDT alone and molecular testing alone, respectively. Of those positive children treated, 7/16 (44%) tested by RIDT vs. 22/31 (71%) by molecular testing started treatment on the day of testing (Figure, B). Conclusion Half of hospitalized children with ARI who tested positive for influenza received antiviral treatment. Although there was high variability in testing and treatment by site, in positive patients who were treated the use of molecular testing appeared to be associated with prompt antiviral therapy. Understanding clinician reasons for relatively low treatment overall will require further investigation. Disclosures J. Englund, Gilead: Consultant and Investigator, Research support Chimerix: Investigator, Research support Alios: Investigator, Research support Novavax: Investigator, Research support MedImmune: Investigator, Research support GlaxoSmithKline: Investigator, Research support N. B. Halasa, sanofi pasteur: Research Contractor, Research support Astra Zeneca: Research Contractor, Grant recipient

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The importance of gastrointestinal presentation for understanding respiratory virus infection in patients with acute respiratory illness: a cross-sectional study in Guangzhou

Journal of Epidemiological Research ◽

10.5430/jer.v4n2p18 ◽

2018 ◽

Vol 4 (2) ◽

pp. 18

Author(s):

Wen-Kuan Liu ◽

Qian Liu ◽

De-Hui Chen ◽

Wei-Ping Tan ◽

Shu-Yan Qiu ◽

...

Keyword(s):

Respiratory Virus ◽

Age Groups ◽

Respiratory Illness ◽

Respiratory Viruses ◽

Influenza B Virus ◽

Influenza B ◽

Human Bocavirus ◽

Acute Respiratory Illness ◽

Virus Infections ◽

Respiratory Virus Infections

Background: Respiratory virus infections often cause a wide spectrum of symptoms including gastrointestinal presentations (GP). The epidemiology of respiratory viruses in patients with GP needs to be better described.Methods: Throat swabs were collected and tested for 15 respiratory viruses from pediatric patients (≤14 years old) with acute respiratory illness in Guangzhou over a 3-year period. The features of respiratory virus infections were analyzed among those with GP.Results: Of 4,242 patients enrolled, 1,223 (28.8%) had GP. Among those, 647 (52.9%) were positive with one or more of the 15 tested respiratory viruses. The most frequently detected viruses were respiratory syncytial virus (RSV) (21.1%, 258), enterovirus (EV) (10.1%, 124), influenza A virus (infA) (7.8%, 95), adenovirus (ADV) (5%, 61), human metapneumovirus (HMPV) (4.1%, 50), and human bocavirus (HBoV) (3.5%, 43). More RSV (p = .001) and EV (P<0.001) infections were found in patients with GP than in patients without GP. 734 (60.0%) patients with GP presented with “Poor appetite”, 480 (39.2%) with “Vomiting”, 301 (24.6%) with “Diarrhea” and 73 (6.0%) with “Stomachache”. Significant differences in the virus positivity rate were found for RSV (p < .001), EV (p = .002) and PIV3 (p = .037). 90.6% (1,108/1,223) of patients with GP were under 5 years old. Among different age groups, significant differences in the virus positivity rate were found for infA (p = .005), influenza B virus (infB) (p = .006), RSV (p < .001), parainfluenza virus type 3 (PIV3) (p = .019), ADV (P<0.001), and HBoV (p = .009). RSV was mostly detected in patients under 2 years old (90.3%, 233/258) with frequency declining with age, while frequency of infA and infB increased with age. ADV, HBoV, and PIV3 reached their highest peaks in the age groups of 6-10 years old (11%), 7-12 months (8%) and 4–6 months (5.8%), respectively. In general, sample positivity rates in patients with GP increased when seasons changed. RSV, EV, infA, ADV, HMPV, and HBoV formed the bulk of the positive samples.Conclusions: In this study, the epidemiology of respiratory virus infections in patients with GP was analyzed. This information increases our understanding of respiratory virus infections and may help in clinical diagnosis of these viruses.

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