Published online Apr 9, 2019. doi: 10.5409/wjcp.v8.i2.33
Peer-review started: November 30, 2018
First decision: January 9, 2019
Revised: February 20, 2019
Accepted: February 27, 2019
Article in press: February 27, 2019
Published online: April 9, 2019
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory infections among children.
To investigate the proportion of RSV and non-RSV respiratory viral infections among hospitalized children ≤ 5 years.
Hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections (ALRI), admitted between August 2011-August 2013, were included. Cases were defined as laboratory-confirmed RSV and non-RSV respiratory viruses by direct fluorescence assay from the nasopharyngeal wash.
Of 383 1-59 mo old children hospitalized with an acute lower respiratory infection, 33.9% (130/383) had evidence of viral infection, and RSV was detected in 24.5% (94/383). Co-infections with RSV and other respiratory viruses (influenza A or B, adenovirus, para influenza 1, 2 or 3) were seen in children 5.5% (21/383). Over 90% of the RSV-positive children were under 2 years of age. RSV was detected throughout the year with peaks seen after the monsoon season. Children hospitalized with RSV infection were more likely to have been exposed to a shorter duration of breastfeeding of less than 3 mo. RSV positive children had a shorter hospital stay, although there were significant complications requiring intensive care. Use of antibiotics was high among those with RSV and non-RSV viral infections.
Our study provides evidence of a high proportion of RSV and other virus-associated ALRI among hospitalized children in India. RSV infection was associated with fewer days of hospital stay compared to other causes of lower respiratory infections. A high level of antibiotic use was seen among all respiratory virus-associated hospitalizations. These results suggest the need for implementing routine diagnostics for respiratory pathogens in order to minimize the use of unnecessary antibiotics and plan prevention strategies among pediatric populations.
Core tip: The study shows that a significant proportion of young children hospitalized for acute lower respiratory tract infection were associated with respiratory syncytial virus (RSV) and other viral infections. Early diagnosis of viral infections using a simple test such as the RSV and viral direct fluorescence assay test, in settings where PCR is not feasible, would be useful in the timely institution of appropriate care, minimization of antibiotic overuse, and appropriate follow-up care for complications and sequelae, potentially leading to a reduction of costs of medical care.