Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Apr 9, 2019; 8(2): 33-42
Published online Apr 9, 2019. doi: 10.5409/wjcp.v8.i2.33
Prevalence of respiratory syncytial virus infection among children hospitalized with acute lower respiratory tract infections in Southern India
Sandesh Kini, Bhuvanesh Sukhlal Kalal, Sara Chandy, Ranjani Shamsundar, Anita Shet
Sandesh Kini, Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
Bhuvanesh Sukhlal Kalal, Department of Biochemistry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, Karnataka, India
Sara Chandy, Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Thiruvalla 689101, Kerala, India
Ranjani Shamsundar, Department of Microbiology, St. John’s Medical College, Bengaluru 560034, Karnataka, India
Anita Shet, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
Author contributions: Kini S and Kalal BS contributed equally to this work. Shet A and Kini S designed the study; Kini S and Kalal BS recruited the children, collected samples and data; Kalal BS and Shamsundar R performed laboratory experiments; Kini S and Kalal BS analysed data and wrote the manuscript; Chandy S, Shamsundar R and Shet A gave technical support and conceptual advice; Shet A critically reviewed the manuscript and supervised the whole study process; all authors read and approved the final manuscript.
Institutional review board statement: Ethical clearance was obtained from the Institutional Ethics Committee (IRB No 134/2008) at St. Johns Medical College Hospital prior to initiating the study.
Informed consent statement: Informed consent was obtained from the caregivers of eligible children.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Anita Shet, MD, PhD, Full Professor, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States. ashet1@jhu.edu
Telephone: +1-410-5022629
Received: November 30, 2018
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
ARTICLE HIGHLIGHTS
Research background

Respiratory syncytial virus (RSV) is the most frequent agent of viral-associated acute lower respiratory diseases (ALRI) and is known to be associated with hospitalization and mortality among high-risk cases.

Research motivation

Early diagnosis of viral infections using a simple test such as the RSV and viral fluorescent antibody assay (DFA) test, in settings where PCR is not feasible, would be useful in the timely institution of appropriate supportive care, minimization of antibiotic overuse, and appropriate follow-up care for complications and sequelae, potentially leading to a reduction of costs of medical care.

Research objectives

The principal objective of the study was to investigate the proportion of RSV and non-RSV respiratory viral infections as a cause of ALRI among 1-59 mo old children admitted to a tertiary care hospital in India. The study also assesses the seasonality, clinical features, risk factors and outcome of RSV and non-RSV respiratory viral infections among these hospitalized children.

Research methods

The prospective study was conducted on hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections (ALRI), admitted between August 2011-August 2013, were included. Nasopharyngeal (NP) swabs were obtained from eligible children, and transported to the laboratory in suitable media. Slides were prepared from the media, and DFA staining was performed using SimulFluor Respiratory Screen kit on NP wash samples.

Research results

The median age of subjects was 8 mo (inter quartile range 5-15 mo), and 89.0% were less than 2 years of age. Viral etiology (RSV, influenza A or B, adenovirus, para influenza 1, 2 or 3) was confirmed in 33.9% (130/383) of children hospitalized for ALRI. RSV was positive in 24.5% (94/383) non-RSV viruses in 14.8% (57/383) while co-infection with RSV and non-RSV viruses was seen in 5.5% (21/383) children. A peak of RSV positive cases was seen after the rainy season during the months of August through November. The RSV infection was significantly associated with being exclusively breastfed for less than 3 mo. There was no significant association between RSV infection and independent variables such as low birth weight, prematurity, complicated neonatal course, family history of asthma, household smoking or indoor wood fuel usage. Mean hospital stay was 4.6 ± 5.1 d and 8.3 ± 6.5 d in RSV-positive and RSV-negative children, respectively. The respiratory complications such as acute respiratory distress syndrome and respiratory failure requiring PICU admission, were 13.8% (13/94), 8.7% (5/57) and 16.6% (42/253) of children with RSV positive, non-RSV positive and viral negative results.

Research conclusions

A high proportion of RSV and other virus-associated ALRI were seen among hospitalized children in India. The study demonstrates that exclusive breastfeeding for over 3 mo of age, may have a protective effect against RSV and other respiratory viral infections. The viral DFA test was easy to perform and results were available within 4-5 h.

Research perspectives

Early diagnosis of viral infections using a simple test such as the RSV and would be useful in the timely institution of appropriate supportive care, minimization of antibiotic overuse, and appropriate follow-up care for complications and sequelae, potentially leading to a reduction of costs of medical care.