Dubai Medical Journal
ISSN: 2571-726X
Pioneering research in medicine, health sciences, nursing, pharmaceuticals, and laboratory work
Patterns of Viral Pathogens Causing Upper Respiratory Tract Infections in Children Under 13 Years Old: A Retrospective Analysis
Published date: Oct 30 2024
Journal Title: Dubai Medical Journal
Issue title: Dubai Medical Journal (DMJ): Volume 7 Issue 1
Pages: 24–38
Authors:
Abstract:
Background: Respiratory viral infections strain healthcare globally, accounting for 15% of encounters in the UAE. However, seasonal prevalence in the region remains unclear. This hospitalbased study aims to understand viral causes of upper respiratory tract infections (URTIs) in children under 13, focusing on influenza and RSV.
Methods: We conducted a retrospective chart review at Hatta Hospital in Dubai, collecting data from pediatric patients under 13 years old with URTI diagnoses from 2022 to 2023. Nasopharyngeal aspirate samples were analyzed using a multiplex chain reaction (mPCR) assay to identify viral pathogens. Data were collected from the hospital’s emergency department, walk-in clinic, and admitted patients.
Results: During the study period, 2714 samples were analyzed, with 1870 (69%) testing positive for any respiratory pathogen. Most infected individuals were males (56.7%), aged between 1 and 3 years (37.9%). Single viral infections were predominant (85.3%), with 27.3% attributed to Human Enterovirus/Rhinovirus, 26.6% to Influenza A, and 10.2% to respiratory syncytial virus (RSV). The RSV season was observed to span from August to December, peaking in October, while Influenza A had semi-seasonal peaks in June and October. Hospital admissions varied significantly between single (21%) and multiple viral infections (27%). Of 340 children hospitalized with single viral infections, 28.2% were infected with Human Enterovirus/Rhinovirus, 16.7% with RSV, and 13.5% with Influenza A.
Conclusion: The study provides insights into viral epidemiology among children in the UAE, highlighting the high prevalence and seasonal peaks of viral pathogens. Awareness of these trends can reduce unnecessary streptococcal testing and antibiotic overuse. Understanding the seasonal patterns aids in optimizing prophylactic measures and vaccination strategies for RSV and influenza, benefiting high-risk infants and children.
Keywords: Hatta Hospital, seasonality, respiratory tract infections, prevalence, influenza, RSV, vaccination
References:
[1] Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 2003 Feb;163(4):487–494.
[2] Schnell D, Gits-Muselli M, Canet E, Lemiale V, Schlemmer B, Simon F, et al. Burden of respiratory viruses in patients with acute respiratory failure. J Med Virol. 2014 Jul;86(7):1198–1202.
[3] Loney T, Aw TC, Handysides DG, Raghib A, Ian B, Michal G, et al. An analysis of the health status of the United Arab Emirates: The ’Big 4’ public health issues. Glob Health Action. 2013;6:20100.
[4] Glezen P, Denny FW. Epidemiology of acute lower respiratory disease in children. N Engl J Med. 1973 Mar;288(10):498–505.
[5] Heikkinen T, Järvinen A. The common cold. Lancet. 2003 Jan;361(9351):51–59.
[6] Sanghavi SK, Bullotta A, Husain S, Rinaldo CR. Clinical evaluation of multiplex real-time PCR panels for rapid detection of respiratory viral infections. J Med Virol. 2012 Jan;84(1):162–169.
[7] Tanner H, Boxall E, Osman H. Respiratory viral infections during the 2009-2010 winter season in Central England, UK: Incidence and patterns of multiple virus co-infections [PMC free article]. Eur J Clin Microbiol Infect Dis. 2012 Nov;31(11):3001–3006.
[8] Ambrosioni J, Bridevaux PO, Wagner G, Mamin A, Kaiser L. Epidemiology of viral respiratory infections in a tertiary care centre in the era of molecular diagnosis, Geneva, Switzerland, 2011-2012. Clin Microbiol Infect. 2014 Sep;20(9):O578–O584.
[9] Bloom-Feshbach K, Alonso WJ, Charu V, Tamerius J, Simonsen L, Miller MA, et al. Latitudinal variations in seasonal activity of influenza and respiratory syncytial virus (RSV): A global comparative review. PLoS One. 2013;8(2):e54445.
[10] Paynter S. Humidity and respiratory virus transmission in tropical and temperate settings. Epidemiol Infect. 2015 Apr;143(6):1110–1118.
[11] Tang JW, Loh TP. Correlations between climate factors and incidence—a contributor to RSV seasonality. Rev Med Virol. 2014 Jan;24(1):15–34.
[12] Tamerius JD, Shaman J, Alonso WJ, Bloom-Feshbach K, Uejio CK, Comrie A, et al. Environmental predictors of seasonal influenza epidemics across temperate and tropical climates. PLoS Pathog. 2013 Mar;9(3):e1003194.
[13] Jeon JH, Han M, Chang HE, Park SS, Lee JW, Ahn YJ, et al. Incidence and seasonality of respiratory viruses causing acute respiratory infections in the Northern United Arab Emirates. J Med Virol. 2019 Aug;91(8):1378–1384.
[14] Cureus. Seasonal prevalence of respiratory pathogens among children in the United Arab Emirates: A multicenter cross-sectional study in the Pre-COVID-19 Era. Cureus. 2023, September;15(9):e45204. https://doi.org/10. 7759/cureus.45204
[15] Albogami SS, Alotaibi MR, Alsahli SA, Masuadi E, Alshaalan M. Seasonal variations of respiratory viruses detected from children with respiratory tract infections in Riyadh, Saudi Arabia. J Infect Public Health. 2018;11(2):183–186.
[16] Rockman S, Dyson A, Koernig S, Becher D, Ng M, Morelli AB, et al. Evaluation of the bioactivity of influenza vaccine strains in vitro suggests that the introduction of new strains in the 2010 Southern Hemisphere trivalent influenza vaccine is associated with adverse events. Vaccine. 2014 Jun;32(30):3861–3868.
[17] Morikawa S, Kohdera U, Hosaka T, Ishii K, Akagawa S, Hiroi S, et al. Seasonal variations of respiratory viruses and etiology of human rhinovirus infection in children. J Clin Virol. 2015 Dec;73:14–19.
[18] Kim JM, Jung HD, Cheong HM, Lee A, Lee NJ, Chu H, et al. Nation-wide surveillance of human acute respiratory virus infections between 2013 and 2015 in Korea. J Med Virol. 2018 Jul;90(7):1177–1183.
[19] Writing Committee of the WHO consultation on clinical aspects of Pandemic (H1N1) 2009 influenza, Bautista E, Chotpitayasunondh T, et al. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362(18):1708-1719.
[20] Munoz FM, Williams J, Herrera G, et al. Safety and immunogenicity of a respiratory syncytial virus prefusion F vaccine in pregnant women. N Engl J Med. 2019;381(23):2321–2334.
[21] Ruckwardt TJ, Morabito KM, Graham BS. Immunological lessons from respiratory syncytial virus vaccine development. Immunity. 2019 Sep;51(3):429–442.
[22] Hammitt LL, Dagan R, Yuan Y, Baca Cots M, Bosheva M, Madhi SA, et al.; MELODY Study Group. Nirsevimab for prevention of RSV in healthy late-preterm and term infants. N Engl J Med. 2022 Mar;386(9):837–846.
[23] Griffin MP, Yuan Y, Takas T, Domachowske JB, Madhi SA, Manzoni P, et al.; Nirsevimab Study Group. Single-dose Nirsevimab for prevention of RSV in preterm infants. N Engl J Med. 2020 Jul;383(5):415– 425.
[24] Dowell SF. Seasonal variation in host susceptibility and cycles of certain infectious diseases. Emerg Infect Dis. 2001;7(3):369–374.
[25] Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: The ups and downs of a seasonal virus. Pediatr Infect Dis J. 2003 Feb;22(2 Suppl):S21–S32.
[26] Richard SA, Viboud C, Miller MA. Evaluation of Southern Hemisphere influenza vaccine recommendations. Vaccine. 2010 Mar;28(15):2693–2699.
[27] de Mello WA, de Paiva TM, Ishida MA, Benega MA, Dos Santos MC, Viboud C, et al. The dilemma of influenza vaccine recommendations when applied to the tropics: The Brazilian case examined under alternative scenarios. PLoS One. 2009;4(4):e5095.
[28] Alonso WJ, Viboud C, Simonsen L, Hirano EW, Daufenbach LZ, Miller MA. Seasonality of influenza in Brazil: A traveling wave from the Amazon to the subtropics. Am J Epidemiol. 2007 Jun;165(12):1434–42.
[29] Panozzo CA, Stockman LJ, Curns AT, Anderson LJ. Use of respiratory syncytial virus surveillance data to optimize the timing of immunoprophylaxis. Pediatrics. 2010 Jul;126(1):e116–e123.
[30] Aberle JH, Aberle SW, Pracher E, Hutter HP, Kundi M, Popow-Kraupp T. Single versus dual respiratory virus infections in hospitalized infants: Impact on clinical course of disease and interferon-gamma response. Pediatr Infect Dis J. 2005 Jul;24(7):605–610.
[31] Subbarao EK, Griffis J, Waner JL. Detection of multiple viral agents in nasopharyngeal specimens yielding respiratory syncytial virus (RSV). An assessment of diagnostic strategy and clinical significance. Diagn Microbiol Infect Dis. 1989;12(4):327–332.
[32] Drews AL, Atmar RL, Glezen WP, Baxter BD, Piedra PA, Greenberg SB. Dual respiratory virus infections. Clin Infect Dis. 1997 Dec;25(6):1421–1429.
[33] Brunstein JD, Cline CL, McKinney S, Thomas E. Evidence from multiplex molecular assays for complex multipathogen interactions in acute respiratory infections. J Clin Microbiol. 2008 Jan;46(1):97–102.
[34] Follin P, Lindqvist A, Nyström K, Lindh M. A variety of respiratory viruses found in symptomatic travellers returning from countries with ongoing spread of the new influenza A(H1N1)v virus strain. Euro Surveill. 2009 Jun;14(24):19242.
[35] DaPalma T, Doonan BP, Trager NM, Kasman LM. A systematic approach to virus-virus interactions. Virus Res. 2010 Apr;149(1):1–9.
[36] Asner SA, Science ME, Tran D, Smieja M, Merglen A, Mertz D. Clinical disease severity of respiratory viral co-infection versus single viral infection: A systematic review and meta-analysis. PLoS One. 2014 Jun;9(6):e99392.
[37] Semple MG, Cowell A, Dove W, Greensill J, McNamara PS, Halfhide C, et al. Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis. J Infect Dis. 2005 Feb;191(3):382–386.
[38] Greensill J, McNamara PS, Dove W, Flanagan B, Smyth RL, Hart CA. Human metapneumovirus in severe respiratory syncytial virus bronchiolitis. Emerg Infect Dis. 2003 Mar;9(3):372–375.
[39] Papadopoulos NG, Moustaki M, Tsolia M, Bossios A, Astra E, Prezerakou A, et al. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med. 2002 May;165(9):1285–1289.
[40] Subbarao EK, Griffis J, Waner JL. Detection of multiple viral agents in nasopharyngeal specimens yielding respiratory syncytial virus (RSV). An assessment of diagnostic strategy and clinical significance. Diagn Microbiol Infect Dis. 1989;12(4):327–332.
[41] Huang JJ, Huang TY, Huang MY, Chen BH, Lin KH, Jeng JE, et al. Simultaneous multiple viral infections in childhood acute lower respiratory tract infections in southern Taiwan. J Trop Pediatr. 1998 Oct;44(5):308–311.
[42] Lazar I, Weibel C, Dziura J, Ferguson D, Landry ML, Kahn JS. Human metapneumovirus and severity of respiratory syncytial virus disease. Emerg Infect Dis. 2004 Jul;10(7):1318–1320.
[43] Legg JP, Warner JA, Johnston SL, Warner JO. Frequency of detection of picornaviruses and seven other respiratory pathogens in infants. Pediatr Infect Dis J. 2005 Jul;24(7):611–616.
[44] Richard N, Komurian-Pradel F, Javouhey E, Perret M, Rajoharison A, Bagnaud A, et al. The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis. Pediatr Infect Dis J. 2008 Mar;27(3):213–217.
[45] Palacios G, Hornig M, Cisterna D, Savji N, Bussetti AV, Kapoor V, et al. Streptococcus pneumonae coinfection is correlated with the severity of H1N1 pandemic influenza. PLoS One. 2009 Dec;4(12):e8540.
[46] UAE Ministry of Climate Change and Environment (MOCCAE). The UAE State of Climate Report: A Review of the Arabian Gulf Region’s Changing Climate & Its Impacts. UAE Ministry of Climate Change and Environment; 2021.
[47] Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections. Mäkinen TM, Juvonen R, Jokelainen J, et al. Respir Med. 2009;103:456–462.
[48] Mansbach JM, Piedra PA, Teach SJ, Sullivan AF, Forgey T, Clark S, Camargo CA. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med. 2012;166(8):700-706.
[49] Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, et al. The burden of respiratory syncytial virus infection in young children. **N Engl J Med. 2009;360(6):588-598.
[50] Fagbo SF, Garbati MA, Hasan R, AlShahrani D, Al-Shehri M, AlFawaz T, et al. Acute viral respiratory infections among children in MERS-endemic Riyadh, Saudi Arabia, 2012-2013. J Med Virol. 2017;89:195–201.
[51] Farrag MA, Hamed ME, Amer HM, Almajhdi FN. Epidemiology of respiratory viruses in Saudi Arabia: Toward a complete picture. Arch Virol. 2019 Aug;164(8):1981–1996.
[52] Fisman D. Seasonality of viral infections: mechanisms and unknowns. Clin Microbiol Infect. 2012 Oct;18(10):946–954.
[53] Wei J, Li Y. Airborne spread of infectious agents in the indoor environment. Am J Infect Control. 2016 Sep;44(9 Suppl):S102–S108.
[54] Rose EB, Wheatley A, Langley G, Gerber S, Haynes A; Centers for disease control and prevention. Respiratory Syncytial Virus Seasonality - United States, 2014-2017. MMWR Morb Mortal Wkly Rep. 2018 Jan;67(2):71–76.
[55] Olsen SJ, Winn AK, Budd AP, Prill MM, Steel J, Midgley CM, et al. Centers for disease control and prevention. Changes in influenza and other respiratory virus activity during the COVID-19 Pandemic - United States, 2020-2021. MMWR Morb Mortal Wkly Rep. 2021 Jul;70(29):1013–1019.
[56] Goka E, Vallely P, Mutton K, Klapper P. Influenza A viruses dual and multiple infections with other respiratory viruses and risk of hospitalisation and mortality. Influenza Other Respir Viruses. 2013 Nov;7(6):1079–1087.
[57] Jacobs SE, Lamson DM, St George K, Walsh TJ. Human rhinoviruses. Clin Microbiol Rev. 2013 Jan;26(1):135–162.