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Surveillance Open Access
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Abstract

Background

Seasonal influenza-like illness (ILI) affects millions of people yearly. Severe acute respiratory infections (SARI), mainly influenza, are a leading cause of hospitalisation and mortality. Increasing evidence indicates that non-influenza respiratory viruses (NIRV) also contribute to the burden of SARI. In Belgium, SARI surveillance by a network of sentinel hospitals has been ongoing since 2011.

Aim

We report the results of using in-house multiplex qPCR for the detection of a flexible panel of viruses in respiratory ILI and SARI samples and the estimated incidence rates of SARI associated with each virus.

Methods

We defined ILI as an illness with onset of fever and cough or dyspnoea. SARI was defined as an illness requiring hospitalisation with onset of fever and cough or dyspnoea within the previous 10 days. Samples were collected in four winter seasons and tested by multiplex qPCR for influenza virus and NIRV. Using catchment population estimates, we calculated incidence rates of SARI associated with each virus.

Results

One third of the SARI cases were positive for NIRV, reaching 49.4% among children younger than 15 years. In children younger than 5 years, incidence rates of NIRV-associated SARI were twice that of influenza (103.5 vs 57.6/100,000 person-months); co-infections with several NIRV, respiratory syncytial viruses, human metapneumoviruses and picornaviruses contributed most (33.1, 13.6, 15.8 and 18.2/100,000 person-months, respectively).

Conclusion

Early testing for NIRV could be beneficial to clinical management of SARI patients, especially in children younger than 5 years, for whom the burden of NIRV-associated disease exceeds that of influenza.

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/content/10.2807/1560-7917.ES.2021.26.38.2001104
2021-09-23
2021-10-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2021.26.38.2001104
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References

  1. Forum of International Respiratory Societies. The global impact of respiratory disease - Second edition. Sheffield: European Respiratory Society; 2017. Available from: https://www.who.int/gard/publications/The_Global_Impact_of_Respiratory_Disease.pdf
  2. Malosh RE, Martin ET, Ortiz JR, Monto AS. The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review. Vaccine. 2018;36(1):141-7.  https://doi.org/10.1016/j.vaccine.2017.11.018  PMID: 29157959 
  3. 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;163(4):487-94.  https://doi.org/10.1001/archinte.163.4.487  PMID: 12588210 
  4. Gilca R, Amini R, Douville-Fradet M, Charest H, Dubuque J, Boulianne N, et al. Other respiratory viruses are important contributors to adult respiratory hospitalizations and mortality even during peak weeks of the influenza season. Open Forum Infect Dis. 2014;1(2):ofu086.  https://doi.org/10.1093/ofid/ofu086  PMID: 25734152 
  5. Furuta T, Hasegawa S, Mizutani M, Iwai T, Ohbuchi N, Kawano S, et al. Burden of human metapneumovirus and respiratory syncytial virus infections in asthmatic children. Pediatr Infect Dis J. 2018;37(11):1107-11.  https://doi.org/10.1097/INF.0000000000002038  PMID: 29742646 
  6. Taylor S, Lopez P, Weckx L, Borja-Tabora C, Ulloa-Gutierrez R, Lazcano-Ponce E, et al. Respiratory viruses and influenza-like illness: Epidemiology and outcomes in children aged 6 months to 10 years in a multi-country population sample. J Infect. 2017;74(1):29-41.  https://doi.org/10.1016/j.jinf.2016.09.003  PMID: 27667752 
  7. Uddin SMI, Englund JA, Kuypers JY, Chu HY, Steinhoff MC, Khatry SK, et al. Burden and risk factors for coronavirus infections in infants in rural Nepal. Clin Infect Dis. 2018;67(10):1507-14.  https://doi.org/10.1093/cid/ciy317  PMID: 29668900 
  8. Bénézit F, Loubet P, Galtier F, Pronier C, Lenzi N, Lesieur Z, et al. , FLUVAC Study Group. Non-influenza respiratory viruses in adult patients admitted with influenza-like illness: a 3-year prospective multicenter study. Infection. 2020;48(4):489-95.  https://doi.org/10.1007/s15010-019-01388-1  PMID: 32056143 
  9. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545-55.  https://doi.org/10.1016/S0140-6736(10)60206-1  PMID: 20399493 
  10. World Health Organization (WHO). A manual for estimating disease burden associated with seasonal influenza. Geneva: WHO; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/178801/9789241549301_eng.pdf;jsessionid=AECA0159A38911F4578CACA12131DD04?sequence=1
  11. Fischer N, Dauby N, Bossuyt N, Reynders M, Gérard M, Lacor P, et al. Monitoring of human coronaviruses in Belgian primary care and hospitals, 2015-20: a surveillance study. Lancet Microbe. 2021;2(3):e105-14.  https://doi.org/10.1016/S2666-5247(20)30221-4  PMID: 33937883 
  12. Rothman KJ, Greenland S. Modern epidemiology. 2nd edition. Philadelphia: Lippincott-Raven, 1998.
  13. Broberg EK, Waris M, Johansen K, Snacken R, Penttinen P, European Influenza Surveillance Network. Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016. Euro Surveill. 2018;23(5):17-00284.  https://doi.org/10.2807/1560-7917.ES.2018.23.5.17-00284  PMID: 29409569 
  14. Subissi L, Bossuyt N, Reynders M, Gérard M, Dauby N, Bourgeois M, et al. Capturing respiratory syncytial virus season in Belgium using the influenza severe acute respiratory infection surveillance network, season 2018/19. Euro Surveill. 2020;25(39):1900627.  https://doi.org/10.2807/1560-7917.ES.2020.25.39.1900627  PMID: 33006303 
  15. Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med. 2000;160(21):3243-7.  https://doi.org/10.1001/archinte.160.21.3243  PMID: 11088084 
  16. Ma X, Conrad T, Alchikh M, Reiche J, Schweiger B, Rath B. Can we distinguish respiratory viral infections based on clinical features? A prospective pediatric cohort compared to systematic literature review. Rev Med Virol. 2018;28(5):e1997.  https://doi.org/10.1002/rmv.1997  PMID: 30043515 
  17. Kurskaya O, Ryabichenko T, Leonova N, Shi W, Bi H, Sharshov K, et al. Viral etiology of acute respiratory infections in hospitalized children in Novosibirsk City, Russia (2013 - 2017). PLoS One. 2018;13(9):e0200117.  https://doi.org/10.1371/journal.pone.0200117  PMID: 30226876 
  18. Chakhunashvili G, Wagner AL, Power LE, Janusz CB, Machablishvili A, Karseladze I, et al. Severe Acute Respiratory Infection (SARI) sentinel surveillance in the country of Georgia, 2015-2017. PLoS One. 2018;13(7):e0201497.  https://doi.org/10.1371/journal.pone.0201497  PMID: 30059540 
  19. Li Y, Reeves RM, Wang X, Bassat Q, Brooks WA, Cohen C, et al. , RSV Global Epidemiology Network, RESCEU investigators. Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis. Lancet Glob Health. 2019;7(8):e1031-45.  https://doi.org/10.1016/S2214-109X(19)30264-5  PMID: 31303294 
  20. van Asten L, Bijkerk P, Fanoy E, van Ginkel A, Suijkerbuijk A, van der Hoek W, et al. Early occurrence of influenza A epidemics coincided with changes in occurrence of other respiratory virus infections. Influenza Other Respir Viruses. 2016;10(1):14-26.  https://doi.org/10.1111/irv.12348  PMID: 26369646 
  21. Price OH, Sullivan SG, Sutterby C, Druce J, Carville KS. Using routine testing data to understand circulation patterns of influenza A, respiratory syncytial virus and other respiratory viruses in Victoria, Australia. Epidemiol Infect. 2019;147:e221.  https://doi.org/10.1017/S0950268819001055  PMID: 31364539 
  22. Achten NB, Wu P, Bont L, Blanken MO, Gebretsadik T, Chappell JD, et al. Interference between respiratory syncytial virus and human rhinovirus infection in Infancy. J Infect Dis. 2017;215(7):1102-6.  https://doi.org/10.1093/infdis/jix031  PMID: 28368456 
  23. Cowling BJ, Fang VJ, Nishiura H, Chan K-H, Ng S, Ip DKM, et al. Increased risk of noninfluenza respiratory virus infections associated with receipt of inactivated influenza vaccine. Clin Infect Dis. 2012;54(12):1778-83.  https://doi.org/10.1093/cid/cis307  PMID: 22423139 
  24. Skowronski DM, Zou M, Clarke Q, Chambers C, Dickinson JA, Sabaiduc S, et al. Influenza vaccine does not increase the risk of coronavirus or other noninfluenza respiratory viruses: retrospective analysis from Canada, 2010-2011 to 2016-2017. Clin Infect Dis. 2020;71(16):2285-8.  https://doi.org/10.1093/cid/ciaa626  PMID: 32442261 
  25. Nickbakhsh S, Ho A, Marques DFP, McMenamin J, Gunson RR, Murcia P. Epidemiology of seasonal coronaviruses: Establishing the context for the emergence of coronavirus disease 2019. J Infect Dis. 2020;222(1):17-25.  https://doi.org/10.1093/infdis/jiaa185  PMID: 32296837 
  26. Hirve S, Crawford N, Palekar R, Zhang W, WHO RSV surveillance Group. Clinical characteristics, predictors, and performance of case definition-Interim results from the WHO global respiratory syncytial virus surveillance pilot. Influenza Other Respir Viruses. 2020;14(6):647-57.  https://doi.org/10.1111/irv.12688  PMID: 31670892 
  27. Williams TC, Kim S, Spiro DJ, Campbell H. Preparing for the future implementation of respiratory syncytial virus vaccines. Lancet Respir Med. 2020;8(3):233-5.  https://doi.org/10.1016/S2213-2600(19)30478-3  PMID: 31978328 
  28. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-27.  https://doi.org/10.1056/NEJMoa1500245  PMID: 26172429 
  29. Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372(9):835-45.  https://doi.org/10.1056/NEJMoa1405870  PMID: 25714161 
  30. Kodama F, Nace DA, Jump RLP. Respiratory syncytial virus and other noninfluenza respiratory viruses in older adults. Infect Dis Clin North Am. 2017;31(4):767-90.  https://doi.org/10.1016/j.idc.2017.07.006  PMID: 29079159 
  31. Pavia AT. Viral infections of the lower respiratory tract: old viruses, new viruses, and the role of diagnosis. Clin Infect Dis. 2011;52(Suppl 4):S284-9.  https://doi.org/10.1093/cid/cir043  PMID: 21460286 
  32. Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 2018;6(10):782-92.  https://doi.org/10.1016/S2213-2600(18)30274-1  PMID: 30076119 
  33. Blyth CC, Webb SAR, Kok J, Dwyer DE, van Hal SJ, Foo H, et al. The impact of bacterial and viral co-infection in severe influenza. Influenza Other Respir Viruses. 2013;7(2):168-76.  https://doi.org/10.1111/j.1750-2659.2012.00360.x  PMID: 22487223 
  34. Teng F, Liu X, Guo S-B, Li Z, Ji W-Q, Zhang F, et al. Community-acquired bacterial co-infection predicts severity and mortality in influenza-associated pneumonia admitted patients. J Infect Chemother. 2019;25(2):129-36.  https://doi.org/10.1016/j.jiac.2018.10.014  PMID: 30448361 
  35. Ieven M, Coenen S, Loens K, Lammens C, Coenjaerts F, Vanderstraeten A, et al. Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries. Clin Microbiol Infect. 2018;24(11):1158-63.  https://doi.org/10.1016/j.cmi.2018.02.004  PMID: 29447989 
  36. Talbot HK, Falsey AR. The diagnosis of viral respiratory disease in older adults. Clin Infect Dis. 2010;50(5):747-51.  https://doi.org/10.1086/650486  PMID: 20121411 
  37. Matsuno O, Kataoka H, Takenaka R, Okubo F, Okamoto K, Masutomo K, et al. Influence of age on symptoms and laboratory findings at presentation in patients with influenza-associated pneumonia. Arch Gerontol Geriatr. 2009;49(2):322-5.  https://doi.org/10.1016/j.archger.2008.11.015  PMID: 19150140 
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