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Surveillance Open Access
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Abstract

Background

Knowledge on the burden attributed to influenza viruses vs other respiratory viruses in children hospitalised with severe acute respiratory infections (SARI) in Belgium is limited.

Aim

This observational study aimed at describing the epidemiology and assessing risk factors for severe disease.

Methods

We retrospectively analysed data from routine national sentinel SARI surveillance in Belgium. Respiratory specimens collected during winter seasons 2011 to 2020 were tested by multiplex real-time quantitative PCR (RT-qPCR) for influenza and other respiratory viruses. Demographic data and risk factors were collected through questionnaires. Patients were followed-up for complications or death during hospital stay. Analysis focused on children younger than 15 years. Binomial logistic regression was used to identify risk factors for severe disease in relation to infection status.

Results

During the winter seasons 2011 to 2020, 2,944 specimens met the study case definition. Complications were more common in children with underlying risk factors, especially asthma (adjusted risk ratio (aRR): 1.87; 95% confidence interval (CI): 1.46–2.30) and chronic respiratory disease (aRR: 1.88; 95% CI: 1.44–2.32), regardless of infection status and age. Children infected with non-influenza respiratory viruses had a 32% higher risk of complications (aRR: 1.32; 95% CI: 1.06–1.66) compared with children with influenza only.

Conclusion

Multi-virus testing in children with SARI allows a more accurate assessment of the risk of complications and attribution of burden to respiratory viruses beyond influenza. Children with asthma and respiratory disease should be prioritised for clinical care, regardless of their virological test result and age, and targeted for prevention campaigns.

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/content/10.2807/1560-7917.ES.2023.28.29.2300056
2023-07-20
2024-05-09
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.29.2300056
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References

  1. Krammer F, Smith GJD, Fouchier RAM, Peiris M, Kedzierska K, Doherty PC, et al. Influenza. Nat Rev Dis Primers. 2018;4(1):3.  https://doi.org/10.1038/s41572-018-0002-y  PMID: 29955068 
  2. Martínez A, Soldevila N, Romero-Tamarit A, Torner N, Godoy P, Rius C, et al. Risk factors associated with severe outcomes in adult hospitalized patients according to influenza type and subtype. PLoS One. 2019;14(1):e0210353.  https://doi.org/10.1371/journal.pone.0210353  PMID: 30633778 
  3. Mandelia Y, Procop GW, Richter SS, Worley S, Liu W, Esper F. Dynamics and predisposition of respiratory viral co-infections in children and adults. Clin Microbiol Infect. 2021;27(4):631.e1-6.  https://doi.org/10.1016/j.cmi.2020.05.042  PMID: 32540470 
  4. Althouse BM, Flasche S, Toizumi M, Nguyen HT, Vo HM, Le MN, et al. Differences in clinical severity of respiratory viral infections in hospitalized children. Sci Rep. 2021;11(1):5163.  https://doi.org/10.1038/s41598-021-84423-2  PMID: 33664311 
  5. World Health Organisation (WHO). World health statistics 2023: monitoring health for the SDGs, sustainable Development goals. Geneva: WHO; 2023. Available from: https://www.who.int/publications/i/item/9789240074323
  6. World Health Organisation (WHO). Global influenza strategy summary 2019-2030 influenza. Geneva: WHO; 2019. Available from: https://www.who.int/publications/i/item/9789241515320
  7. Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2018;391(10127):1285-300.  https://doi.org/10.1016/S0140-6736(17)33293-2  PMID: 29248255 
  8. Wang X, Li Y, O’Brien KL, Madhi SA, Widdowson MA, Byass P, et al. Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study. Lancet Glob Health. 2020;8(4):e497-510.  https://doi.org/10.1016/S2214-109X(19)30545-5  PMID: 32087815 
  9. World Health Organization. Vaccines against influenza: WHO position paper – May 2022. Wkly Epidemiol Rec. 2022;97(19):185-208.
  10. Conseil Supérieur de la Santé. Avis du conseil supérieur de la santé n° 9488. Vaccination contre la grippe saisonnière. Saison hivernale 2018-2019. [Opinion of the superior health council no. 9488. Seasonal influenza vaccination. Winter season 2018/19]. Bruxelles: Conseil Supérieur de la Santé; 2018. French. Available from: https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/css_9488_avis_grippe_update201810.pdf
  11. Williams K, Bastian AR, Feldman RA, Omoruyi E, de Paepe E, Hendriks J, et al. Phase 1 safety and immunogenicity study of a respiratory syncytial virus vaccine with an adenovirus 26 vector encoding prefusion F (Ad26.RSV.preF) in adults aged ≥60 Years. J Infect Dis. 2020;222(6):979-88.  https://doi.org/10.1093/infdis/jiaa193  PMID: 32320465 
  12. Karron RA, San Mateo J, Wanionek K, Collins PL, Buchholz UJ. Evaluation of a live attenuated human metapneumovirus vaccine in adults and children. J Pediatric Infect Dis Soc. 2018;7(1):86-9.  https://doi.org/10.1093/jpids/pix006  PMID: 28444226 
  13. Edlmayr J, Niespodziana K, Popow-Kraupp T, Krzyzanek V, Focke-Tejkl M, Blaas D, et al. Antibodies induced with recombinant VP1 from human rhinovirus exhibit cross-neutralisation. Eur Respir J. 2011;37(1):44-52.  https://doi.org/10.1183/09031936.00149109  PMID: 20530036 
  14. Bossuyt N, Thomas I, Barbezange C, Bustos-Sierra N, Van Cauteren D, Vermeulen M. Surveillance des infections à influenza: rapport épidémiologique, saison 2018-2019 [Surveillance of influenza infections : epidemiological report, 2018-2019 season]. Brussels: Sciensano; 2019. D/2019/14.440/103. Available from: https://www.sciensano.be/en/biblio/surveillance-des-infections-a-influenza-rapport-epidemiologique-saison-2018-2019
  15. 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 
  16. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. [Accessed: 18 Mar 2022]. Available from: https://www.r-project.org
  17. Kwon JM, Shim JW, Kim DS, Jung HL, Park MS, Shim JY. Prevalence of respiratory viral infection in children hospitalized for acute lower respiratory tract diseases, and association of rhinovirus and influenza virus with asthma exacerbations. Korean J Pediatr. 2014;57(1):29-34.  https://doi.org/10.3345/kjp.2014.57.1.29  PMID: 24578714 
  18. Mattila JM, Vuorinen T, Heikkinen T. Comparative severity of influenza A and B infections in hospitalized children. Pediatr Infect Dis J. 2020;39(6):489-93.  https://doi.org/10.1097/INF.0000000000002610  PMID: 32091502 
  19. Tran D, Vaudry W, Moore D, Bettinger JA, Halperin SA, Scheifele DW, et al. Hospitalization for Influenza A Versus B. Pediatrics. 2016;138(3):e20154643.  https://doi.org/10.1542/peds.2015-4643  PMID: 27535144 
  20. Peltola V, Ziegler T, Ruuskanen O. Influenza A and B virus infections in children. Clin Infect Dis. 2003;36(3):299-305.  https://doi.org/10.1086/345909  PMID: 12539071 
  21. Rebolledo J, Igoe D, O’Donnell J, Domegan L, Boland M, Freyne B, et al. Influenza in hospitalized children in Ireland in the pandemic period and the 2010/2011 season: risk factors for paediatric intensive-care-unit admission. Epidemiol Infect. 2014;142(9):1826-35.  https://doi.org/10.1017/S0950268813002732  PMID: 24229618 
  22. Caini S, Kroneman M, Wiegers T, El Guerche-Séblain C, Paget J. Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: A systematic literature review. Influenza Other Respir Viruses. 2018;12(6):780-92.  https://doi.org/10.1111/irv.12575  PMID: 29858537 
  23. Hauge SH, Bakken IJ, de Blasio BF, Håberg SE. Risk conditions in children hospitalized with influenza in Norway, 2017-2019. BMC Infect Dis. 2020;20(1):769.  https://doi.org/10.1186/s12879-020-05486-6  PMID: 33076855 
  24. Keren R, Zaoutis TE, Bridges CB, Herrera G, Watson BM, Wheeler AB, et al. Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA. 2005;294(17):2188-94.  https://doi.org/10.1001/jama.294.17.2188  PMID: 16264160 
  25. Azziz-Baumgartner E, Duca LM, González R, Calvo A, Kaydos-Daniels SC, Olson N, et al. Incidence of respiratory virus illness and hospitalizations in a Panama and El Salvador birth cohort, 2014-2018. Lancet Reg Health Am. 2022;13:100304.  https://doi.org/10.1016/j.lana.2022.100304  PMID: 36189114 
  26. 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 
  27. Lagare A, Maïnassara HB, Issaka B, Sidiki A, Tempia S. Viral and bacterial etiology of severe acute respiratory illness among children < 5 years of age without influenza in Niger. BMC Infect Dis. 2015;15(1):515.  https://doi.org/10.1186/s12879-015-1251-y  PMID: 26567015 
  28. Jartti T, Lehtinen P, Vuorinen T, Osterback R, van den Hoogen B, Osterhaus AD, et al. Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis. 2004;10(6):1095-101.  https://doi.org/10.3201/eid1006.030629  PMID: 15207063 
  29. Hardelid P, Verfuerden M, McMenamin J, Gilbert R. Risk factors for admission to hospital with laboratory-confirmed influenza in young children: birth cohort study. Eur Respir J. 2017;50(3):1700489.  https://doi.org/10.1183/13993003.00489-2017  PMID: 28954782 
  30. Zaman K, Roy E, Arifeen SE, Rahman M, Raqib R, Wilson E, et al. Effectiveness of maternal influenza immunization in mothers and infants. N Engl J Med. 2008;359(15):1555-64.  https://doi.org/10.1056/NEJMoa0708630  PMID: 18799552 
  31. World Health Organisation (WHO). End-to-end integration of SARS-CoV-2 and influenza sentinel surveillance: revised interim guidance. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Integrated_sentinel_surveillance-2022.1
  32. World Health Organisation Regional Office for Europe (WHO/Europe), European Centre for Disease Prevention and Control (ECDC). Operational considerations for respiratory virus surveillance in Europe. Copenhagen: WHO/Europe and Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/operational-considerations-respiratory-virus-surveillance-europe
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