Viral causes of severe acute respiratory infection in hospitalized children and association with outcomes: A two-year prospective surveillance study in Suriname

• Published in: PloS one 2021-02, Vol.16 (2), p.e0247000-e0247000
• Main Authors: Juliana, Amadu E, Tang, Ming-Jan, Kemps, Lex, Noort, Albert C, Hermelijn, Sandra, Plötz, Frans B, Zonneveld, Rens, Wilschut, Jan C
• Format: Article
• Language: English
• Subjects: Age; Analysis; Biology and life sciences; Body temperature; Causes of; Children; Communicable diseases in children; Congenital diseases; Demographic variables; Developing countries; Diagnosis; Economic analysis; Editing; Emergency communications systems; Fever; Health care facilities; Hemoglobin; Hydrologic data; Infections; Influenza; Laboratories; LDCs; Medical records; Medicine and Health Sciences; Microbiology; Oxygen; Oxygen content; Patient outcomes; Pediatrics; People and Places; Pneumonia; Pulse rate; Rectum; Regression analysis; Research and Analysis Methods; Respiration; Respiratory rate; Respiratory tract infection; Reviews; Saturation; Sentinel health events; Severe acute respiratory syndrome; Software; Statistical analysis; Surveillance; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0247000

Viruses are the most frequent cause of severe acute respiratory infection (SARI) in children. It is currently unknown whether presence of a virus, the number of viruses, or type of virus, are associated with clinical outcomes of pediatric SARI in developing countries. Between 2012 and 2014 nasopharyngeal swabs and demographic and clinical variables were prospectively collected for surveillance of viral causes of SARI in Surinamese children within 48 hours after hospitalization. These swabs were tested for 18 respiratory viruses using a multiplex polymerase chain reaction (PCR) panel to identify the specific viral causes of SARI, unknown to the treating physicians. In post hoc analyses we evaluated if the PCR results, and demographic and clinical characteristics, were associated with course of disease, duration of respiratory support, and length of stay (LOS). Of a total of 316 analyzed children, 290 (92%) had one or more viruses. Rhinovirus/enterovirus (43%) and respiratory syncytial virus (34%) were most prevalent. Course of disease was mild in 234 (74%), moderate in 68 (22%), and severe in 14 (4%) children. Neither presence of a single virus, multiple viruses, or the type of virus, were different between groups. Prematurity and lower weight-for-age-z-score were independent predictors of a severe course of disease, longer duration of respiratory support, and longer LOS. Viruses are common causes of pediatric SARI in Suriname, yet not necessarily associated with clinical outcomes. In developing countries, demographic and clinical variables can help to identify children at-risk for worse outcome, while PCR testing may be reserved to identify specific viruses, such as influenza, in specific patient groups or during outbreaks.