Characterisation of acute respiratory infections at a United Kingdom paediatric teaching hospital: observational study assessing the impact of influenza A (2009 pdmH1N1) on predominant viral pathogens

BMC Infectious Diseases

Paul S McNamara⁸  Malcolm Guiver⁶  Kent Thorburn⁷  Alison Timmis⁵  Gareth Howel³  Fiona Hardiman¹  Christine Gerrard¹  Enitan D Carrol²  Emily A Lees⁴ 

[1] Microbiology Department, Alder Hey Children’s NHS Foundation Trust Hospital, Eaton Road, Liverpool L12 2AP, England;Institute of Infection and Global Health, University of Liverpool, The Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, England;Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, England;Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, England;Department of Paediatrics, Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL, England;Molecular Diagnostics Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WZ, England;Paediatric Intensive Care Unit, Alder Hey Children’s NHS Foundation Trust Hospital, Eaton Road, Liverpool L12 2AP, England;Institute of Child Health, Alder Hey Children’s NHS Foundation Trust Hospital, Eaton Road, Liverpool L12 2AP, England

关键词: Co-morbidities;    Virology;    Paediatrics;    Influenza;    H1N1;   

Others  :  1127511
DOI  :  10.1186/1471-2334-14-343

 received in 2013-08-20, accepted in 2014-06-09,  发布年份 2014

【 摘 要 】

Background

According to the World Health Organisation, influenza A (2009 pdmH1N1) has moved into the post-pandemic phase, but there were still high numbers of infections occurring in the United Kingdom in 2010-11. It is therefore important to examine the burden of acute respiratory infections at a large children’s hospital to determine pathogen prevalence, occurrence of co-infection, prevalence of co-morbidities and diagnostic yield of sampling methods.

Methods

This was a retrospective study of respiratory virus aetiology in acute admissions to a paediatric teaching hospital in the North West of England between 1st April 2010 and 31st March 2011. Respiratory samples were analysed either with a rapid RSV test if the patient had symptoms suggestive of bronchiolitis, followed by multiplex PCR testing for ten respiratory viruses, or with multiplex PCR testing alone if the patient had suspected other ARI. Patient demographics and data regarding severity of illness, presence of co-morbidities and respiratory virus sampling method were retrieved from case notes.

Results

645 patients were admitted during the study period. 82/645 (12.7%) patients were positive for 2009 pdmH1N1, of whom 24 (29.2%) required PICU admission, with 7.3% mortality rate. Viral co-infection occurred in 48/645 (7.4%) patients and was not associated with more severe disease. Co-morbidities were present more frequently in older children, but there was no significant difference in prevalence of co-morbidity between 2009 pdmH1N1 patients and those with other ARI. NPA samples had the highest diagnostic yield with 192/210 (91.4%) samples yielding an organism.

Conclusions

Influenza A (2009 pdmH1N1) is an ongoing cause of occasionally severe disease affecting both healthy children and those with co-morbidities. Surveillance of viral pathogens provides valuable information on patterns of disease.

【 授权许可】

   
2014 Lees et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]World Health Organisation: Global Action Plan for Prevention and Control of Pneumonia (GAPP). November 2009. Available from: http://whqlibdoc.who.int/hq/2009/WHO_FCH_CAH_NCH_09.04_eng.pdf?ua=1 webcite
• [2]Pebody RG, McLean E, Zhao H, Cleary P, Bracebridge S, Foster K, Charlett A, Hardelid P, Waight P, Ellis J, Bermingham A, Zambon M, Evans B, Salmon R, McMenamin J, Smyth B, Catchpole M, Watson JM: Pandemic Influenza A (H1N1) 2009 and mortality in the United Kingdom: risk factors for death, April 2009 to March 2010. Euro Surveill 2010., 15(20)
• [3]Bosely S: Swine flu response was £1.2 billion well spent, review finds. Guardian[Internet]. 1 July 2010; Available from: http://www.guardian.co.uk/world/2010/jul/01/swine-flu-response-review-gsk webcite
• [4]Chan M: H1N1 in post-pandemic period. World Health Organiz 2010. Available from: http://www.who.int/mediacentre/news/statements/2010/h1n1_vpc_20100810/en/ webcite
• [5]Health Protection Agency: National Influenza Weekly Reports Archive (Update November 3rd 2011). Available from: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1222154877315 webcite
• [6]Alder Hey Children’s NHS Foundation Trust hospital website Available from: http://www.alderhey.nhs.uk webcite
• [7]Aitken C, Jeffries DJ: Nosocomial spread of viral disease. Clin Microbiol Rev 2001, 14(3):528-546.
• [8]Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DA: Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis 2009, 5:291-300.
• [9]Degail MA, Hughes GJ, Maule C, Holmes C, Lilley M, Pebody R, Bonnet J, Bermingham A, Bracebridge S: A human metapneumovirus outbreak at a community hospital in England, July to September 2010. Euro Surveill 2012., 17(15)
• [10]World Health Organisation: CDC protocol of realtime RTPCR for influenza A (H1N1) (revision 2). 2009. Available from: http://www.who.int/csr/resources/publications/swineflu/realtimeptpcr/en/ webcite
• [11]Maertzdorf J, Wang CK, Brown JB, Quinto JD, Chu M, De Graaf M, van den Hoogen BG, Spaete R, Osterhaus AD, Fouchier RA: Real-time reverse transcriptase PCR assay for detection of human metapneumoviruses from all known genetic lineages. J Clin Microbiol 2004, 42(3):981-986.
• [12]Scheltinga SA, Templeton KE, Beersma MF, Claas EC: Diagnosis of human metapneumovirus and rhinovirus in patients with respiratory tract infections by an internally controlled multiplex real-time RNA PCR. J Clin Virol 2005, 33(4):306-311.
• [13]Hackett S, Hill L, Patel J, Ratnaraja N, Ifeyinwa A, Farooqi M, Nusgen U, Debenham P, Gandhi D, Makwana M, Smit E, Welch S: Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet 2009, 374(9690):605.
• [14]Jouvet P, Hutchison J, Pinto R, Menon K, Rodin R, Choong K, Kesselman M, Veroukis S, Andre Dugas M, Santschi M, Guerguerian AM, Withington D, Alsaati B, Joffe AR, Drews T, Skippen P, Rolland E, Kumar A, Fowler R, Canadian Critical Care Trials Group H1N1 Collaborative: Critical illness in children with influenza A/pH1N1 2009 infection in Canada. Pediatr Crit Care Med 2010, 11(5):603-609.
• [15]Calitri C, Gabiano C, Garazzino S, Pinon M, Zoppo M, Cuozzo M, Scolfaro C, Tovo PA: Clinical features of hospitalised children with 2009 H1N1 influenza virus infection. Eur J Pediatr 2010, 169(12):1511-1515.
• [16]Lister P, Reynolds F, Parslow R, Chan A, Cooper M, Plunkett A, Riphagen S, Peters M: Swine-origin influenza virus H1N1, seasonal influenza virus, and critical illness in children. Lancet 2009, 374(9690):605-607.
• [17]Sachedina N, Donaldson LJ: Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study. Lancet 2010, 376(9755):1846-1852.
• [18]Ercole A, Menon DK, O’Donnell DR: Modelling the impact of pandemic influenza A(H1N1) on UK paediatric intensive care demand. Arch Dis Child 2009, 94(12):962-964.
• [19]Libster R, Bugna J, Coviello S, Hijano DR, Dunaiewsky M, Reynoso N, Cavalieri M, Guglielmo M, Areso S, Gilligan T, Santucho F, Cabral G, Gregorio GL, Moreno R, Lutz MI, Panigasi AL, Saligari L, Caballero MT, Egües Almeida RM, Gutierrez Meyer ME, Neder MD, Davenport MC, Del Valle MP, Santidrian VS, Mosca G, Garcia Domínguez M, Alvarez L, Landa P, Pota A, Boloñati N, et al.: Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med 2010, 362(1):45-55.
• [20]McNamara PS, Van Doorn R: Chapter 23 - Respiratory Viruses. In Manson’s Tropical Diseases. 23rd edition. Edited by Cook G. London: Elsevier; 2012.
• [21]Bezerra PG, Britto MC, Correia JB, Duarte Mdo C, Fonceca AM, Rose K, Hopkins MJ, Cuevas LE, McNamara PS: Viral and atypical bacterial detection in acute respiratory infection in children under five years. PLoS One 2011, 6(4):e18928.
• [22]Tregoning JS, Schwarze J: Respiratory viral infections in infants: causes, clinical symptoms, virology, and immunology. Clin Microbiol Rev 2010, 23(1):74-98.
• [23]Calvo C, Pozo F, Garcia-Garcia ML, Sanchez M, Lopez-Valero M, Perez-Brena P, Casas I: Detection of new respiratory viruses in hospitalized infants with bronchiolitis: a three-year prospective study. Acta Paediatr 2010, 99(6):883-887.
• [24]Chan KH, Peiris JS, Lim W, Nicholls JM, Chiu SS: Comparison of nasopharyngeal flocked swabs and aspirates for rapid diagnosis of respiratory viruses in children. J Clin Virol 2008, 42(1):65-69.
• [25]de la Tabla VO, Masia M, Antequera P, Martin C, Gazquez G, Bunuel F, Gutierrez F: Comparison of combined nose-throat swabs with nasopharyngeal aspirates for detection of pandemic influenza A/H1N1 2009 virus by real-time reverse transcriptase PCR. J Clin Microbiol 2010, 48(10):3492-3495.