brazjinfectdis2017;21(4):486–488
w w w . e l s e v ie r . c o m / l o c a t e / b j i d
The
Brazilian
Journal
of
INFECTIOUS
DISEASES
Letter
to
the
Editor
Epidemiological
characteristics
of
seven
respiratory
viruses
among
pediatric
patients
with
acute
respiratory
tract
infections
from
2011
to
2015
in
Dongguan,
Southern
China
DearEditor,
Respiratoryvirusesarethemajorputativeagentsininfants andchildrenwithacuterespiratorytractinfections(ARTIs). Theprevalenceandclinicalcharacteristicsofacuterespiratory tractinfectionsamongchildreninChinahavebeenpreviously reported.However,thosesurveyswereconductedmostlyin developedcities, such asBeijing,1 Shanghai,2 Guangzhou,3 and Shenzhen.4 Limited data on pediatric patients with variousrespiratoryviruseswereavailableinmediumor small-sized cities in China. This study aims to determine the epidemiological characteristics ofsevenrespiratory viruses (including Influenza A virus, InfA; Influenza B virus, InfB; Respiratory syncytial virus, RSV; Adenovirus, ADV; Parain-fluenzavirustype1/2/3,PIV1/2/3)amongchildren(0–14years old)presentingwithARTIsbetweenJune2011andSeptember 2015inDongguan,southernChina.
Inthestudy,atotalof8031samplesfromnasopharyngeal swabswerecollectedfrom childrenwithARTIsatthe Chil-dren’sHospitalofDongguan.ARTIswerediagnosedaccording totheChinese guidelines.Thisstudy wasapprovedbythe Ethics Committee of Children’s Hospital of Dongguan. All patients’parentsprovidedwritteninformedconsent.Seven respiratoryvirusesweretestedbyusingD3UltraDFA
Respira-toryVirusScreening&IDKit,Ohio,USA.Allprocedureswere conductedinaccordancewiththemanufactures’manual.
Ofthe8031enrolledpatients, 1867(23.2%)werepositive foratleastonevirus,and otherchildrenwithARTIsmight havebeeninfectedbyotherrespiratory virusesor microor-ganisms,suchasmycoplasma,chlamydiaandbacteria,which werenottestedinourstudy.Thepositiverateoftheseven respiratoryviruses washigher than thatreported in Shen-zhen(4346/30,443,14.3%)4andWuhan(5194/39,756,13.1%),5 butlowerthanpositivityratefoundinGuangzhou(1482/4242, 34.9%).3 Thediscrepancy mightbe duetodifferent sample size,varied climate,geographic location, and sensitivityof differentdetectionmethods.
RSV (11.8%, 949/8031)wasthe mostfrequently detected virus causing ARTIs in this study, which was frequently
identified amongchildrenless than two years old,notably less than six monthsofage (Table 1). Thiswas consistent with previous domestic and foreign studies. RSV infection occurredthroughouttheyear,butthehigh-incidenceperiod wasfromwintertospringandfromsummertoautumninour study.TheseasonalchangesaffectingtheprevalenceofRSV infection weresimilartothatinGuangzhou,3 butwere dif-ferentfromBeijing(winter),1Shanghai(winter),2andWuhan (winter).5Thesefindingssuggestthatseasonaldistributionof RSVinfectionmightbeassociatedtogeographiclocationsand meteorology.
Influenzaviruswasthesecondmostfrequentlydiscovered pathogen, includingInfA (3.76%, 302/8031)andInfB (1.86%, 149/8031),withtheinfectionratesincreasingwithage(from 0to14years)(Table1).Theresultswereconcordantwiththe previousstudyinGuangzhou.3Interestingly,theseasonal dis-tributionofInfAinfectionwasdifferentfromInfBinfectionin thecurrentstudy.InfAwasfrequentlydetectedinspringand summer,whereasInfBwasmostlydetectedinwinter(Fig.1A). TheseasonaldistributionofInfAinfectionwasslightly differ-entfromotherstudiesinShenzhen4andShanghai.2
Atotalof177(2.2%)ADVinfectedpatientshadbeen iden-tified,whichwasmostfrequentlydetectedinpatientsaged 3–5years(Table1).Theagedistributionwasnotinlinewith thatreportedinShenzhen(peakage1–3years)4andShanghai (peakage>6years).2Thesedifferencesmighthavebeendue tothedistributionofdifferentADVserotypesinabovecities. Additionally,theseasonaldistributionofADVinfectionwas notobvious andsometimesdiagnosedthroughoutthe year (Fig.1B),whichwasconsistentwithastudyfromGuangzhou,3 butwasdifferentfromreportsfromShenzhen(winter)4and Wuhan(springandwinter).5
Therewere309childreninfectedwithPIVs,includingPIV1 (0.9%,69/8031),PIV2(0.2%,14/8031)andPIV3(2.8%,226/8031), which were mostly found in children aged 7–12 months (Table1).ThiswasdifferentfromstudiesinGuangzhou(peak age3–6months)3andWuhan(peakage3–6years).5Duetothe limitednumberofPIV1andPIV2infectionsinthisstudy,their seasonaldistributionswereunclear.PIV3infectionoccurred
brazj infect dis.2017;21(4):486–488
487
Table1–Pathogenpositivityratesamongpatientsindifferentagegroups.
Pathogens 0–3m (n=1110) 4–6m (n=767) 7–12m (n=1116) 1–2y (n=2330) 3–5y (n=1805) 6–10y (n=788) 11–14y (n=115) p-Value InfA 19(1.7%) 12(1.6%) 26(2.5%) 109(4.7%) 84(4.7%) 44(5.6%) 8(7.0%) <0.001 InfB 3(0.3%) 4(0.6%) 10(0.9%) 31(1.3%) 46(2.5%) 46(5.8%) 9(7.8%) <0.001 RSV 236(21.3%) 176(22.9%) 174(15.6%) 270(11.6%) 88(4.9%) 4(0.5%) 1(0.9%) <0.001 ADV 3(0.3%) 4(0.5%) 13(1.2%) 48(2.1%) 86(4.8%) 23(2.9%) 0(0%) <0.001 PIV1 4(0.4%) 4(0.5%) 7(0.6%) 41(1.8%) 12(0.7%) 1(0.1%) 0(0%) <0.001 PIV2 0(0%) 2(0.3%) 2(0.2%) 3(0.1%) 7(0.4%) 0(0%) 0(0%) 0.182 PIV3 27(2.4%) 23(3.0%) 60(5.4%) 93(4.0%) 19(1.1%) 2(0.3%) 2(1.7%) <0.001 40% 35% 30% 25% 20% 15% 10% 5% 0% Ju n Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec 40% 35% 30% 25% 20% 15% 10% 5% 0% 40% 35% 30% 25% 20% 15% 10% 5% 0% 2015 2014 2013 Time (year/month) Inf A Inf B RSV ADV PIV1 PIV2 PIV3 2012 2011 Ju n Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec 2015 2014 2013 Time (year/month) P o sitiv e r a te , % P ositiv e r a te , % P ositiv e r a te , % 2012 2011 Ju n Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Ju n Ja n Fe b Mar Apr Ma y Ju l Au g Sep Oct No v Dec 2015 2014 2013 Time (year/month) 2012 2011
A
B
C
Fig.1–Seasonaldistributionofthesevenrespiratoryvirusesin8031childrenwithARTIsinDongguanfromJune2011to September2015.(A)SeasonaldistributionofFluAandFluB.(B)SeasonaldistributionofRSVandADV.(C)Seasonal distributionofPIV1-3.
488
braz j infect dis.2017;21(4):486–488nearlythroughouttheyear,andtheseasonalpeakwassimilar toRSVinfection.
Additionally, ourresultsshowedthat co-infectionswere relatively uncommon in Dongguan, detected only 1.02% (19/1867). It could be attributed to the limited number of pathogensincludedinthestudy andthe lackofsensitivity ofDFAmethodcomparingwithPCRmethod.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgments
ThisworkwassupportedbytheNaturalScienceFoundation of Guangdong Province (Project Number: 2015A030313803), the Dongguan Bureau of Science and Technology for the CityKey ProgramofScienceandTechnology(Project Num-ber:2014108101028)andtheDongguanBureauofScienceand TechnologyfortheCityKeyProgramofScienceand Technol-ogy(ProjectNumber:2013108101017). Wealsothankallthe childrenand theirparentsfortheircooperationduringthis work.
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MingyuXiea,b,1,QiangMaa,b,1,XiuyingChena,b, XiaomeiLua,b,∗, BaimaoZhonga,b,∗
aGuangdongMedicalUniversity,Children’sHospitalofDongguan,
DepartmentofPediatricInfectiousDiseases,Dongguan,China
bDongguan Institute of Pediatrics, Department of Medical and
MolecularGenetics,Dongguan,China
∗Correspondingauthors.
E-mailaddresses:lxm020@126.com(X.Lu),zbomao@163.com (B.Zhong).
1Theseauthorscontributedequallytothiswork.
Received19November2016 Accepted16December2016 Availableonline23February2017 1413-8670/
©2017SociedadeBrasileiradeInfectologia.Publishedby ElsevierEditoraLtda.Thisisanopenaccessarticleunderthe CCBY-NC-NDlicense(http://creativecommons.org/licenses/ by-nc-nd/4.0/).
