BMJ Open Respiratory Research (Aug 2021)
Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe—results from the PED-MERMAIDS multicentre case–control study
- Cristina Calvo,
- Andrew Riordan,
- Liviana Da Dalt,
- Federico Martinón-Torres,
- Peter Horby,
- Julia A Bielicki,
- Maria Tsolia,
- Michael Sharland,
- Herman Goossens,
- Marion Koopmans,
- Despoina Gkentzi,
- Peter J Openshaw,
- Menno D de Jong,
- Elias Iosifidis,
- Emmanuel Roilides,
- Carlo Giaquinto,
- Louise Sigfrid,
- Margareta Ieven,
- Malte Kohns Vasconcelos,
- Pablo Rojo,
- Cristina Epalza,
- Sigita Burokiene,
- Hanna Renk,
- Samsul Islam,
- Vana Spoulou,
- Katherine Loens,
- Daniele Donà,
- Veerle Matheeussen,
- Savvas Papachristou,
- Manuel Gijon,
- Chiara Minotti,
- Jessica Jarvis,
- Aggeliki Syggelou,
- Maggie Nyirenda Nyang’wa,
- Sophie Keers,
- Anna-Lena Gemmel,
- Carmen D’Amore,
- Marta Ciofi degli Atti,
- Carmen Rodríguez-Tenreiro Sánchez,
- Tessa Goetghebuer,
- Markus Hufnagel,
- Pieter L A Fraaij
Affiliations
- Cristina Calvo
- Paediatrics and Infectious Diseases Department, La Paz University Hospital, Madrid, Spain
- Andrew Riordan
- Department of Paediatric Infectious Diseases, Alder Hey Children's Hospital, Liverpool, UK
- Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
- Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain
- Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George’s, University of London, London, UK
- Maria Tsolia
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children’s Hospital, Athens, Greece
- Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George’s, University of London, London, UK
- Herman Goossens
- Medical Microbiology, Vaccine and Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Marion Koopmans
- Department of Viroscience, ErasmusMC, Rotterdam, The Netherlands
- Despoina Gkentzi
- Department of Paediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
- Peter J Openshaw
- National Heart and Lung Division, Faculty of Medicine, Imperial College London, London, UK
- Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands
- Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University Hospital of Padua, Padova, Italy
- Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George’s, University of London, London, UK
- Pablo Rojo
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Sigita Burokiene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
- Samsul Islam
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George’s, University of London, London, UK
- Vana Spoulou
- st Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, Agia Sophia Children’s Hospital of Athens, Athens, Greece
- Katherine Loens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium
- Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University Hospital of Padua, Padova, Italy
- Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium
- Savvas Papachristou
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Manuel Gijon
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Chiara Minotti
- Division of Paediatric Infectious Diseases, Department of Women’s and Children’s Health, University Hospital of Padua, Padova, Italy
- Jessica Jarvis
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George’s, University of London, London, UK
- Aggeliki Syggelou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children’s Hospital, Athens, Greece
- Maggie Nyirenda Nyang’wa
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
- Sophie Keers
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
- Anna-Lena Gemmel
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
- Carmen D’Amore
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
- Marta Ciofi degli Atti
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
- Carmen Rodríguez-Tenreiro Sánchez
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain
- Tessa Goetghebuer
- Department of Paediatrics, St-Pierre Hospital Brussels, Brussels, Belgium
- Markus Hufnagel
- Division of Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
- Pieter L A Fraaij
- Sophia Children’s Hospital, ErasmusMC, Rotterdam, The Netherlands
- DOI
- https://doi.org/10.1136/bmjresp-2021-000887
- Journal volume & issue
-
Vol. 8,
no. 1
Abstract
Background Both pathogenic bacteria and viruses are frequently detected in the nasopharynx (NP) of children in the absence of acute respiratory infection (ARI) symptoms. The aim of this study was to estimate the aetiological fractions for ARI hospitalisation in children for respiratory syncytial virus (RSV) and influenza virus and to determine whether detection of specific respiratory pathogens on NP samples was associated with ARI hospitalisation.Methods 349 children up to 5 years of age hospitalised for ARI (following a symptom-based case definition) and 306 hospital controls were prospectively enrolled in 16 centres across seven European Union countries between 2016 and 2019. Admission day NP swabs were analysed by multiplex PCR for 25 targets.Results RSV was the leading single cause of ARI hospitalisations, with an overall population attributable fraction (PAF) of 33.4% and high seasonality as well as preponderance in younger children. Detection of RSV on NP swabs was strongly associated with ARI hospitalisation (OR adjusted for age and season: 20.6, 95% CI: 9.4 to 45.3). Detection of three other viral pathogens showed strong associations with ARI hospitalisation: influenza viruses had an adjusted OR of 6.1 (95% CI: 2.5 to 14.9), parainfluenza viruses (PIVs) an adjusted OR of 4.6 (95% CI: 1.8 to 11.3) and metapneumoviruses an adjusted OR of 4.5 (95% CI: 1.3 to 16.1). Influenza viruses had a PAF of 7.9%, PIVs of 6.5% and metapneumoviruses of 3.0%. In contrast, most other pathogens were found in similar proportions in cases and controls, including Streptococcus pneumoniae, which was weakly associated with case status, and endemic coronaviruses.Conclusion RSV is the predominant cause of ARI hospitalisations in young children in Europe and its detection, as well as detection of influenza virus, PIV or metapneumovirus, on NP swabs can establish aetiology with high probability. PAFs for RSV and influenza virus are highly seasonal and age dependent.
