Association of respiratory viruses with outcomes of severe childhood pneumonia in Botswana.

TitleAssociation of respiratory viruses with outcomes of severe childhood pneumonia in Botswana.
Publication TypeJournal Article
Year of Publication2015
AuthorsKelly MS, Smieja M, Luinstra K, Wirth KE, Goldfarb DM, Steenhoff AP, Arscott-Mills T, Cunningham CK, Boiditswe S, Sethomo W, Shah SS, Finalle R, Feemster KA
JournalPLoS One
Volume10
Issue5
Paginatione0126593
Date Published2015
ISSN1932-6203
Abstract

BACKGROUND: The highest incidence of childhood acute lower respiratory tract infection (ALRI) is in low- and middle-income countries. Few studies examined whether detection of respiratory viruses predicts ALRI outcomes in these settings.

METHODS: We conducted prospective cohort and case-control studies of children 1-23 months of age in Botswana. Cases met clinical criteria for pneumonia and were recruited within six hours of presentation to a referral hospital. Controls were children without pneumonia matched to cases by primary care clinic and date of enrollment. Nasopharyngeal specimens were tested for respiratory viruses using polymerase chain reaction. We compared detection rates of specific viruses in matched case-control pairs. We examined the effect of respiratory syncytial virus (RSV) and other respiratory viruses on pneumonia outcomes.

RESULTS: Between April 2012 and August 2014, we enrolled 310 cases, of which 133 had matched controls. Median ages of cases and controls were 6.1 and 6.4 months, respectively. One or more viruses were detected from 75% of cases and 34% of controls. RSV and human metapneumovirus were more frequent among cases than controls, but only enterovirus/rhinovirus was detected from asymptomatic controls. Compared with non-RSV viruses, RSV was associated with an increased risk of treatment failure at 48 hours [risk ratio (RR): 1.85; 95% confidence interval (CI): 1.20, 2.84], more days of respiratory support [mean difference (MD): 1.26 days; 95% CI: 0.30, 2.22 days], and longer duration of hospitalization [MD: 1.35 days; 95% CI: 0.20, 2.50 days], but lower in-hospital mortality [RR: 0.09; 95% CI: 0.01, 0.80] in children with pneumonia.

CONCLUSIONS: Respiratory viruses were detected from most children hospitalized with ALRI in Botswana, but only RSV and human metapneumovirus were more frequent than among children without ALRI. Detection of RSV from children with ALRI predicted a protracted illness course but lower mortality compared with non-RSV viruses.

DOI10.1371/journal.pone.0126593
Alternate JournalPLoS ONE
PubMed ID25973924
PubMed Central IDPMC4431806
Grant ListP30 AI045008 / AI / NIAID NIH HHS / United States
P30 AI064518 / AI / NIAID NIH HHS / United States
P30-AI045008 / AI / NIAID NIH HHS / United States
P30-AI064518 / AI / NIAID NIH HHS / United States
T32 HD060558 / HD / NICHD NIH HHS / United States
T32 HD060558 / HD / NICHD NIH HHS / United States