Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe-results from the PED-MERMAIDS multicentre case-control study.
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Kohns Vasconcelos Malte, Loens Katherine, Sigfrid Louise, Iosifidis Elias, Epalza Cristina, Donà Daniele, Matheeussen Veerle, Papachristou Savvas, Roilides Emmanuel, Gijon Manuel, Rojo Pablo, Minotti Chiara, Da Dalt Liviana, Islam Samsul, Jarvis Jessica, Syggelou Aggeliki, Tsolia Maria, Nyirenda Nyang'wa Maggie, Keers Sophie, Renk Hanna, Gemmel Anna-Lena, D'Amore Carmen, Ciofi Degli Atti Marta, Rodríguez-Tenreiro Sánchez Carmen, Martinón-Torres Federico, Burokienė Sigita, Goetghebuer Tessa, Spoulou Vana, Riordan Andrew, Calvo Cristina, Gkentzi Despoina, Hufnagel Markus, Openshaw Peter J, de Jong Menno D, Koopmans Marion, Goossens Herman, Ieven Margareta, Fraaij Pieter L A, Giaquinto Carlo, Bielicki Julia A, Horby Peter, Sharland Michael
Аннотация
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.