Age-dependent Interactions Among Clinical Characteristics, Viral Loads and Disease Severity in Young Children With Respiratory Syncytial Virus Infection

Abstract

Background: Age-dependent differences in clinical presentation and viral loads in infants and young children with respiratory syncytial virus (RSV) infection, and their correlation with disease severity are poorly defined. Methods: Previously healthy children <2 years old with mild (outpatients) and severe (inpatients) RSV infection were enrolled and viral loads measured by polymerase chain reaction in nasopharyngeal swabs. Patients were stratified by age in 0–<3, 3–6 and >6–24 months, and multivariable analyses were performed to identify clinical and viral factors associated with severe disease. Results: From 2014 to 2018, we enrolled 534 children with RSV infection, 130 outpatients with mild RSV infection and 404 inpatients with severe RSV disease. Median duration of illness was 4 days for both groups, yet viral loads were higher in outpatients than in inpatients (P < 0.001). In bivariate analyses, wheezing was more frequent in outpatients of older age (>3 months) than in inpatients (P < 0.01), while fever was more common in inpatients than outpatients (P < 0.01) and its frequency increased with age. Adjusted analyses confirmed that increased work of breathing and fever were consistently associated with hospitalization irrespective of age, while wheezing in infants >3 months, and higher RSV loads in children >6–24 months were independently associated with reduced disease severity. Conclusions: Age had a significant impact defining the interactions among viral loads, specific clinical manifestations and disease severity in children with RSV infection. These observations highlight the importance of patient stratification when evaluating interventions against RSV.

Diagnosis and clinical significance of Human bocavirus 1 in children hospitalized for lower acute respiratory infection: molecular detection in respiratory secretions and serum

“…Regarding the clinical diagnosis, HBoV1 single detection in RS was linked to bronchiolitis and pneumonia (Tables 2 and 3), in agreement with previously published reports ⁠ [12, 52–55]⁠. In general, frequent clinical signs and symptoms of HBoV1 infection are similar to those associated with other common respiratory viral agents [56, 57]⁠, with cough and rhinitis as remarkable features of single HBoV1 infection ().…”

Respiratory syncytial virus and SARS‐CoV‐2 coinfections in children

“…Despite the limitations of the small sample size and single‐center experience, we found that the rates of RSV/SARS‐CoV‐2 coinfections were lower than that expected based on previous experience with endemic coronaviruses, which typically range from 8% to 12%, 5 suggesting the possibility of viral interference. In fact, before the COVID‐19 pandemic endemic coronaviruses have been the second most common codetected viruses in infants with RSV‐LRTI.…”

“…Two children had underlying comorbidities, a 9-monthold born at 29 weeks of gestation and with no additional risk factors (in Group 2), and a healthy 3-month-old born at 36 weeks of gestation (in Group 3). We found that 62.5% of children in Despite the limitations of the small sample size and single-center experience, we found that the rates of RSV/SARS-CoV-2 coinfections were lower than that expected based on previous experience with endemic coronaviruses, which typically range from 8% to 12%, 5 suggesting the possibility of viral interference. In fact, before the COVID-19 pandemic endemic coronaviruses have been the second most common codetected viruses in infants with RSV-LRTI.…”

Clinical characteristics of children with omicron SARS-CoV-2 infection in Changchun, China from march to april 2022: A retrospective study

“…In addition, our data also demonstrated that there was no significant difference in clinical types among age groups. In general, unlike other respiratory viral infections (such as respiratory syncytial virus) ( 19 ), the SARS-COV-2 infection in children has no age-dependent distribution. Interestingly, a previous study demonstrated that children aged 6 through 15 years had a longer persistence of viral genome in nasopharyngeal samples ( 20 ).…”