Usefulness of multiplex PCR methods and respiratory viruses’ distribution in children below 15 years old according to age, seasons and clinical units in France: A 3 years retrospective study

Abstract

BackgroundTo date, only influenza and RSV testing are recommended for respiratory viruses’ detection in paediatric units. In this study, we described, according to seasons, ages and clinical units, the results obtained in children (<15 years old) by multiplex-PCR (mPCR) tests allowing a quick and wide range detection of all respiratory viruses. These results were also compared with RSV specific detection.MethodsAll nasopharyngeal mPCR and RSV tests requested by clinicians in our French teaching hospitals group between 2011 and 2014 were retrospectively included. All repeated samples for the same children in the same month were discarded.ResultsOf the 381 mPCR tests (344 children) performed, 51.4% were positive. Positivity and viral co-infection rates were higher in the 6–36 months old strata (81% and 25%, p<0.0001 and p = 0.04, respectively). Viral distribution showed strong variations across ages. During specific influenza epidemic periods, only 1/39 (2.5%) mPCR tests were positive for influenza and 19/39 (48.7%) for other viruses. During specific RSV epidemic periods, only 8/46 (17.4%) mPCR tests were positive for RSV and 14/46 (30.4%) for other viruses. 477/1529 (31.2%) of RSV immunochromatography-tests were positive. Among the negatives immunochromatography-test also explored by mPCR, 28/62 (31%) were positive for other respiratory viruses.ConclusionThis study provides a wide description of respiratory viruses’ distribution among children in hospital settings using mPCR over 3 years. It emphasizes the number of undiagnosed respiratory viruses according to the current diagnosis practice in France and gives a better picture of respiratory viruses identified in hospital settings by mPCR all over the year in France.

Epidemiology and seasonality of acute respiratory infections in hospitalized children over four consecutive years (2012–2016)

“…Our present results emphasized the great variations in the positivity rate and viral distribution from one age group to another, and confirmed some of previous observations made in France [10] whereby very young children (under the age of 1 month) had lower positivity and viral coinfection rates than older children. However, the picornaviruses (EVs/hRVs) were most frequent in all age groups.…”

“…The application of new multiplex PCR assays has provided new insights into the epidemiology of viral respiratory infections in children and adults [9][10][11][12][13]. However, some situations have yet to be characterized.…”

Prevalence of respiratory viruses among adults, by season, age, respiratory tract region and type of medical unit in Paris, France, from 2011 to 2016

“…Many aspects of the burden of respiratory viruses in hospital settings remain to be investigated. In pediatric populations, in which respiratory virus pathogenicity has been well demonstrated for some viral groups, rapid mPCR assays have been shown to improve the detection of respiratory viruses and to decrease the time required to obtain results, thereby making it possible to decrease the duration of antibiotic treatment or the time spent in the emergency department [25,48]. In adults, evidence for the pathogenicity of respiratory viruses is increasingly evidenced [6,[19][20][21][22][23], but antibiotic treatment is often continued after positive PCR tests for viruses, even with a normal chest radiography; further studies and new recommendations are therefore required today [49].…”

Evaluation of national guidelines for bronchiolitis: AGREEments and controversies

“…In addition to inconsistencies in the evidence, there are some further limitations to these guidelines. PREDICT focuses on the outcomes of hospital admission, length of stay, intensive care admission and death but does not discuss other clinically relevant outcomes such as the reduction of interventions, including antibiotic use, chest radiography and blood and urine investigations, which may represent a potential benefit of routine viral testing . A recent meta‐analysis demonstrated that the use of rapid viral testing in acute respiratory illness in children reduced the rate of chest radiography, while the evidence was not conclusive regarding the reduction of other invasive investigations or antibiotics, and further research is needed .…”

“…In particular, recent progress on RSV vaccines emphasises the need for better characterisation of the burden of RSV disease in Australia to support assessment of their possible cost‐effectiveness in the future . Finally, routine viral testing may have a role in the surveillance of emerging respiratory epidemics of public health importance …”