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Indian Pediatr 2015;52: 339-340 |
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Respiratory Syncytial Virus in Children with
Influenza-like Illness
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Mahima Sahu, Bhupesh K Kori, Lalit Sahare and *Pradip V
Barde
Regional Medical
Research Centre for Tribals (RMRCT), Indian Council of Medical Research
(ICMR), Nagpur Road, Garha, Jabalpur, Madhya Pradesh, India.
*[email protected]
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Respiratory Syncytial Virus (RSV) is a major cause of acute respiratory
tract infection among children. It is documented that by age of three
years, virtually all children are infected by RSV, and re-infection
occurs throughout life [1]. The World Health Organization (WHO)
estimates global RSV burden as 64 million cases and about 160,000 deaths
annually [2]. The clinical presentation of RSV and influenza is similar,
but the antiviral treatment is different. This study aimed to detect the
positivity for RSV in hospitalized children ( ≤2
years) suspected of influenza-A (H1N1) pdm 09 infection during the 2009
influenza pandemic.
The samples (throat swab, nasopharyngeal swab or lung
aspirates) were referred to Virus Research and Diagnostic Laboratory of
Regional Medical Research Centre for Tribals, Jabalpur, India following
the Government of India guidelines [3]. A total of 2549 samples (Oct
2009-Dec 2012) consisting of 398 (16%) samples of age group
≤2 years were
received and processed for diagnosis of influenza by WHO recommended qRT-PCR
[4]. Part of the samples was stored at -70ºC. From the aforesaid age
group, 54 (14%) samples were found to be positive for Influenza A. From
remaining 344 samples, 75 cases were randomly selected for RSV testing.
Viral RNA extraction was done (Qiagen, Germany) followed by RT-PCR as
described by Stockton, et al. [5] with minor modifications. The
study was approved by our Centre’s ethical committee.
Table I Distribution of RSV Cases By Age
Age group |
Tested for RSV
|
Positive for RSV |
³01 mo
|
9 |
2 (RSV-A=2; RSV-B=0) |
02-06 mo
|
23 |
13 (RSV-A=12; RSV-B=1) |
07-12 mo
|
20 |
7 (RSV-A=6; RSV-B=1) |
13-24 mo
|
23 |
11(RSV-A=5; RSV-B=6) |
Total |
75 |
33 (RSV-A=25; RSV-B=8) |
RSV-Respiratory syncytial virus. |
Out of 75 samples, 33 (44%) were positive for RSV, of
which 25 (76%) and 8 (24%) were positive for RSV-A and RSV-B,
respectively (Table I). There was no significant
difference observed in clinical features (fever, cough, sore throat,
nasal catarrh, shortness of breath, and pneumonia and/or pneumonia like
symptoms) of RSV and Influenza. Studies from developing countries have
reported that RSV is responsible for 27-96% of hospitalized cases of
acute respiratory tract infections, and it has higher positivity than
any other respiratory virus in pediatric age group [6-8]. When RSV
positivity was compared with contemporary Influenza A positivity, the
children ( ≤2
years) were at significantly higher risk of RSV (p<0.001). During
the recent Influenza A (H1N1) pdm09 pandemic, majority of severe cases
with influenza like illness might have been labelled and treated for
influenza, though most of the children (≤2
years) probably had RSV infection. Oseltamivir that was used as a
frontline antiviral drug for Influenza A (H1N1) pdm09 has known
psychological and neuropsychiatric side-effects in children, and has
also been shown to prolong RSV shedding [9]. We suggest that samples
from age group ≤2
years in children with influenza like illness should be tested
simultaneously for RSV in order to rationalize antiviral treatment.
Acknowledgement: The Director, RMRCT for her
support and encouragement.
Contributors: PVB, MS: conceived the idea and
designed the study; MS, LS: sample processing, RT-PCRs and real time
RT-PCRs; PVB, BKK, MS: data analysis; PVB, MS, BKK: prepared the
manuscript. All authors approved the final manuscript.
Funding: The Director General, ICMR, DHR, MoH and
FW, Government of India, under the Viral Diagnostic Network Project (No.
VIR/43/2011-ECD-1).
Competing interests: None stated.
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