Differences in clinical severity of respiratory viral infections in hospitalized children

Althouse, Benjamin M.; Flasche, Stefan; Toizumi, Michiko; Nguyen, Hien-Anh Thi; Vo, Hien Minh; Le, Minh Nhat; Hashizume, Masahiro; Ariyoshi, Koya; Anh, Dang Duc; Rodgers, Gail L.; Klugman, Keith P.; Hu, Hao; Yoshida, Lay-Myint

It is uncertain whether clinical severity of an infection varies by pathogen or by multiple infections. Using hospital-based surveillance in children, we investigate the range of clinical severity for patients singly, multiply, and not infected with a group of commonly circulating viruses in Nha Trang, Vietnam. RT-PCR was performed to detect 13 respiratory viruses in nasopharyngeal samples from enrolled patients. We apply a novel clinical severity score and examine associations with the odds of being severe and differences in raw severity scores. We find no difference in severity between 0-, 1-, and 2-concurrent infections and little differences in severity between specific viruses. We find RSV and HMPV infections to be associated with 2- and 1.5-fold increase in odds of being severe, respectively, and that infection with ADV is consistently associated with lower risk of severity. Clinically, based on the results here, if RSV or HMPV virus is suspected, PCR testing for confirmatory diagnosis and for detection of multiple coinfecting viruses would be fruitful to assess whether a patient’s disease course is going to be severe.