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. 2014 Jun 19;9(6):e99419.
doi: 10.1371/journal.pone.0099419. eCollection 2014.

Viral etiologies of hospitalized acute lower respiratory infection patients in China, 2009-2013

Luzhao Feng  1 , Zhongjie Li  1 , Shiwen Zhao  2 , Harish Nair  3 , Shengjie Lai  1 , Wenbo Xu  4 , Mengfeng Li  5 , Jianguo Wu  6 , Lili Ren  7 , Wei Liu  8 , Zhenghong Yuan  9 , Yu Chen  10 , Xinhua Wang  11 , Zhuo Zhao  12 , Honglong Zhang  1 , Fu Li  5 , Xianfei Ye  9 , Sa Li  1 , Daniel Feikin  13 , Hongjie Yu  1 , Weizhong Yang  1
Affiliations

Viral etiologies of hospitalized acute lower respiratory infection patients in China, 2009-2013

Luzhao Feng et al. PLoS One. .

Abstract

Background: Acute lower respiratory infections (ALRIs) are an important cause of acute illnesses and mortality worldwide and in China. However, a large-scale study on the prevalence of viral infections across multiple provinces and seasons has not been previously reported from China. Here, we aimed to identify the viral etiologies associated with ALRIs from 22 Chinese provinces.

Methods and findings: Active surveillance for hospitalized ALRI patients in 108 sentinel hospitals in 24 provinces of China was conducted from January 2009-September 2013. We enrolled hospitalized all-age patients with ALRI, and collected respiratory specimens, blood or serum collected for diagnostic testing for respiratory syncytial virus (RSV), human influenza virus, adenoviruses (ADV), human parainfluenza virus (PIV), human metapneumovirus (hMPV), human coronavirus (hCoV) and human bocavirus (hBoV). We included 28,369 ALRI patients from 81 (of the 108) sentinel hospitals in 22 (of the 24) provinces, and 10,387 (36.6%) were positive for at least one etiology. The most frequently detected virus was RSV (9.9%), followed by influenza (6.6%), PIV (4.8%), ADV (3.4%), hBoV (1.9), hMPV (1.5%) and hCoV (1.4%). Co-detections were found in 7.2% of patients. RSV was the most common etiology (17.0%) in young children aged <2 years. Influenza viruses were the main cause of the ALRIs in adults and elderly. PIV, hBoV, hMPV and ADV infections were more frequent in children, while hCoV infection was distributed evenly in all-age. There were clear seasonal peaks for RSV, influenza, PIV, hBoV and hMPV infections.

Conclusions: Our findings could serve as robust evidence for public health authorities in drawing up further plans to prevent and control ALRIs associated with viral pathogens. RSV is common in young children and prevention measures could have large public health impact. Influenza was most common in adults and influenza vaccination should be implemented on a wider scale in China.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Enrollment of 28,369 hospitalized patients with acute lower respiratory infection tested for seven virus etiologies from January 1, 2009 to September 30, 2013 in China.
Figure 2
Figure 2. Location of 81 surveillance hospitals for hospitalized acute lower respiratory infection patients.
The red dots indicate the location of the surveillance hospitals. A total of 81 hospitals in 22 provinces participate in acute lower respiratory infection surveillance for final analysis. The box indicates Spratly Islands in Southern China Sea.
Figure 3
Figure 3. Average proportions of viral etiologies for hospitalized acute lower respiratory infection patients in 2009–2013 by age group.
Figure 4
Figure 4. Proportion of viral etiologies for hospitalized acute lower respiratory infection patients by year.
A) RSV. B) Influenza. C) PIV. D) ADV. E) hBoV. F) hMPV. Panel G) hCoV. H) Co-detection.
Figure 5
Figure 5. Number and percentage of patients positive by viral etiology.
A) RSV. B) Influenza. C) PIV. D) ADV. E) hBoV. F) hMPV. G) hCoV. H) Co-detection.
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