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. 2019 Jan;13(1):36-43.
doi: 10.1111/irv.12606. Epub 2018 Oct 16.

"Differential risk of hospitalization among single virus infections causing influenza-like illnesses"

Ana A Ortiz-Hernández  1 , Katherine K Nishimura  2 , Daniel E Noyola  3 , Sarbelio Moreno-Espinosa  4 , Ana Gamiño  4 , Arturo Galindo-Fraga  5 , Rafael Valdéz Vázquez  6 , Martín Magaña Aquino  7 , Alejandra Ramirez-Venegas  8 , Raydel Valdés Salgado  9 , Diana Andrade-Platas  1 , Juliana Estevez-Jimenéz  1 , Guillermo M Ruiz-Palacios  5 , Maria Lourdes Guerrero  5 , John Beigel  10 , Mary C Smolskis  2 , Sally Hunsberger  2 , Laura Freimanis-Hence  9 , Beatriz Llamosas-Gallardo  1 ; Mexico Emerging Infectious Diseases Clinical Research Network (La Red)
Affiliations

"Differential risk of hospitalization among single virus infections causing influenza-like illnesses"

Ana A Ortiz-Hernández et al. Influenza Other Respir Viruses. 2019 Jan.

Abstract

Background: Acute respiratory infections are a major cause of morbidity in children and are often caused by viruses. However, the relative severity of illness associated with different viruses is unclear. The objective of this study was to evaluate the risk of hospitalization from different viruses in children presenting with an influenza-like illness (ILI).

Methods: Data from children 5 years old or younger participating in an ILI natural history study from April 2010 to March 2014 was analyzed. The adjusted odds ratio for hospitalization was estimated in children with infections caused by respiratory syncytial virus (RSV), metapneumovirus, bocavirus, parainfluenza viruses, rhinovirus/enterovirus, coronavirus, adenovirus, and influenza.

Results: A total of 1486 children (408 outpatients and 1078 inpatients) were included in this analysis. At least one virus was detected in 1227 (82.6%) patients. The most frequent viruses detected as single pathogens were RSV (n = 286), rhinovirus/enterovirus (n = 251), parainfluenza viruses (n = 104), and influenza A or B (n = 99). After controlling for potential confounders (age, sex, recruitment site, days from symptom onset to enrollment, and underlying illnesses), children with RSV and metapneumovirus infections showed a greater likelihood of hospitalization than those infected by parainfluenza viruses (OR 2.7 and 1.9, respectively), rhinovirus/enterovirus (OR 3.1 and 2.1, respectively), coronaviruses (OR 4.9 and 3.4, respectively), adenovirus (OR 4.6 and 3.2, respectively), and influenza (OR 6.3 and 4.4, respectively).

Conclusions: Children presenting with ILI caused by RSV and metapneumovirus were at greatest risk for hospitalization, while children with rhinovirus/enterovirus, parainfluenza, coronavirus, adenovirus, and influenza were at lower risk of hospitalization.

Keywords: acute respiratory infection; hospitalization; influenza-like illness; single virus.

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Figures

Figure 1
Figure 1
Proportion of patients ≤5 y of age with ILI that required hospitalization or were treated as outpatients, according to etiology. Only children with single viral infections are included
Figure 2
Figure 2
Pairwise comparisons for the likelihood of requiring hospitalization in children ≤5 y of age with ILI caused by different viruses. Each panel shows the comparison between a specific virus and each of the other viruses included in the study. The adjusted odds ratios (taking into account age, sex, days from onset of symptoms, presence of underlying illness, and study site) are shown for comparisons between each pair of viruses. Statistically significant differences are shown in solid lines; nonsignificant comparisons are shown in dotted lines
See this image and copyright information in PMC

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