Clinical characterisation and phylogeny of respiratory syncytial virus infection in hospitalised children at Red Cross War Memorial Children’s Hospital, Cape Town

摘要

Background Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting. Methods The clinical presentation, patient and phylogenetic characteristicsof laboratory-confirmed cases of RSV, as well as risk factors for nosocomial infectionat Red Cross War Memorial Children’s Hospital in Cape Town were analysed. A multiplex PCR assay that detects 7 respiratory viruses was used to identify RSV nucleic acid on respiratory specimens. Results A total of 226 children were studied, ages ranging between 1?week and 92.5?months (median: 2.8?months, IQR: 1.3–6.3?months) and 51.8?% were males. The median duration of symptoms prior to diagnosis was 2?days (IQR: 1–4 days). Nosocomial infections wereidentified in 22 (9.7?%) children. There were pre-existing medical conditions in 113 (50.0?%) excluding HIV, most commonly prematurity ( n =?58, 50.0?%) and congenital heart disease ( n =?34, 29.3?%). The commonest presenting symptoms were cough (196, 86.7?%), difficulty in breathing (115, 50.9?%) and fever (91, 41.6?%).A case fatality rate of 0.9?% was recorded. RSV group A predominated ( n =?181, 80.1?%) while group B accounted for only 45 (19.9?%) of the infections. The prevalent genotypes were NA1 ( n =?127,70.1?%), ON1 ( n =?45,24.9?%) and NA2 ( n =?9,5.0?%) for group A while the only circulating RSV B genotype was BA4. There was no significant difference in the genotype distribution between the nosocomial and community-acquired RSV infections. Age?≥?6?months was independently associated with nosocomial infection. Conclusions A large percentage of children with RSV infection had pre-existing conditions. Approximately one tenth of the infections were nosocomial with age 6?months or older being a risk factor. Though both RSV groups co-circulated during the season, group A was predominant and included the novel ON1 genotype. Continued surveillance is necessary to identify prevalent and newly emerging genotypes ahead of vaccine development and efficacy studies.