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Lee, Lee, Ha, Sheen, Sung, Jung, Lee, Jee, and Han: Prevalence of respiratory virus infection with regard to age, sex, and seasonality factors: A single center experience against children hospitalized during the 10 years

Abstract

Purpose

It is well known that respiratory viral infection has epidemiological characteristics, including season. This study aimed to investigate the patterns of the prevalence of common respiratory viruses during a period of 10 years with regard to age, sex, and season in Korean children.

Methods

From June 2006 to November 2016, we obtained 11,798 specimens from patients aged less than 18 years who were admitted with lower respiratory infections. Ten respiratory viruses were detected using multiplex reverse transcription-polymerase chain reaction.

Results

Of 11,798 specimens, at least 1 virus was detected in 4,845 (41.1%). Respiratory syncytial virus (RSV, 18.9%) was the most common virus detected, followed by human rhinovirus (HRV, 14.8%), adenovirus (9.5%), and human bocavirus (HBoV, 7.4%). The detection rate of HRV was higher in male subjects (male 60.0% vs. female 40.0%, P=0.004), but the other viruses had no significant differences with regard to sex. The subjects who were positive for RSV test were youngest (median, 10.5 months; interquartile range, 3.0–25.0 months), followed by human coronavirus (median, 13.0 months), HRV (median, 14 months), and parainfluenza (median, 14 months). HBoV was most commonly detected in spring (29.3%), enterovirus in summer (25.8%), HRV in fall (22.6%), and RSV in October and winter (22.6%).

Conclusion

We found that the prevalence of respiratory viruses in Korean children during a period of 10 years was associated with age, sex, and season when the infection occurred. Further nationwide data is warranted to infer clinical implication of our results.

Figures and Tables

Fig. 1

Distribution of age groups for each respiratory viruses. ADV, adenovirus; IFV A, influenza virus A; IFV B, influenza virus B; hMPV, human metapneumovirus; HRV, human rhinovirus; HCoV, human coronavirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus; HBoV, human bocavirus; HEV, human enterovirus.

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Table 1

Detection rate of respiratory viruses and sex distribution of total 11,798 patients hospitalized during the study period

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Respiratory virus No. of subjects Positive cases, n (%) Sex, n (%)
Male Female P-value
RSV 11,798 2,230 (18.9) 1,303 (58.4) 927 (41.6) 0.058
Rhinovirus 9,497 1,409 (14.8) 845 (60.0) 564 (40.0) 0.004*
Adenovirus 11,798 1,124 (9.5) 634 (56.4) 490 (43.6) 0.869
Bocavirus 2,858 212 (7.4) 123 (58.0) 89 (42.0) 0.429
Parainfl 11,798 830 (7.0) 496 (59.8) 334 (40.2) 0.060
Influenza A viruss 11,798 626 (5.3) 366 (58.5) 260 (41.5) 0.342
Enterovirus 2,858 131 (4.6) 73 (55.7) 58 (44.3) 0.943
Metapneumovirus 11,798 493 (4.2) 286 (58.0) 207 (42.0) 0.529
Coronavirus 5,159 133 (2.6) 80 (60.2) 53 (39.8) 0.356
Influenza B virus 11,798 129 (1.1) 80 (62.0) 49 (38.0) 0.215
Total 11,798 4,845 (41.1) 2,822 (58.3) 2,023 (41.8) 0.003*

*P<0.05, statistically significant. Percentage of males and females in subjects who were tested positive for each virus by polymerase chain reaction test.

Table 2

Monthly incidence of respiratory virus isolation

aard-5-320-i002
Season Month No. Positive cases, n (%) Positive cases of respiratory viruses, n (%)
ADV IFV A IFV B hMPV HRV HCoV PIV RSV HBoV HEV
Spring Mar 900 332 (36.9) 56 (6.2) 50 (5.6) 62 (6.9)* 82 (9.1) 103 (14.8) 11 (2.5) 18 (2.0) 110 (12.2) 28 (11.5) 0 (0)
Apr 1,224 428 (35.0) 130 (10.6) 95 (7.8) 46 (3.8) 188 (15.4)* 164 (14.8) 13 (2.5) 84 (6.9) 75 (6.1) 66 (25.3) 2 (0.8)
May 1,166 424 (36.3) 161 (13.8) 36 (3.1) 4 (0.3) 109 (9.3) 186 (19.9) 12 (2.6) 223 (19.1)* 37 (3.2) 68 (29.3)* 12 (5.2)
Summer Jun 756 262 (34.7) 93 (12.3) 6 (0.8) 0 (0) 30 (4.0) 123 (20.0) 10 (3.1) 141 (18.7) 7 (0.9) 20 (11.3) 23 (13)
Jul 635 219 (34.5) 43 (6.8) 3 (0.5) 1 (0.2) 12 (1.9) 104 (20.4) 3 (1.0) 102 (16.1) 16 (2.5) 2 (1.1) 48 (25.8)*
Aug 782 221 (28.3) 137 (17.5)* 3 (0.4) 0 (0) 4 (0.5) 73 (11.9) 2 (0.5) 76 (9.7) 37 (0.7) 4 (1.6) 21 (8.6)
Fall Sep 996 263 (26.5) 137 (13.8) 21 (2.1) 0 (0) 4 (0.4) 120 (15.8) 2 (0.5) 67 (6.7) 97 (9.7) 0 (0) 6 (3.0)
Oct 1,198 514 (42.9) 114 (9.5) 48 (4.0) 0 (0) 11 (0.9) 207 (22.3)* 12 (1.9) 59 (4.9) 271 (22.6) 9 (2.5) 13 (3.6)
Nov 1,357 725 (53.4) 98 (7.2) 89 (6.6) 0 (0) 5 (0.4) 121 (11.9) 12 (1.8) 30 (2.2) 555 (40.9) 2 (0.6) 5 (1.5)
Winter Dev 1,050 580 (55.3) 54 (5.1) 55 (5.2) 1 (0.1) 2 (0.2) 97 (9.8) 26 (7.4)* 10 (1.0) 477 (45.4)* 1 (0.4) 0 (0)
Jan 967 533 (55.1) 67 (6.9) 128 (13.2)* 5 (0.5) 15 (1.6) 58 (7.2) 22 (6.6) 9 (0.9) 347 (35.9) 5 (2.9) 0 (0)
Feb 767 342 (44.6) 34 (4.4) 92 (12.0)* 10 (1.3) 31 (4.0) 53 (8.1) 8 (2.9) 11 (1.4) 201 (26.2) 7 (4.3) 1 (0.6)
Total 11,798 4,118 (34.9) 1,124 (9.5) 626 (5.3) 129 (1.1) 493 (4.2) 1,409 (14.8) 133 (2.6) 830 (7.0) 2,230 (18.9) 212 (7.4) 131 (4.6)

Numbers in parenthesis is the positive percentage of each viruses.

No., number of respiratory aspirations collected; ADV, adenovirus; IFV A, influenza virus A; IFV B, influenza virus B; hMPV, human metapneumovirus; HRV, human rhinovirus; HCoV, human coronavirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus; HBoV, human bocavirus; HEV, human enterovirus.

*Month when the prevalence of disease caused by respiratory virus was highest. Month when the isolation of respiratory virus was highest. Month when the number of collected samples were highest.

Table 3

Positive rate of respiratory viruses in each age group

aard-5-320-i003
Age (yr) Positive, % Positive rate of respiratory viruses, %
ADV IFV A IFV B hMPV HRV HCoV PIV RSV HBoV HEV
<1 43.4 5.4 3.7 0.6 4.2 15.3* 3.6 7.3 24.5* 6.0 5.3
1 45.2 12.0* 5.1 0.8 5.4 16.3* 3.4 10.2* 19.2* 16.5* 4.2
2 43.1 15.4* 4.3 1.6 6.4 16.7* 2.4 8.5 17.4* 9.6 5.9
3–4 36.6 15.0* 6.4 2.1 4.0 13.0* 0.9 4.9 12.6* 4.1 4.8
5–7 34.6 9.4 10.1* 1.4 1.2 12.4* 1.9 3.0 11.4* 2.0 3.8
8–17 26.3 5.3 9.1 1.7 0.4 9.7 0.6 1.6 8.1 1.4 0.9
Total 41.1 9.5 5.3 1.1 4.2 14.8 2.6 6.5 18.9 7.4 4.6

Total of positive rates may be smaller than the sum of positive rate of each virus due to coinfection.

ADV, adenovirus; IFV A, influenza virus A; IFV B, influenza virus B; hMPV, human metapneumovirus; HRV, human rhinovirus; HCoV, human coronavirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus; HBoV, human bocavirus; HEV, human enterovirus.

*Positive rate of 10% and above.

Table 4

Annual number of the respiratory viruses isolated from children with acute respiratory tract infection

aard-5-320-i004
Year No. Positive cases, n (%) Positive cases of respiratory viruses, n (%)
ADV IFV A IFV B hMPV HRV HCoV PIV RSV HBoV HEV
2006 607 182 (30.0) 14 (2.3) 2 (0.3) 0 (0) 0 (0) - 10 (1.6) 47 (7.7) 129 (21.3) - -
2007 1,303 319 (24.5) 136 (10.4) 51 (3.9) 1 (0.1) 73 (5.6) - 15 (1.2) 104 (8.0) 152 (11.7) - -
2008 853 366 (42.9) 27 (3.2) 34 (4.1) 24 (2.8) 16 (1.9) 41 (8.9) 12 (3.1) 45 (5.3) 254 (29.8) - -
2009 1,503 708 (47.1) 151 (10.0) 324 (21.6) 0 (0) 73 (4.9) 239 (15.8) - 131 (8.7) 316 (21.0) - -
2010 654 347 (53.7)* 48 (7.3) 47 (7.2) 8 (1.2) 25 (3.8) 81 (12.4) - 31 (4.7) 283 (43.3) - -
2011 367 146 (39.8) 8 (2.2) 15 (4.1) 1 (0.3) 14 (3.8) 51 (13.9) - 22 (6.0) 109 (29.7) - -
2012 414 210 (50.7)* 20 (4.8) 26 (6.3) 5 (1.2) 16 (3.9) 39 (9.4) - 29 (7.0) 154 (37.2) - -
2013 652 258 (39.6) 50 (7.7) 12 (1.8) 0 (0) 16 (2.5) 52 (8.0) - 36 (5.5) 211 (32.4) - -
2014 1,438 431 (30.0) 37 (2.6) 5 (0.3) 1 (0.1) 83 (5.8) 105 (7.3) - 96 (6.7) 334 (23.2) - -
2015 1,809 582 (32.2) 122 (6.7) 49 (27) 15 (0.8) 79 (4.4) 310 (17.1) 27 (4.1) 146 (8.1) 228 (12.6) 8 (1.2) 15 (2.3)
2016 2,198 1,290 (58.7)* 511 (23.2) 61 (2.8) 74 (3.4) 98 (4.5) 492 (22.4) 69 (3.1) 143 (6.5) 60 (2.7) 204 (9.3) 116 (5.3)
Total, % 34.9 9.5 5.3 1.1 4.2 14.8 2.6 7.0 18.9 7.4 4.6

ADV, adenovirus; IFV A, influenza virus A; IFV B, influenza virus B; hMPV, human metapneumovirus; HRV, human rhinovirus; HCoV, human coronavirus; PIV, parainfluenza virus; RSV, respiratory syncytial virus; HBoV, human bocavirus; HEV, human enterovirus.

*Year when the isolation of respiratory virus were highest. Year when the prevalence of disease caused by respiratory virus were highest.

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Man Yong Han
https://orcid.org/0000-0002-9077-5779

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