Dong Keon Yon; Chae-Yeon Min; Eun Kyo Ha; Hye Mi Jee; Young-Ho Jung; Kyung Suk Lee; Youn Ho Sheen; Man Yong Han

doi:10.4168/aard.2018.6.2.110

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Yon, Min, Ha, Jee, Jung, Lee, Sheen, and Han: Clinical characteristics and genetic variation in respiratory syncytial virus isolated from infants hospitalized due to acute bronchiolitis in Korea during winter season 2016–2017

Original Article

Allergy Asthma Respir Dis 2018;6(2):110-115.

Published online: 5 March 2018

DOI: https://doi.org/10.4168/aard.2018.6.2.110

Clinical characteristics and genetic variation in respiratory syncytial virus isolated from infants hospitalized due to acute bronchiolitis in Korea during winter season 2016–2017

Dong Keon Yon¹, Chae-Yeon Min¹, Eun Kyo Ha¹, Hye Mi Jee¹, Young-Ho Jung¹, Kyung Suk Lee¹, Youn Ho Sheen², Man Yong Han¹

¹Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

²Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea

Correspondence to: Man Yong Han https://orcid.org/0000-0002-9077-5779 Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: +82-31-780-6262, Fax : +82-31-780-5239, E-mail: drmesh@gmail.com

• The study included the genetic data analyses as consultation from the Korea Centers for Disease Control and Prevention.

Received 11 July 201721 September 2017 Accepted 28 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Circulating patterns of predominant respiratory syncytial virus (RSV) genotypes in the community may be helpful in understanding molecular epidemiology and predicting future outbreaks of the RSV genotype. We investigated the association of genetic variations in RSV with acute severe bronchiolitis in infants.

Methods

We reviewed medical records of infants younger than 1 year of age hospitalized due to acute bronchiolitis between November 2016 and February 2017. Subjects were classified as severe or mild based on the use of mechanical or noninvasive ventilation. The associations between severity of the disease, sex, age at admission, oxygen saturation at admission and laboratory test results were analyzed. RSV sequence analysis was performed in the severe group.

Results

Among 114 infants, 80 underwent respiratory viral polymerase chain reaction using nasopharyngeal swab; of these, 53 (66.3%) showed positive for RSV. Of the 53 RSV-positive samples, 9 were categorized as the severe group and 44 were categorized as the mild group. Male sex, young age, longer duration of admission, minimum SaO2 at admission and bronchiolitis severity score were significantly correlated with disease severity in the severe group than in the mild group (all variables, P<0.001). Phylogenetic and sequence analysis in the severe group revealed 8 RSV-A, ON1 genotype and 1 RSV-B, BA4 genotype.

Conclusion

Phylogenetic types of RSV in subjects of the severe group were RSV-A, ON1 genotype or RSV-B, BA4 genotype which were prevalent in the Korean community at the same time. Our study showed that disease severity was not significantly associated with RSV genotypic evolution or antigenic drift in Korea during winter season 2016–17.

Keywords: Respiratory syncytial virus, Genotype, Phylogenetic analysis, Bronchiolitis, Severity

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Fig. 1.

Phylogenetic analysis of the RSV-A/RSV-B strains using partial G protein sequences and reference sequences of identified genotypes. All cases are classified into RSV-A, ON1 genotype (n=8) and RSV-B, BA4 genotype (n=1) that are currently circulatin. RSV, respiratory syncytial virus.

Table 1.

Demographic characteristics of the study subjects

Characteristic	Group		P-value
Characteristic	Mild (n=44)	Severe (n=9)	P-value
Age (mo)	2.5 (0.5–4.8)	1.0 (1.0–2.0)	0.011∗
Length of admission (day)	3.0 (2.3–4.0)	6.0 (4.0–10.0)	<0.001∗
Male sex, n (%)	23 (52)	9 (100)	<0.001∗
Minimum SaO2 at admission (%)	98.0 (97.0–99.0)	83.0 (80.0–92.5)	<0.001∗
BSS	6.0 (5.0–7.0)	13.0 (11.0–14.0)	<0.001∗
VBGA pH	7.37 (7.35–7.42)	7.28 (7.13–7.32)	<0.001∗
VBGA pCO₂ (mmHg)	40.8 (35.1–45.6)	62.3 (54.6–95.0)	<0.001∗
VBGA HCO3 (mmol/L)	23.5 (20.9–24.8)	28.2 (25.5–31.2)	<0.001∗
WBCs at admission (×10³/mm³)	11.0 (9.09–13.2)	8.1 (7.79–10.1)	0.086
Hemoglobin at admission (g/dL)	11.7 (10.9–12.3)	10.8 (9.8–12.0)	0.128
C-reactive protein at admission (mg/dL)	0.4 (0.0–0.97)	0.3 (0.13–0.52)	0.935

Values are presented as median (interquartile range) unless otherwise indicated.

BSS, bronchiolitis severity score; VBGA, venous blood gas analysis; WBC, white blood cell.

^∗ P<0.05.

Table 2.

Clinical characteristics of the study subjects in the severe group

Case	Sex	Age (day)	Length of admission (day)	Minimum SaO2 at admission (%)	BSS	Initial VBGA (pH–pCO2∗–HCO3^#)	Ventilator mode	RSV (type/genotype)	Complications
1	Male	24	9	94	12	7.17–97.4–34.9	Invasive	A/ON1	None
2	Male	39	12	8	16	6.73–164.8–21.1	Invasive	A/ON1	Mild hypoxic encephalopathy
3	Male	44	6	70	13	7.08–92.6–26.9	Invasive	A/ON1	None
4	Male	47	11	91	11	7.23–80.1–32.9	Invasive	B/BA4	None
5	Male	54	6	93	14	7.31–59.5–29.4	HFNC	A/ON1	None
6	Male	59	4	92	7	7.32–51.6–26.5	HFNC	A/ON1	None
7	Male	70	6	90	14	7.31–57.6–28.5	HFNC	A/ON1	None
8	Male	71	6	90	11	7.28–62.3–28.2	nCPAP	A/ON1	None
9	Male	87	4	90	13	7.36–44.4–24.5	HFNC	A/ON1	None

BSS, bronchiolitis severity score; VBGA, venous blood gas analysis; RSV, respiratory syncytial virus; HFNC, heated humidified high flow nasal cannula therapy; nCPAP, nasal continuous positive airway pressure.

^∗ pCO₂, mmHg.

^# HCO₃, mmol/L.

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