Skip to main content
Log in

Prospective population-based study of viral lower respiratory tract infections in children under 3 years of age (the PRI.DE study)

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Population-based incidence data from Europe on the disease burden of lower respiratory tract infections (LRTI) due to respiratory syncytial viruses (RSV), parainfluenza viruses (PIV) and influenzaviruses (IV) are lacking, especially with respect to the disease burden. In a 2-year prospective multicentre study of children aged <3 years in Germany, we registered population-based cases as outpatients (n=2386), inpatients (n=2924), and nosocomially-acquired (n=141). Nasopharyngeal secretions were tested for viral RNA. The annual incidence for physician visits per 100 children for all LRTI was 28.7, RSV 7.7, PIV 3.8 and IV 1.1. Annual hospitalisation rates per 105 children were for all LRTI 2941, RSV 1117, PIV 261 and IV 123. Annual nosocomial cases per 105 hospital days were for all LRTI 79, RSV 29, PIV 9 and IV 1.5. All five children (0.27%) who died had an underlying disease and four were nosocomially acquired. Conclusion: Hospitalisation rates due to lower respiratory tract infections in healthy children were similar to those reported elsewhere; the rates for outpatient visits were approximately ten times higher.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CI :

confidence interval

IV :

influenza virus

LOS :

length of stay

LRTI :

lower respiratory tract infection

NPS :

nasopharyngeal secretion

PIV :

parainfluenza virus

RSV :

respiratory syncytial virus

References

  1. Anestad G (1987) Surveillance of respiratory viral infections by rapid immunofluorescence diagnosis, with emphasis on virus interference. Epidemiol Infect 99: 523–531

    CAS  PubMed  Google Scholar 

  2. Behrendt CE, Decker MD, Burch DJ, Watson PH (1998) International variation in the management of infants hospitalized with respiratory syncytial virus. International RSV Study Group. Eur J Pediatr 57: 215–220

    Article  Google Scholar 

  3. Berner R, Schwoerer F, Schumacher RF, Meder M, Forster J (2001) Community and nosocomially acquired respiratory syncytial virus infection in a German paediatric hospital from 1988 to 1999. Eur J Pediatr 160: 541–547

    Article  CAS  PubMed  Google Scholar 

  4. Boyce TG, Mellen BG, Mitchel EF Jr, Wright PF, Griffin MR (2000) Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr 137: 865–870

    Article  CAS  PubMed  Google Scholar 

  5. Chiu SS, Lau YL, Chan KH, Wong WH, Peiris JS (2002) Influenza hospitalisations among children in Hong Kong. N Eng J Med 347: 2097–2103

    Article  Google Scholar 

  6. Constantopoulos AG, Kafetzis DA, Syrogiannopoulos GA, Roilides EJ, Malaka-Zafiriu EE, Sbyrakis SS, Marcopoulos ML (2002) Burden of respiratory syncytial viral infections on paediatric hospitals: a two-year prospective epidemiological study. Eur J Clin Microbiol Infect Dis 21: 102–107

    Google Scholar 

  7. Cooney MK, Fox JP, Hall CE (1975) The Seattle virus watch. VI. Observations of infections with and illness due to parainfluenza, mumps and respiratory syncytial viruses and Mycoplasma pneumoniae. Am J Epidemiol 101: 532–551

    CAS  PubMed  Google Scholar 

  8. Counihan ME, Shay DK, Holman RC, Lowther SA, Anderson LJ (2001) Human parainfluenza virus-associated hospitalizations among children less than five years of age in the United States. Pediatr Infect Dis J 20: 646–653

    Article  CAS  PubMed  Google Scholar 

  9. Denny FD, Clyde WA (1986) Acute lower respiratory tract infections in nonhospitalized children. J Pediatr 108: 635–646

    CAS  PubMed  Google Scholar 

  10. Duppenthaler A, Gorgievski-Hrisoho M, Frey U, Aebi C (2003) Two-year periodicity of respiratory syncytial virus epidemics in Switzerland. Infection 31: 75–80

    CAS  PubMed  Google Scholar 

  11. Eriksson M, Bennet R, Rotzen-Ostlund M, von Sydow M, Wirgart BZ (2002) Population-based rates of severe respiratory syncytial virus infection in children with and without risk factors and outcome in a tertiary care setting. Acta Paediatr 91: 593–598

    Article  CAS  PubMed  Google Scholar 

  12. Glezen WP, Paredes A, Allison JE, Taber LH, Frank AL (1981) Risk of respiratory syncytial virus infection for infants from low-income families in relationship to age, sex, ethnic group, and maternal antibody level. J Pediatr 98: 708–15

    CAS  PubMed  Google Scholar 

  13. Glezen WP, Keitel WA, Taber LH, Piedra PA, Clover RD, Couch RB (1991) Age distribution of patients with medically-attended illnesses caused by sequential variants of influenza A/H1N1: comparison to age-specific infection rates, 1978–1989. Am J Epidemiol 133: 296–304

    CAS  PubMed  Google Scholar 

  14. Hall CB (2000) Nosocomial respiratory syncytial virus infections: the “Cold War” has not ended. Clin Infect Dis 31: 590–596

    Google Scholar 

  15. Henrickson KJ (2003) Parainfluenzaviruses. Clin Microbiol Rev 16: 242–264

    Article  CAS  PubMed  Google Scholar 

  16. Hindiyeh M, Hillyard DR, Carroll KC (2001) Evaluation of the Prodesse Hexaplex multiplex PCR assay for direct detection of seven respiratory viruses in clinical specimens. Am J Clin Pathol 116: 218–224

    Article  CAS  PubMed  Google Scholar 

  17. Holmes NR, Ni Bhrolchain CM (2002) Case mix presenting to paediatricians in a UK district (1998). Public Health 116: 179–183

    CAS  PubMed  Google Scholar 

  18. Howard TS, Hoffman LH, Stang PE, Simoes EA (2000) Respiratory syncytial virus pneumonia in the hospital setting: length of stay, charges, and mortality. J Pediatr 137: 227–232

    Article  CAS  PubMed  Google Scholar 

  19. Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, Black S, Shinefield H, Fukuda K (2000) Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 342: 232–239

    Article  CAS  PubMed  Google Scholar 

  20. Karron RA, Singleton RJ, Bulkow L, Parkinson A, Kruse D, DeSmet I, Indorf C, Petersen KM, Leombruno D, Hurlburt D, Santosham M, Harrison LH (1999) Severe respiratory syncytial virus disease in Alaska native children. RSV Alaska Study Group. J Infect Dis 180: 41–49

    Article  CAS  PubMed  Google Scholar 

  21. Kehl SC, Henrickson KJ, Hua W, Fan J (2001) Evaluation of the Hexaplex assay for detection of respiratory viruses in children. J Clin Microbiol 39: 696–701

    Google Scholar 

  22. Kleinbaum DG, Kupper LL, Morgenstern H (1983) Epidemiologic research. Wadsworth Inc., Belmont

  23. Kneyber MC, Moons KG, de Groot R, Moll HA (2002) Prediction of duration of hospitalization in respiratory syncytial virus infection. Pediatr Pulmonol 33: 453–457

    Article  PubMed  Google Scholar 

  24. Liolios L, Jenney A, Spelman D, Kotsimbos T, Catton M, Wesselingh S (2001) Comparison of a multiplex reverse transcription-PCR-enzyme hybridization assay with conventional viral culture and immunofluorescence techniques for the detection of seven viral respiratory pathogens. J Clin Microbiol 39: 2779–2783

    Google Scholar 

  25. Madge P, Paton JY, McColl JH, Mackie PLK (1992) Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory syncytial virus. Lancet 340: 1079–1083

    Article  CAS  PubMed  Google Scholar 

  26. Monto AS, Cavallaro JJ (1971) The Tecumseh study of respiratory illness. II. Patterns of occurence or infection with respiratory pathogens, 1965–1969. Am J Epidemiol 94: 280–289

    CAS  PubMed  Google Scholar 

  27. Mullooly JP, Barker WH (1982) Impact of type A influenza on children: a retrospective study. Am J Public Health 72: 1008–1016

    CAS  PubMed  Google Scholar 

  28. Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR (2000) The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 342: 225–231

    Article  CAS  PubMed  Google Scholar 

  29. Neuzil KM, Zhu Y, Griffin MR, Edwards KM, Thompson JM, Tollefson SJ, Wright P (2002) Burden of interpandemic influenza in children younger than 5 years: a 25-year prospective study. J Infect Dis 185: 147–152

    Article  PubMed  Google Scholar 

  30. Reed G, Jewett PH, Thompson J, Tollefson S, Wright PF (1997) Epidemiology and clinical impact of parainfluenza virus infections in otherwise healthy infants and young children <5 years old. J Infect Dis 175: 807–813

    CAS  PubMed  Google Scholar 

  31. Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B (2000) Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am J Respir Crit Care Med 161: 1501–1507

    CAS  PubMed  Google Scholar 

  32. Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM, Wright AL, Martinez FD (1999) Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 354: 541–545

    Article  CAS  PubMed  Google Scholar 

  33. Vainionpaa R, Hyypia T (1994) Biology of parainfluenza viruses. Clin Microbiol Rev 7: 265–275

    CAS  PubMed  Google Scholar 

  34. Wang EE, Law BJ, Stephens D, Langley JM, MacDonald NE, Robinson JL, Dobson S, McDonald J, Boucher FD, de Carvalho V, Mitchell I (1996) Study of interobserver reliability in clinical assessment of RSV lower respiratory illness: a Pediatric Investigators Collaborative Network for Infections in Canada (PICNIC) study. Pediatr Pulmonol 22: 23–27

    Article  CAS  PubMed  Google Scholar 

  35. Weigl JA, Puppe W, Grondahl B, Schmitt HJ (2000) Epidemiological investigation of nine respiratory pathogens in hospitalised children in Germany using multiplex reverse-transcriptase polymerase chain reaction. Eur J Clin Microbiol Infect Dis 19: 336–343

    Google Scholar 

  36. Weigl JA, Puppe W, Schmitt HJ (2001) Incidence of respiratory syncytial virus-positive hospitalizations in Germany. Eur J Clin Microbiol Infect Dis 20: 452–459.

    Google Scholar 

  37. Weigl JA, Puppe W, Schmitt HJ (2002) The incidence of influenza-associated hospitalizations in children in Germany. Epidemiol Infect 129: 525–533

    CAS  PubMed  Google Scholar 

  38. Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C (2002) Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infectious Diseases 2: 25–32

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the members of the PRI.DE study group for the excellent cooperation. Hospitals: M. Posselt, S. Hameister I. Kambeck, S. Ruess, M. Brandis (Freiburg); J. Bittscheidt, U. Schauer, J. Schwarze (Bochum); K. Nemat, W. Leupold (Dresden), V. Legner, and N. Alex (Hamburg). Paediatric practices: A .Neufang, W. Jonitz, I. Keefer-Hildebrand (Freiburg); U. Staemmler, C. Hoffman, D. Hirsch, E. Weber (Dresden); K. Heemann, J. Meyer, C. Simon (Bochum); H. Schloon, and H. Sontheimer (Hamburg). We thank B. Arnold (Freiburg) for data management and C. Hertling and S. Merschkötter (Wyeth, Münster) for the project management. Also many thanks are due to the patients and their parents for participation in the study. The study was supported by Wyeth Vaccines, Pearl River, USA. The Zentrum Klinische Studien (ZKS) receives funding from the BMBF (Federal Ministry of Education and Research), Germany.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Johannes Forster.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Forster, J., Ihorst, G., Rieger, C.H.L. et al. Prospective population-based study of viral lower respiratory tract infections in children under 3 years of age (the PRI.DE study). Eur J Pediatr 163, 709–716 (2004). https://doi.org/10.1007/s00431-004-1523-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-004-1523-9

Keywords

Navigation