Disease Burden of Virus-associated Lower Respiratory Tract Infections among Hospitalized Children Under Five Years of Age in Sarawak

Background Lower respiratory tract infections (LRTI) have a great impact upon young children globally, with high mortality rates. We studied the disease burden of virus-associated LRTI among hospitalized young children in Central Sarawak.

Methods This is a cross-sectional, observational study of under-five children recruited between June 2017 and May 2018 in Sibu and Kapit Hospitals. We reviewed medical records to compare the disease burden among children with nasopharyngeal swab that were positive by molecular assays for respiratory syncytial virus (RSV), Adenoviruses (AdV), Coronaviruses, Enteroviruses, Influenza or Para influenza viruses.

Results A total of 196 children with LRTI (mean age: 1.34 +/- 1.08 years) were identified. RSV was the commonest virus detected (54.1%), followed by AdV (24.0%). Compared to the others, AdV-LRTI had a statistically significant longer length of stay (10.1 days vs 7.0 days), duration for intravenous hydration (33.8 hours vs. 17.0 hours), as well as nebulization using saline (128.4 hours vs. 66.3 hours) and salbutamol (151.5 hours vs. 111.32 hours). More children with AdV infection were treated with steroids (23.4%, OR= 7.3, 95% CI: 2.52, 21.01), magnesium sulphate (46.8%, OR= 2.7, 95% CI: 1.35, 5.27), high flow nasal cannula (48.9%, OR= 2.3, 95% CI: 1.17, 4.48), being intubated (10.6%, OR= 5.8, 95% CI: 1.33, 25.25) and received antibiotics (93.6%, OR= 4.0, 95% CI: 1.17, 13.77) than children with other etiologies.

Conclusion Among under-five children with LRTI, RSV was the most prevalent viral etiological cause, but AdV infection was associated with a higher disease burden by several metrics.