Surveillance for respiratory syncytial virus and parainfluenza virus among patients hospitalized with pneumonia in Sarawak, Malaysia

Background
Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are frequent causes of pneumonia and death among children at Sibu and Kapit Hospitals in Sarawak, Malaysia.
Objectives
To determine the prevalence and risk factors for RSV subtypes A and B and PIV types 1–4 among patients hospitalized with pneumonia.
Methods
In a cross-sectional, pilot study nasopharyngeal swabs were studied with real-time reverse transcription polymerase chain reaction assays. Concurrently, we helped Sibu and Kapit Hospitals adapt their first molecular diagnostics for RSV and PIV.
Results
Of 129 specimens collected (June to July 2017), 39 tested positive for RSV-A (30.2%), two were positive for RSV B (1.6%), one was positive for PIV-3 (0.8%) and one was positive for PIV-4 (0.8%). No samples were positive for PIV-1 or PIV-2. Of the 39 RSV-A positive specimens, 46.2% were collected from children under one year of age and only 5.1% were from patients over the age of 18. A multivariable analysis found the odds of children <1 year of age testing positive for RSV-A were 32.7 (95% CI: 3.9, 276.2) times larger than >18 years of age, and the odds of patients hospitalized at Kapit Hospital testing positive for RSV-A were 3.2 (95% CI: 1.3, 7.8) times larger than patients hospitalized at Sibu Hospital.
Conclusion
This study found an unusually high prevalence of RSV-A among pneumonia patients admitted to the two hospitals. Subsequently, Sibu Hospital adapted the molecular assays with the goal of providing more directed care for such pneumonia patients.

背景
呼吸道合胞病毒（Respiratory syncytial virus, RSV）与副流感病毒（parainfluenza virus, PIV）是马来西亚砂拉越州诗巫医院与加帛医院内儿童罹患肺炎并导致死亡的常见致病原。
研究目标
明确住院肺炎患者中呼吸道合胞病毒A、B亚型与副流感病毒1~4型的感染流行率及相关危险因素。
研究方法
本研究为横断面先导研究，采用实时逆转录聚合酶链反应（real-time reverse transcription polymerase chain reaction）技术对鼻咽拭子标本开展检测；同时协助诗巫医院与加帛医院适配其首个针对呼吸道合胞病毒与副流感病毒的分子诊断体系。
研究结果
2017年6月至7月期间共收集129份标本，其中39份呼吸道合胞病毒A亚型（RSV-A）检测呈阳性（占比30.2%），2份呼吸道合胞病毒B亚型（RSV-B）检测呈阳性（占比1.6%），1份副流感病毒3型（PIV-3）、1份副流感病毒4型（PIV-4）检测呈阳性（各占比0.8%）；未检出副流感病毒1型（PIV-1）与副流感病毒2型（PIV-2）阳性标本。在39份RSV-A阳性标本中，46.2%采集自1岁以下儿童，仅5.1%来自18岁以上患者。多变量分析显示，1岁以下儿童RSV-A检测阳性的比值比为18岁以上患者的32.7倍（95%置信区间：3.9~276.2）；加帛医院住院患者RSV-A检测阳性的比值比为诗巫医院住院患者的3.2倍（95%置信区间：1.3~7.8）。
研究结论
本研究发现两家医院收治的肺炎患者中呼吸道合胞病毒A亚型的感染流行率异常偏高。此后，诗巫医院对该分子检测方案进行优化，以期为此类肺炎患者提供更具针对性的诊疗服务。