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Li L, Wang H, Liu A, Chen J, Yang Y, Wang W. Age-Dependent Clinical Characteristics of Acute Lower Respiratory Infections in Young Hospitalized Children with Respiratory Syncytial Virus Infection. Infect Drug Resist 2022; 15:5971-5979. [PMID: 36262595 PMCID: PMC9576216 DOI: 10.2147/idr.s380681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Human respiratory syncytial virus (HRSV) is the most common cause of acute lower respiratory infection (LRTI) in children. The main clinical manifestations are fever, cough, wheezing, and intercostal retractions. Its age-dependent clinical characteristics remain to be defined. Objective We investigated whether HRSV caused any age-related differences in clinical manifestations of LRTI. Methods We enrolled 130 hospitalized children with LRTI caused by HRSV. These were stratified into four age groups. The main signs and symptoms and rates thereof were compared across the four age groups. Results The incidence of pneumonia was the same in all four age groups. Patients in the 1-6 months old group experienced fever and the highest body temperature ≥ 38.5°C less frequently than patients in other age groups.The frequency of fever increased with age among the patients under 24 months old. Children over 12 months old experienced less wheezing, tachypnoea, hypoxia, and intercostal retractions than children in the 1-6 months old group. Conclusion HRSV caused age-related differences in clinical manifestations of LRTI. Reduced fever responses among patients 6 months old and younger during RSV infection does not implicate less severity, wheezing, tachypnoea, hypoxia, and intercostal retractions are the main clinical manifestations, Fever responses were enhanced with advancing age among children under 24 months old.
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Affiliation(s)
- Li Li
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Heping Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Ailiang Liu
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Jiehua Chen
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Yonghong Yang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China,Microbiology Laboratory, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China,Correspondence: Yonghong Yang, Microbiology Laboratory, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China, Email
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China,Wenjian Wang, Department of Respiratory Diseases, Shenzhen Children’s Hospital, No. 7019 Yitian Road, Futian District, Shenzhen, Guangdong, People’s Republic of China, Email
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2
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Ren S, Shi T, Shan W, Shen S, Chen Q, Zhang W, Dai Z, Xue J, Zhang T, Tian J, Zhao G. Hospitalization rate of respiratory syncytial virus-associated acute lower respiratory infection among young children in Suzhou, China, 2010-2014. Influenza Other Respir Viruses 2022; 16:789-799. [PMID: 34989118 PMCID: PMC9178065 DOI: 10.1111/irv.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is a limited amount of data in China on the disease burden of respiratory syncytial virus‐ (RSV) associated acute lower respiratory infection (ALRI) among young children. This study aimed to estimate the hospitalization rate of RSV‐associated ALRI (RSV‐ALRI) among children aged 0–59 months in Suzhou, China. Methods All cases from children hospitalized with ALRI who were aged 0–59 months in Suzhou University Affiliated Children's Hospital during January 2010 to December 2014 were retrospectively identified. Detailed diagnosis and treatment data were collected by reviewing each individual's medical chart. In accordance with the World Health Organization (WHO) influenza disease burden estimation, the hospitalization rate of RSV‐ALRI among children aged 0–59 months in Suzhou, China, was then estimated. Results Out of the 28,209 ALRI cases, 19,317 (68.5%) were tested for RSV, of which the RSV positive proportion was 21.3% (4107/19,317). The average hospitalization rate of RSV‐ALRI for children aged 0–59 months was 14 (95% confidence interval [CI]:14–14)/1000 children years, and that for children aged 0–5, 6–11, 12–23, and 24–59 months were 70 (95% CI: 67–73), 31 (95% CI: 29–33), 11 (95% CI: 10–12), and 3 (95% CI: 3–3)/1000 children years, respectively. Conclusion A considerable degree of RSV‐ALRI hospitalization exists among children aged 0–59 months, particularly in those under 1 year of age. Therefore, an effective monoclonal antibody or vaccine is urgently needed to address the substantial hospitalization burden of RSV infection.
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Affiliation(s)
- Shaolong Ren
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Ting Shi
- Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Wei Shan
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Si Shen
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Qinghui Chen
- Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Wanqing Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Zirui Dai
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jian Xue
- Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jianmei Tian
- Soochow University Affiliated Children's Hospital, Suzhou, China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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3
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Havdal LB, Bøås H, Bekkevold T, Bakken Kran AM, Rojahn AE, Størdal K, Debes S, Døllner H, Nordbø SA, Barstad B, Haarr E, Fernández LV, Nakstad B, Inchley C, Flem E. Risk factors associated with severe disease in respiratory syncytial virus infected children under 5 years of age. Front Pediatr 2022; 10:1004739. [PMID: 36110112 PMCID: PMC9468371 DOI: 10.3389/fped.2022.1004739] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate risk factors for severe disease in children under 59 months of age hospitalized with respiratory syncytial virus (RSV) infection. STUDY DESIGN We prospectively enrolled 1,096 cases of laboratory confirmed RSV infection during three consecutive RSV seasons in 2015-2018. Potential risk factors for severe disease were retrieved through patient questionnaires and linkage to national health registries. Need for respiratory support (invasive ventilation, bi-level positive airway pressure, or continuous positive airway pressure), and length of stay exceeding 72 h were used as measures of disease severity. Associations were investigated using multivariable logistic regression analyses. Multiple imputation was used to avoid bias and inference induced by missing data. RESULTS Risk factors associated with a need for respiratory support included age younger than 3 months of age [aOR: 6.73 (95% CI 2.71-16.7)], having siblings [aOR: 1.65 (95% CI 1.05-2.59)] and comorbidity [aOR: 2.40 (95% CI 1.35-4.24)]. The length of hospital stay >72 h was significantly associated with being younger than 3 months of age [aOR: 3.52 (95% CI 1.65-7.54)], having siblings [aOR: 1.45 (95% CI 1.01-2.08)], and comorbidity [aOR: 2.18 (95% CI 1.31-3.61)]. Sub-group analysis of children younger than 6 months of age confirmed the association between both young age and having siblings and the need for respiratory support. CONCLUSION In a large cohort of children <59 months hospitalized with RSV infection, young age, comorbidity, and having siblings were associated with more severe disease.
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Affiliation(s)
- Lise Beier Havdal
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Håkon Bøås
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Anne-Marte Bakken Kran
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Astrid Elisabeth Rojahn
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ketil Størdal
- Department of Paediatrics, Østfold Hospital Kalnes, Grålum, Norway.,Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sara Debes
- Department of Medical Microbiology, Østfold Hospital Kalnes, Grålum, Norway
| | - Henrik Døllner
- Department of Paediatrics, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Arne Nordbø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Medical Microbiology, St. Olavs University Hospital, Trondheim, Norway
| | - Bjørn Barstad
- Department of Paediatric and Adolescent Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Elisebet Haarr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Britt Nakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christopher Inchley
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Elmira Flem
- Norwegian Institute of Public Health, Oslo, Norway
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Korsten K, Adriaenssens N, Coenen S, Butler CC, Verheij TJM, Bont LJ, Wildenbeest JG. World Health Organization Influenza-Like Illness Underestimates the Burden of Respiratory Syncytial Virus Infection in Community-Dwelling Older Adults. J Infect Dis 2021; 226:S71-S78. [PMID: 34904176 PMCID: PMC9374507 DOI: 10.1093/infdis/jiab452] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) surveillance is heavily dependent on the influenza-like illness (ILI) case definition from the World Health Organization (WHO). Because ILI includes fever in its syndromic case definition, its ability to accurately identify acute respiratory tract infections (ARTI) caused by RSV in older adults is uncertain. Methods The accuracy of the WHO ILI and a modified ILI (requiring only self-reported fever) case definitions in identifying patients with PCR-confirmed RSV-ARTI was evaluated in community-dwelling older adults (≥60 years) from the prospective European RESCEU cohort study. Results Among 1040 participants, 750 ARTI episodes were analyzed including 36 confirmed RSV-ARTI. Due to a general lack of fever, sensitivity for RSV-ARTI was 33% for modified ILI and 11% for ILI. The area under the curve for both ILI definitions was 0.52 indicating poor discrimination for RSV. RSV-ARTI could not be distinguished from all other ARTI based on clinical symptoms. Conclusions The use of ILI underestimated the occurrence of RSV-ARTI in community-dwelling older adults up to 9-fold (11% sensitivity). Because worldwide RSV surveillance depends largely on ILI, there is an urgent need for a better approach to measure the occurrence of RSV disease and the impact of future RSV vaccine introduction. Clinical Trials Registration. NCT03621930.
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Affiliation(s)
- Koos Korsten
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niels Adriaenssens
- Vaccine and Infectious Disease Institute, Laboratory of Medical Microbiology, University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.,Department of Family Medicine and Population Medicine, Primary and Interdisciplinary Care, Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Vaccine and Infectious Disease Institute, Laboratory of Medical Microbiology, University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.,Department of Family Medicine and Population Medicine, Primary and Interdisciplinary Care, Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Chris C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Havdal LB, Bøås H, Bekkevold T, Kran AMB, Rojahn AE, Størdal K, Debes S, Døllner H, Nordbø SA, Barstad B, Haarr E, Fernández LV, Nakstad B, Inchley C, Flem E. The burden of respiratory syncytial virus in children under 5 years of age in Norway. J Infect 2021; 84:205-215. [PMID: 34906596 DOI: 10.1016/j.jinf.2021.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To estimate age-specific incidence of medically attended respiratory syncytial virus (RSV) infections in hospitalised Norwegian children and describe disease epidemiology. METHODS Active prospective hospital surveillance for RSV in children <59 months of age was conducted during 2015-2018. All febrile children 12-59 months of age were enrolled, whereas children <12 months were enrolled based on respiratory symptoms regardless of fever. Surveillance data were linked to national registry data to estimate the clinical burden of RSV. RESULTS Of the children enrolled, 1096 (40%) were infected with RSV. The highest incidence rates were found in children 1 month of age, with a peak incidence of 43 per 1000 during the 2016-2017 season. In comparison, children 24-59 months of age had an infection rate of 1.4 per 1000 during the same winter season. The peak season was during the 2016-2017 winter, with an incidence rate of 6.0 per 1000 children 0-59 months of age. In the study population a total of 168 (15%) of the infected children had pre-existing medical conditions predisposing for more severe disease. High infection rates were found in this population. CONCLUSIONS Children with comorbidities showed high hospital contact rates, but the majority of children in need of medical attention associated with RSV infection were previously healthy.
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Affiliation(s)
- Lise Beier Havdal
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Postboks 1000, 1478 Lørenskog, Norway; Norwegian Institute of Public Health, PO BOX 222 Skøyen, 0213, Oslo, Norway.
| | - Håkon Bøås
- Norwegian Institute of Public Health, PO BOX 222 Skøyen, 0213, Oslo, Norway
| | - Terese Bekkevold
- Norwegian Institute of Public Health, PO BOX 222 Skøyen, 0213, Oslo, Norway
| | - Anne-Marte Bakken Kran
- Norwegian Institute of Public Health, PO BOX 222 Skøyen, 0213, Oslo, Norway; Department of Microbiology, Oslo University Hospital, Ullevål, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Astrid Elisabeth Rojahn
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Ullevål, Postboks, 4950 Nydalen, 0424 Oslo, Norway
| | - Ketil Størdal
- Department of Paediatrics, Østfold Hospital, Kalnes, Postboks 300, 1714 Grålum, Norway; Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sara Debes
- Department of Medical Microbiology, Østfold Hospital, Kalnes, Postboks 300, 1714 Grålum, Norway
| | - Henrik Døllner
- Department of Paediatrics, St. Olavs University Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - Svein Arne Nordbø
- Department of Medical Microbiology, St. Olavs University Hospital, Postboks 3250 Torgarden, 7006 Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Norway
| | - Bjørn Barstad
- Department of Paediatric and adolescent Medicine, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
| | - Elisebet Haarr
- Department of Medical Microbiology, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway
| | | | - Britt Nakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Postboks 1000, 1478 Lørenskog, Norway; Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christopher Inchley
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Postboks 1000, 1478 Lørenskog, Norway
| | - Elmira Flem
- Norwegian Institute of Public Health, PO BOX 222 Skøyen, 0213, Oslo, Norway
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Brenes-Chacon H, Garcia-Mauriño C, Moore-Clingenpeel M, Mertz S, Ye F, Cohen DM, Ramilo O, Mejias A. Age-dependent Interactions Among Clinical Characteristics, Viral Loads and Disease Severity in Young Children With Respiratory Syncytial Virus Infection. Pediatr Infect Dis J 2021; 40:116-122. [PMID: 33433159 PMCID: PMC7808270 DOI: 10.1097/inf.0000000000002914] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Age-dependent differences in clinical presentation and viral loads in infants and young children with respiratory syncytial virus (RSV) infection, and their correlation with disease severity are poorly defined. METHODS Previously healthy children <2 years old with mild (outpatients) and severe (inpatients) RSV infection were enrolled and viral loads measured by polymerase chain reaction in nasopharyngeal swabs. Patients were stratified by age in 0-<3, 3-6 and >6-24 months, and multivariable analyses were performed to identify clinical and viral factors associated with severe disease. RESULTS From 2014 to 2018, we enrolled 534 children with RSV infection, 130 outpatients with mild RSV infection and 404 inpatients with severe RSV disease. Median duration of illness was 4 days for both groups, yet viral loads were higher in outpatients than in inpatients (P < 0.001). In bivariate analyses, wheezing was more frequent in outpatients of older age (>3 months) than in inpatients (P < 0.01), while fever was more common in inpatients than outpatients (P < 0.01) and its frequency increased with age. Adjusted analyses confirmed that increased work of breathing and fever were consistently associated with hospitalization irrespective of age, while wheezing in infants >3 months, and higher RSV loads in children >6-24 months were independently associated with reduced disease severity. CONCLUSIONS Age had a significant impact defining the interactions among viral loads, specific clinical manifestations and disease severity in children with RSV infection. These observations highlight the importance of patient stratification when evaluating interventions against RSV.
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Affiliation(s)
| | | | | | | | - Fang Ye
- Center for Vaccines and Immunity
| | | | - Octavio Ramilo
- Center for Vaccines and Immunity
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
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Factors Contributing to Symptom Duration and Viral Reduction in Outpatient Children With Respiratory Syncytial Virus Infection. Pediatr Infect Dis J 2020; 39:678-683. [PMID: 32101910 PMCID: PMC7360094 DOI: 10.1097/inf.0000000000002626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND We investigated the association between age, duration of clinical symptoms and viral shedding in outpatient children infected with respiratory syncytial virus (RSV) in Japan. METHODS Outpatients younger than 2 years of age, with suspected RSV infection between 2014 and 2018, were enrolled in the study. Following informed consent, nasal samples were collected at first and second clinic visits (with 0-9 days gap). RSV-A or -B infection and viral load were determined by real-time polymerase chain reaction. Clinical symptoms were recorded at first clinic visit, and fever and symptoms were recorded at home for up to 8 days. Association between clinical symptoms and patient characteristics, such as age, sex and birth weight, were analyzed using ordered logistic regression analysis. The association between viral reduction and estimated shedding period was examined using linear regression analysis. RESULTS Among the 205 cases enrolled in the study, no difference was found in patient characteristics between RSV-A and -B infection. Duration of fever was prolonged with increased age. Duration of rhinorrhea and cough was shorter in females than in males and in groups with birth weight ≥3 kg than in those with <2.5 kg. Daily viral reduction increased and estimated viral elimination period decreased with age. CONCLUSIONS Fever duration was found to increase while viral shedding decreased with patient age.
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