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RSV may increase risk for bacterial pneumonia in infants
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New study results published in PLOS Medicine suggest respiratory syncytial virus may increase the risk for pneumococcal pneumonia in infants.
“The dogma has been that RSV infections do not increase the risk for secondary bacterial infections,” Daniel M. Weinberger, PhD, of Yale School of Public Health, told Infectious Disease News. “While most RSV infections are not followed by bacterial infections, some fraction of infants with pneumonia (not bronchiolitis) who test positive for RSV might have a mixed viral-bacterial infection. Further diagnostic testing can be used to consider whether antibiotic treatment would be appropriate in these instances.”
Weinberger and colleagues analyzed US hospitalization data collected between 1992 and 2009 to investigate the possible association between respiratory syncytial virus (RSV) and pneumonia caused by Streptococcus pneumoniae in children aged younger than 2 years. More than 700,000 hospitalizations for RSV and 16,000 hospitalizations for pneumococcal pneumonia occurred in 36 states during that time. The researchers used Poisson regression analyses to study any possible link between the viral and bacterial infections.
Daniel M. Weinberger
RSV was associated with a subsequent increase in the incidence of pneumococcal pneumonia hospitalizations, with epidemics of both diseases sharing “a distinctive temporal pattern,” according to the researchers. Bacterial pneumonia was attributable to RSV in 20.3% (95% CI, 17.4%-25.1%) of children aged younger than 1 year and 10.1% (95% CI, 7.6%-13.9%) of children aged 1 to 2 years.
Influenza activity also was associated with an increase in pneumococcal pneumonia among children aged 1 to 2 years (3.2%; 95% CI, 1.7%-4.7%). Although influenza was associated with a smaller fraction of pneumococcal pneumonia cases than RSV, the effect was more pronounced in seasons with severe influenza epidemics.
In addition, the researchers found that following the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, there was an 18% decrease in RSV-coded hospitalizations in children aged younger than 1 year, suggesting that some RSV cases may have a mixed viral-bacterial etiology.
According to Weinberger and colleagues, it remains unclear how RSV and pneumococcus interact, and whether the viral infection leads to higher rates of bacteremia or vice versa. However, the data do support the notion that RSV causes increased susceptibility to pneumococcal pneumonia.
“RSV is associated with increases in the incidence of pneumococcal pneumonia, particularly in young infants, and a percentage of RSV hospitalizations might be attributable to pneumococcus, based on post-PCV7 declines,” they wrote. “These findings could help in the design of more effective interventions to treat respiratory infections in young children.” — John Schoen
Disclosure: Weinberger and two other colleagues have received research support from Pfizer. He also has received consulting fees from Merck. One of the researchers is a PLOS Medicine editorial board member.
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