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New studies target respiratory illness epidemiology
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NEW ORLEANS — There are a number of studies under way that should help shed more light on respiratory viruses and help clinicians in the future hone in on which viruses are causing what symptoms, according to a speaker here at the 2012 AAP National Conference and Exhibition.
Penelope H. Dennehy, MD, director of pediatric infectious diseases at Hasbro Children’s Hospital in Providence, R.I., said studies such as the Utah Better Identification of Germs-Longitudinal Viral Epidemiology (BIG-LoVE) study and the CDC’s Evaluation of Processes and Indicators in Infection Control (EPIC) study will hopefully provide further insight into viruses such as human metapneumovirus, respiratory syncytial virus (RSV) and pneumococcal disease and their role in pediatric respiratory disease.
Penelope H. Dennehy
Dennehy said new viral diagnostics are needed to help guide treatment decisions because the old tests “are too slow to be helpful, and the rapid antigen tests are not sensitive.”
Newer diagnostics offer the advantages of speed, reliability, reproducibility and the ability to identify many viruses — including influenza A, B, RSV, parainfluenza, rhinovirus, adenovirus and metapneumovirus — simultaneously.
However, sensitivity of these tests may lead to false positives. This high sensitivity may also detect latent viruses, even if they are not making the patient sick, Dennehy said.
During her talk, she suggested an algorithm for rapid viral testing, noting that clinicians who suspect influenza may want to consider testing in outbreak situations, patients in intensive care, and those children who are at an elevated risk for complications from respiratory illnesses.
A respiratory viral polymerase chain reaction panel (RVP) is useful during outbreaks, but there is a question about using these tools in a non-ICU situation. However, “this may change if we can get some data showing that use of antibiotics drops as a result of these test results,” Dennehy said.
She also reviewed the recently released guidelines on testing for community-acquired pneumonia suggested by the Infectious Diseases Society of America and Pediatric Academic Society. These guidelines suggest considering testing for viruses because antibiotics use could be reduced based on test outcomes. These guidelines also recommend testing for influenza, she said.
“Respiratory viruses are very common in children, and there are high attack rates in young children,” Dennehy said. “Infants and preschool children have a mean of six to 10 infections per year, and that is even higher if the child is in day care. School-aged children and adolescents average about three to five illnesses per year, and all of these infections lead to overuse of antibiotics,” making finding the cause of the illness all the more important.
For more information:
Dennehy P. Session F4102. Presented at: AAP National Conference and Exhibition; Oct. 20-23, 2012; New Orleans.
Disclosure: Dennehy reported no relevant financial disclosures.