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RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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-
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Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377–382.
-
4.
Moreira J, Bressan CS, Brasil P, Siqueira AM, 2018. Epidemiology of acute febrile illness in Latin America. Clin Microbiol Infect 24: 827–835.
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Tang JW, Lam TT, Zaraket H, Lipkin WI, Drews SJ, Hatchette TF, Heraud JM, Koopmans MP, 2017. Global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance. Lancet Infect Dis 17: e320–e326.
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Shek LP, Lee BW, 2003. Epidemiology and seasonality of respiratory tract virus infections in the tropics. Paediatr Respir Rev 4: 105–111.
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Reller ME et al. 2013. Chikungunya as a cause of acute febrile illness in southern Sri Lanka. PLoS One 8: e82259.
-
8.
Reller ME et al. 2012. Unsuspected dengue and acute febrile illness in rural and semi-urban southern Sri Lanka. Emerg Infect Dis 18: 256–263.
-
9.
Reller ME, Bodinayake C, Nagahawatte A, Devasiri V, Kodikara-Arachichi W, Strouse JJ, Flom JE, Dumler JS, Woods CW, 2011. Leptospirosis as frequent cause of acute febrile illness in southern Sri Lanka. Emerg Infect Dis 17: 1678–1684.
-
10.
Reller ME et al. 2012. Unsuspected rickettsioses among patients with acute febrile illness, Sri Lanka, 2007. Emerg Infect Dis 18: 825–829.
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11.
Chen JH, Lam HY, Yip CC, Wong SC, Chan JF, Ma ES, Cheng VC, Tang BS, Yuen KY, 2016. Clinical evaluation of the new high-throughput luminex NxTAG respiratory pathogen panel assay for multiplex respiratory pathogen detection. J Clin Microbiol 54: 1820–1825.
-
12.
Hirve S, Newman LP, Paget J, Azziz-Baumgartner E, Fitzner J, Bhat N, Vandemaele K, Zhang W, 2016. Influenza seasonality in the tropics and subtropics–when to vaccinate? PLoS One 11: e0153003.
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13.
Department of Meteorology SL, 2016. Meterological Data. Colombo, Sri Lanka: Department of Meteorology.
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14.
Minh An DT, Ngoc NT, Nilsson M, 2014. Influenza-like illness in a Vietnamese province: epidemiology in correlation with weather factors and determinants from the surveillance system. Glob Health Action 7: 23073.
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15.
Jain S et al. CDC EPIC Study Team, 2015. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med 372: 835–845.
-
16.
Goldstein B, Giroir B, Randolph A, 2005. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6: 2–8.
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17.
Viallefont V, Raftery AE, Richardson S, 2001. Variable selection and Bayesian model averaging in case-control studies. Stat Med 20: 3215–3230.
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18.
Capeding MR et al. 2013. Dengue and other common causes of acute febrile illness in Asia: an active surveillance study in children. PLoS Negl Trop Dis 7: e2331.
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19.
Phuong HL et al. 2010. Viral respiratory tract infections among patients with acute undifferentiated fever in Vietnam. Southeast Asian J Trop Med Public Health 41: 1116–1126.
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20.
Jones AH et al. 2016. Sentinel surveillance for influenza among severe acute respiratory infection and acute febrile illness inpatients at three hospitals in Ghana. Influenza Other Respir Viruses 10: 367–374.
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21.
Hercik C et al. 2017. A diagnostic and epidemiologic investigation of acute febrile illness (AFI) in Kilombero, Tanzania. PLoS One 12: e0189712.
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Kuberski TT, 1977. Haemorrhage associated with influenza. Lancet 1: 709.
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Lorenzi OD et al. 2013. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections. Am J Trop Med Hyg 88: 472–480.
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Jayaweera J, Noordeen F, Morel A, Pitchai N, Kothalawala S, Abeykoon A, Peiris J, 2016. Viral burden in acute respiratory tract infections in hospitalized children in the wet and dry zones of Sri Lanka. Int J Infect Dis 45S: 1–477.
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Muthulingam A, Noordeen F, Morel A, 2014. Viral etiology in hospitalized children with acute respiratory tract infection in the Kegalle area of Sri Lanka. J Pediatr Infect Dis 9: 167–170.
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Shapiro D et al. 2017. Burden and seasonality of viral acute respiratory tract infections among outpatients in southern Sri Lanka. Am J Trop Med Hyg 97: 88–96.
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Soebiyanto RP et al. 2014. The role of temperature and humidity on seasonal influenza in tropical areas: Guatemala, El Salvador and Panama, 2008–2013. PLoS One 9: e100659.
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Dietz V, Gubler DJ, Ortiz S, Kuno G, Casta-Velez A, Sather GE, Gomez I, Vergne E, 1996. The 1986 dengue and dengue hemorrhagic fever epidemic in Puerto Rico: epidemiologic and clinical observations. P R Health Sci J 15: 201–210.
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42.
Vallieres E, Renaud C, 2013. Clinical and economical impact of multiplex respiratory virus assays. Diagn Microbiol Infect Dis 76: 255–261.
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43.
Robinson J, 2004. Colonization and infection of the respiratory tract: what do we know? Paediatr Child Health 9: 21–24.
| Past two years | Past Year | Past 30 Days | |
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Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka
L. Gayani Tillekeratne
L. Gayani Tillekeratne
Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Duke Global Health Institute, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Champica K. Bodinayake
Champica K. Bodinayake
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
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Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
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Ryan Simmons
Ryan Simmons
Duke Global Health Institute, Durham, North Carolina;
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Ajith Nagahawatte
Ajith Nagahawatte
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
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Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
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Vasantha Devasiri
Vasantha Devasiri
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
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Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
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Wasantha Kodikara Arachchi
Wasantha Kodikara Arachchi
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
Teaching Hospital Karapitiya, Galle, Sri Lanka;
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Teaching Hospital Karapitiya, Galle, Sri Lanka;
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Bradly P. Nicholson
Bradly P. Nicholson
Duke University, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Lawrence P. Park
Lawrence P. Park
Duke University, Durham, North Carolina;
Duke Global Health Institute, Durham, North Carolina;
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Duke Global Health Institute, Durham, North Carolina;
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Sky Vanderburg
Sky Vanderburg
Duke University, Durham, North Carolina;
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Ruvini Kurukulasooriya
Ruvini Kurukulasooriya
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Aruna Dharshan De Silva
Aruna Dharshan De Silva
Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
General Sir Kotelawala Defence University, Ratmalana, Sri Lanka
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General Sir Kotelawala Defence University, Ratmalana, Sri Lanka
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Truls Østybe
Truls Østybe
Duke University, Durham, North Carolina;
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Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Megan E. Reller
Megan E. Reller
Duke University, Durham, North Carolina;
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Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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Christopher W. Woods
Christopher W. Woods
Duke University, Durham, North Carolina;
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Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka;
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The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ≥ 1 year of age admitted to a tertiary care hospital in southern Sri Lanka, June 2012–October 2014. We collected epidemiologic/clinical data and a nasal or nasopharyngeal sample that was tested using polymerase chain reaction (Luminex NxTAG, Austin, TX). We determined associations between weather data and respiratory viral activity using the Spearman correlation and assessed respiratory virus seasonality using a Program for Appropriate Technology definition. Bivariable and multivariable regression analyses were conducted to identify features associated with respiratory virus detection. Among 964 patients, median age was 26.2 years (interquartile range 14.6–39.9) and 646 (67.0%) were male. One-fifth (203, 21.1%) had respiratory virus detected: 13.9% influenza, 1.4% human enterovirus/rhinovirus, 1.4% parainfluenza virus, 1.1% respiratory syncytial virus, and 1.1% human metapneumovirus. Patients with respiratory virus identified were younger (median 9.8 versus 27.7 years, P < 0.001) and more likely to have respiratory signs and symptoms. Influenza A and respiratory viral activity peaked in February–June each year. Maximum daily temperature was associated with influenza and respiratory viral activity (P = 0.03 each). Patients with respiratory virus were as likely as others to be prescribed antibiotics (55.2% versus 52.6%, P = 0.51), and none reported prior influenza vaccination. Respiratory viral infection was a common cause of AFI. Improved access to vaccines and respiratory diagnostics may help reduce disease burden and inappropriate antibiotic use.
Author Notes
Please note that Megan E. Reller and Christopher W. Woods are co-senior authors.
Conflicts of Interest: Dr. Woods reports other relationships with Predigen; personal fees from IDbyDNA, Becton Dickinson, and Giner; grants and personal fees from bioMerieux; and grants from Pfizer, Biofire, Openbiome, Janus, BioMeme, MRI Global, and RTI, outside the submitted work.
Financial support: This work was supported by a grant from the National Institutes of Allergy and Infectious Diseases (K23AI125677 to LGT); Fogarty International Center and the National Institute of Mental Health (#R25 TW009337), the U.S. Department of Defense (BA150703 to CWW); the Office of Naval Research to the Emerging Infectious Diseases Programme, Duke-NUS Graduate Medical School, Singapore; a Johns Hopkins Center for Global Health Junior Faculty Grant (MER); and the Hubert-Yeargan Center for Global Health.
Authors’ addresses: L. Gayani Tillekeratne, Truls Østybe, Megan E. Reller, and Christopher W. Woods, Duke University, Durham, NC, Duke Global Health Institute, Durham, NC, and Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, E-mails: gayani.tillekeratne@dm.duke.edu, truls.ostbye@duke.edu, megan.reller@duke.edu, and chris.woods@duke.edu. Champica K. Bodinayake, Ajith Nagahawatte, and Vasantha Devasiri, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, and Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: bodinayake@gmail.com, ajithnagahawatte@yahoo.co.uk, and vdevasiri@gmail.com. Ryan Simmons, Duke Global Health Institute, Durham, NC, E-mail: ryan.simmons@duke.edu. Wasantha Kodikara Arachchi, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, and Teaching Hospital Karapitiya, Galle, Sri Lanka, E-mail: kody@sltnet.lk. Bradly P. Nicholson and Sky Vanderburg, Duke University, Durham, NC, and Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, E-mails: brad.nicholson@duke.edu and sky.vanderburg@duke.edu. Larry P. Park, Duke University, Durham, NC, and Duke Global Health Institute, Durham, NC, E-mail: larry.park@duke.edu. Ruvini Kurukulasooriya, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, E-mail: ruhunasearch@gmail.com. Aruna Dharshan De Silva, Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, and General Sir Kotelawala Defence University, Ratmalana, Sri Lanka, E-mail: dslv90@yahoo.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Prasad N, Murdoch DR, Reyburn H, Crump JA, 2015. Etiology of severe febrile illness in low- and middle-income countries: a systematic review. PLoS One 10: e0127962.
-
2.
Crump JA et al. 2013. Etiology of severe non-malaria febrile illness in northern Tanzania: a prospective cohort study. PLoS Negl Trop Dis 7: e2324.
-
3.
Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA, 2006. Laboratory medicine in Africa: a barrier to effective health care. Clin Infect Dis 42: 377–382.
-
4.
Moreira J, Bressan CS, Brasil P, Siqueira AM, 2018. Epidemiology of acute febrile illness in Latin America. Clin Microbiol Infect 24: 827–835.
-
5.
Tang JW, Lam TT, Zaraket H, Lipkin WI, Drews SJ, Hatchette TF, Heraud JM, Koopmans MP, 2017. Global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance. Lancet Infect Dis 17: e320–e326.
-
6.
Shek LP, Lee BW, 2003. Epidemiology and seasonality of respiratory tract virus infections in the tropics. Paediatr Respir Rev 4: 105–111.
-
7.
Reller ME et al. 2013. Chikungunya as a cause of acute febrile illness in southern Sri Lanka. PLoS One 8: e82259.
-
8.
Reller ME et al. 2012. Unsuspected dengue and acute febrile illness in rural and semi-urban southern Sri Lanka. Emerg Infect Dis 18: 256–263.
-
9.
Reller ME, Bodinayake C, Nagahawatte A, Devasiri V, Kodikara-Arachichi W, Strouse JJ, Flom JE, Dumler JS, Woods CW, 2011. Leptospirosis as frequent cause of acute febrile illness in southern Sri Lanka. Emerg Infect Dis 17: 1678–1684.
-
10.
Reller ME et al. 2012. Unsuspected rickettsioses among patients with acute febrile illness, Sri Lanka, 2007. Emerg Infect Dis 18: 825–829.
-
11.
Chen JH, Lam HY, Yip CC, Wong SC, Chan JF, Ma ES, Cheng VC, Tang BS, Yuen KY, 2016. Clinical evaluation of the new high-throughput luminex NxTAG respiratory pathogen panel assay for multiplex respiratory pathogen detection. J Clin Microbiol 54: 1820–1825.
-
12.
Hirve S, Newman LP, Paget J, Azziz-Baumgartner E, Fitzner J, Bhat N, Vandemaele K, Zhang W, 2016. Influenza seasonality in the tropics and subtropics–when to vaccinate? PLoS One 11: e0153003.
-
13.
Department of Meteorology SL, 2016. Meterological Data. Colombo, Sri Lanka: Department of Meteorology.
-
14.
Minh An DT, Ngoc NT, Nilsson M, 2014. Influenza-like illness in a Vietnamese province: epidemiology in correlation with weather factors and determinants from the surveillance system. Glob Health Action 7: 23073.
-
15.
Jain S et al. CDC EPIC Study Team, 2015. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med 372: 835–845.
-
16.
Goldstein B, Giroir B, Randolph A, 2005. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6: 2–8.
-
17.
Viallefont V, Raftery AE, Richardson S, 2001. Variable selection and Bayesian model averaging in case-control studies. Stat Med 20: 3215–3230.
-
18.
Capeding MR et al. 2013. Dengue and other common causes of acute febrile illness in Asia: an active surveillance study in children. PLoS Negl Trop Dis 7: e2331.
-
19.
Phuong HL et al. 2010. Viral respiratory tract infections among patients with acute undifferentiated fever in Vietnam. Southeast Asian J Trop Med Public Health 41: 1116–1126.
-
20.
Jones AH et al. 2016. Sentinel surveillance for influenza among severe acute respiratory infection and acute febrile illness inpatients at three hospitals in Ghana. Influenza Other Respir Viruses 10: 367–374.
-
21.
Hercik C et al. 2017. A diagnostic and epidemiologic investigation of acute febrile illness (AFI) in Kilombero, Tanzania. PLoS One 12: e0189712.
-
22.
Kuberski TT, 1977. Haemorrhage associated with influenza. Lancet 1: 709.
-
23.
Lorenzi OD et al. 2013. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections. Am J Trop Med Hyg 88: 472–480.
-
24.
Jayaweera J, Noordeen F, Morel A, Pitchai N, Kothalawala S, Abeykoon A, Peiris J, 2016. Viral burden in acute respiratory tract infections in hospitalized children in the wet and dry zones of Sri Lanka. Int J Infect Dis 45S: 1–477.
-
25.
Muthulingam A, Noordeen F, Morel A, 2014. Viral etiology in hospitalized children with acute respiratory tract infection in the Kegalle area of Sri Lanka. J Pediatr Infect Dis 9: 167–170.
-
26.
World Health Organization, 2013. Research Needs for the Battle against Respiratory Viruses (BRaVe). Available at: http://www.who.int/influenza/patient_care/clinical/BRaVe_Research_Agenda_2013.pdf?ua=1. Accessed March 5, 2018.
-
27.
Shapiro D et al. 2017. Burden and seasonality of viral acute respiratory tract infections among outpatients in southern Sri Lanka. Am J Trop Med Hyg 97: 88–96.
-
28.
Breiman RF, Van Beneden CA, Farnon EC, 2013. Surveillance for respiratory infections in low- and middle-income countries: experience from the Centers for Disease Control and Prevention’s Global Disease Detection International Emerging Infections Program. J Infect Dis 208 (Suppl 3): S167–S172.
-
29.
Peasah SK, Azziz-Baumgartner E, Breese J, Meltzer MI, Widdowson MA, 2013. Influenza cost and cost-effectiveness studies globally—a review. Vaccin 31: 5339–5348.
-
30.
Newman LP, Bhat N, Fleming JA, Neuzil KM, 2018. Global influenza seasonality to inform country-level vaccine programs: an analysis of WHO FluNet influenza surveillance data between 2011 and 2016. PLoS One 13: e0193263.
-
31.
Hirve S, Lambach P, Paget J, Vandemaele K, Fitzner J, Zhang W, 2016. Seasonal influenza vaccine policy, use and effectiveness in the tropics and subtropics–a systematic literature review. Influenza Other Respir Viruses 10: 254–267.
-
32.
Azziz Baumgartner E et al. 2012. Seasonality, timing, and climate drivers of influenza activity worldwide. J Infect Dis 206: 838–846.
-
33.
Soebiyanto RP et al. 2015. Associations between seasonal influenza and meteorological parameters in Costa Rica, Honduras and Nicaragua. Geospat Health 10: 372.
-
34.
Munshili Njifon HL et al. 2018. Influence of meteorological parameters in the seasonality of influenza viruses circulating in northern Cameroon. Influenza Other Respir Viruses, doi:10.1111/irv.12612.
-
35.
Soebiyanto RP et al. 2014. The role of temperature and humidity on seasonal influenza in tropical areas: Guatemala, El Salvador and Panama, 2008–2013. PLoS One 9: e100659.
-
36.
Dietz V, Gubler DJ, Ortiz S, Kuno G, Casta-Velez A, Sather GE, Gomez I, Vergne E, 1996. The 1986 dengue and dengue hemorrhagic fever epidemic in Puerto Rico: epidemiologic and clinical observations. P R Health Sci J 15: 201–210.
-
37.
World Health Organization, 2012. WHO Interim Global Epidemiological Surveillance Standards for Influenza. Geneva, Switzerland: World Health Organization.
-
38.
Fitzner J et al. 2018. Revision of clinical case definitions: influenza-like illness and severe acute respiratory infection. Bull World Health Organ 96: 122–128.
-
39.
Tillekeratne L et al. 2015. An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013. Am J Trop Med Hyg 92: 1023–1029.
-
40.
World Health Organization, 2014. Antimicrobial Resistance- Global Report on Surveillance. Geneva, Switzerland: World Health Organization.
-
41.
Rappo U, Schuetz AN, Jenkins SG, Calfee DP, Walsh TJ, Wells MT, Hollenberg JP, Glesby MJ, 2016. Impact of early detection of respiratory viruses by multiplex PCR assay on clinical outcomes in adult patients. J Clin Microbiol 54: 2096–2103.
-
42.
Vallieres E, Renaud C, 2013. Clinical and economical impact of multiplex respiratory virus assays. Diagn Microbiol Infect Dis 76: 255–261.
-
43.
Robinson J, 2004. Colonization and infection of the respiratory tract: what do we know? Paediatr Child Health 9: 21–24.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 910 | 799 | 50 |
| Full Text Views | 1041 | 24 | 1 |
| PDF Downloads | 275 | 17 | 1 |