Ten years’ experience with year-round active surveillance of up to 19 respiratory pathogens in children
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Surveillance systems for acute respiratory infections (ARI) in children currently are often limited in terms of the panel of pathogens and the age range investigated or are only syndromic and at times only active in the winter season.
Within PID-ARI.net, a research network for ARI in children in Germany, an active, year-round surveillance system was formed in three regions from north to south for population-based analysis. Children from birth to 16 years of age were included and up to 19 noncolonizing airway pathogens were tested for with multiplex RT-PCR.
In the 10-year period from July 1996 to June 2006, a total of 18,899 samples were tested. The positive rate increased with the size of the test panel to up to 72.9%. Picornaviruses (35–39%), paramyxoviruses (23–28%) and orthomyxoviruses (5.8–12.5%) comprised the highest fraction. Reoviruses and Legionella pneumophila were not found at all and Chlamydia pneumoniae and Bordetella parapertussis only rarely. Respiratory syncytial virus and parainfluenza virus (PIV) type 3 were anticyclical in rhythmicity with metapneumovirus and PIV1 and PIV2. The age medians per pathogen depended predominantly upon the attack rate and interepidemic intervals.
Active surveillance systems for ARI are superior to passive systems. They should be pathogen-specific and comprehensive for viruses and bacteria and age ranges. They should be population-based and multilevel to avoid bias. The impact of atypical bacteria in children was highly overestimated in earlier studies.
KeywordsAirway infections Metapneumovirus Multiplex RT-PCR Population-based Surveillance
acute respiratory infection
epidemiological recruitment system
lower respiratory infections
multiplex reverse transcription polymerase chain reaction
We appreciate the help of our co-workers S. Rockahr, B. Reckewitz and G. Delfs. We thank Dr. von Klinggräff and PD Dr. Claaß, former and current head, respectively, of the Pediatric Department, Municipal Hospital, Kiel; PD Dr. Oldigs, head of the Department of Pediatrics, Municipal Hospital, Flensburg; and office pediatricians Mrs. Dr. and Mr. Schäfer, Izehoe; Dr. Hake and Dr. Morf, Flensburg; Dr. Kelber, Lüneburg; Dr. Neufang, Dr. Zaum, Freiburg; Dr. Eppinger, Bad Krozingen; and Dr. Vogel, Dr. Huber, Dr. Humber and Dr. Homann for their collaboration. We thank Dr. Adrian Sewell, University Children’s Hospital Frankfurt/Main, for linguistic assistance. This work was supported by the grant (FKZ 01KI0213) for PID-ARI.net, the Pediatric Infectious Diseases Network on Acute Respiratory Tract Infections, awarded by the Bundesministerium für Forschung (BMBF) via the Deutsches Zentrum für Luft- und Raumfahrt e.V.
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