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BACKGROUND: In the United States, population-based surveillance for hospitalized cases of laboratory-confirmed influenza is conducted in 14 sites. However surveillance for other causes of severe acute respiratory illness (SARI) is not well established. The Minnesota Department of Health (MDH) is conducting pilot hospital-based surveillance to characterize and monitor SARI in children throughout the course of one year.
METHODS: From April 2013 through December 2013, Children’s Hospitals and Clinics of Minnesota submitted residual specimens collected from routine diagnostic testing to the MDH–Public Health Laboratory (PHL). All were upper respiratory specimens collected from children age <18 years hospitalized for suspected respiratory illness. Specimens were tested for 22 viral and bacterial pathogens by real-time reverse transcriptase polymerase chain reaction. Admission records, including history and physical, were reviewed to identify patients meeting SARI case definition of cough, shortness of breath, or difficulty breathing, with or without fever (measured or subjective), and medical records were reviewed to obtain demographic and clinical data on patients with submitted specimens.
RESULTS: To date, 408 (31.3%) specimens were submitted from 1,304 patients meeting SARI case definition (surveillance ongoing through April 2014). Among those with submitted specimens, average patient age was 5.8 years. Admission to an intensive care unit (ICU) occurred in 93 (22.8%) patients; 46 (49.5%) ICU patients received mechanical ventilation. Median length of stay (LOS) for patients not admitted to an ICU was 2 days (range 1-23); median LOS for ICU patients was 8 days (range 1-123). Underlying medical conditions were identified in 269 (65.9%) patients, of which neurologic disorders (24.9%), asthma (16.4%), cardiovascular disease (15.6%) and immunocompromising conditions (8.2%) were most frequently observed. A pathogen was identified in 260 (63.7%) patient specimens, including rhinovirus (71.2%), adenovirus (16.5%), parainfluenza virus (PIV) 1 (7.3%), PIV 4 (6.9%), PIV 3 (5.0%), human metapneumovirus (6.2%), respiratory syncytial virus (5.0%), and mycoplasma (4.2%).
CONCLUSIONS: MDH successfully established a pilot surveillance effort for SARI at a pediatric hospital that aids in understanding the burden and etiology of circulating respiratory infections. Because MDH received residual specimens only when clinicians ordered testing, the number of specimens received reflected only a clinician’s decision to test. However, the volume of specimens received stretched testing resources at MDH-PHL enough that the receipt of more specimens may have overwhelmed their capacity. Further SARI surveillance can help target public health resources for the development of prevention and therapeutic interventions for respiratory infections and provide clinicians information for situational awareness.