Acute Viral Lower Respiratory Infections in Children in
a Rural Community in Thailand
SO NT ANA SIRITA NTIKORN, Dr.rer.nat. *, PILAIPAN PUTHA VA THANA, Ph.D.*,
SUBHAREE SUWANJUTHA, M.D.**, TEERACHAI CHANTAROJANASIRI, M.D.**,
PRAMUAN SUNAKORN, M.D.***, TAPANOK RATANADILOK NA PHUKET, M.D.***,
SUNTI NAWANOPPARATSAKUL, M.D.****, PRA TUENG TEEYA PAIBOONSILPA, M.D.****
SUMALEE TAVEEPVORADEJ, B.Sc.****, JARIYA PENGMESRI, M.Sc.****,
SUCHITTRA PONGPATE, B.Sc.****
Affiliation : *Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700,
** Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400
*** ARI Section, Department of Communicable Disease Control, Ministry of Public Health, Bangkok 10120,
**** Takhli Hospital, Nakhon Sawan 60000, Thailand.
AbstractThe present study was conducted as a population based cohort in a rural community of
Amphoe Takhli, Nakhon Sawan province for the determination of the prevalence of acute viral lower
respiratory infection (ALRI) in pediatric cases under 5 years of age from November 1998 to February
2001. There were 472 ALRI episodes during the study period; and there were 5 cases who contracted
ALRI twice. The etiologic agents were determined by indirect immunofluorescence (IIF) test using
specific monoclonal antibodies for the staining of exfoliated cells in nasopharyngeal aspirate (NPA)
samples. The slides of fixed cells were prepared by Takhli Hospital and posted in ambient tempera
ture to the Virology Laboratory, Siriraj Hospital where they were stained and examined. Among 472
episodes of ALRI, 170 (36.0%) viral agents were found. Viral agents were associated with 41.4 per
cent of all pneumonic cases. Respiratory syncytial virus (RSV) was the most common virus observed
in the present study; and it was also the most common virus associated with pneumonia and bron
chitis. RSV subgrouping was performed directly in NPA samples by IIF test using a panel of sub
group specific monoclonal antibodies. RSV subgroup B predominated over subgroup A in the first
study year, and it was vice versa in the second year. Overall, more cases of subgroup B were found
which was in contrast to what the authors had reported in the previous study. Prevalence of RSV
was seasonal dependent, the epidemic was seen during the rainy season with peaks in August or
September of each year. As the method of viral identification was limited to IIF only, therefore,
fewer viruses were detected. Parainfluenza viruses were detected as the second most common viral
agent, the viruses spread during early summer with peaks in February or March of each year. How
ever, its association with croup could not be demonstrated which may be due to the insensitivity of
IIF in the diagnosis of non-RSV infection. Nevertheless, in terms of feasibility to investigate the
disease in a rural area, IIF is economic, convenient and rapid; and gives enough information for the
nationwide plan of a health care development system.
Keywords : Viral Acute Lower Respiratory Infection, Rural Community
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