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Epidemiology of Parainfluenza Infection in England and Wales

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Epidemiology of Parainfluenza Infection in England and Wales Epidemiol. Infect. (2017), 145, 1210–1220. © Cambridge University Press 2017 doi:10.1017/S095026881600323X Epidemiology of parainfluenza infection in England and Wales, 1998–2013: any evidence of change? 1 2 3 4 1 H. ZHAO ,R.J.HARRIS, J. ELLIS ,M.DONATI AND R. G. PEBODY * 1 Respiratory Diseases Department, National Infection Service, Public Health England, London, UK 2 Statistics and Modelling Economics Department, National Infection Service, Public Health England, London, UK 3 Respiratory Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, UK 4 PHE South West Regional Laboratory, Public Health England, Bristol, UK Received 5 September 2016; Final revision 21 November 2016; Accepted 8 December 2016; first published online 18 January 2017 SUMMARY Human parainfluenza virus (HPIV) infections are one of the commonest causes of upper and lower respiratory tract infections. In order to determine if there have been any recent changes in HPIV epidemiology in England and Wales, laboratory surveillance data between 1998 and 2013 were analysed. The UK national laboratory surveillance database, LabBase, and the newly established laboratory-based virological surveillance system, the Respiratory DataMart System (RDMS), were used. Descriptive analysis was performed to examine the distribution of cases by year, age, sex and serotype, and to examine the overall temporal trend using the χ2 test. A random-effects model was also employed to model the number of cases. Sixty-eight per cent of all HPIV detections were due to HPIV type 3 (HPIV-3). HPIV-3 infections were detected all year round but peaked annually between March and June. HPIV-1 and HPIV-2 circulated at lower levels accounting for 20% and 8%, respectively, peaking during the last quarter of the year with a biennial cycle. HPIV-4 was detected in smaller numbers, accounting for only 4% and also mainly observed in the last quarter of the year. However, in recent years, HPIV-4 detection has been reported much more commonly with an increase from 0% in 1998 to 3·7% in 2013. Although an overall higher proportion of HPIV infection was reported in infants (43·0%), a long-term decreasing trend in proportion in infants was observed. An increase was also observed in older age groups. Continuous surveillance will be important in tracking any future changes. Key words: England and Wales, epidemiology, laboratory surveillance, parainfluenza, seasonality, temporal trend. INTRODUCTION tract infections, especially in young children [1–3]. Human parainfluenza viruses (HPIVs) are among the Some literature has reported that in children aged <5 years, HPIV infections were the second most com- commonest causes of upper and lower respiratory mon cause of acute respiratory illness resulting in hos- pitalization, surpassed only by respiratory syncytial * Author for correspondence: Dr R. G. Pebody, Respiratory virus but ahead of influenza viruses [4]. Immunity to Diseases Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. HPIV is incomplete, and infection and reinfection (Email: [email protected]) occur throughout life [5, 6]. There are four currently Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.22, on 02 Oct 2021 at 01:01:25, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S095026881600323X Epidemiology of parainfluenza infections 1211 recognized HPIV types (1–4), with all causing a full described. Since then no further in depth publication spectrum of respiratory illness, including the common has been reported. In recent years, routine clinical sur- cold, upper respiratory tract illness (URTI), croup, veillance data [23] have shown secular declining trends and severe lower respiratory tract illness (LRTI), in consultation rates in primary-care setting due to such as bronchiolitis and pneumonia [2]. Studies sug- respiratory infections such as influenza-like illness, gest that 2–17% of hospitalizations for acute respira- acute bronchitis, pneumonia, upper and lower respira- tory infections in children aged <5 years are due to tory tract infections in England and Wales. Therefore, HPIV infection [7–9]. HPIV-3 is the most virulent of this analysis of laboratory surveillance data on HPIV the HPIVs and is associated with significant morbidity infection has been undertaken to examine the recent and mortality [10]. A modelling study based on all situation in relation to HPIV and determine if there hospitalizations for lower respiratory tract infection have been any changes in the clinical and epidemio- in children aged <5 years in England between 1995 logical characteristics of HPIV infections between and 1998 estimated that 12·9% of unspecified pneu- 1998 and 2013 in England and Wales. monia hospitalizations were due to parainfluenza infections and 12·7% of unspecified bronchiolitis hos- pitalizations [11]. A study found that HPIV infections METHODS accounted for 6·8% of all hospitalizations for fever, acute respiratory illness, or both in children aged <5 The LabBase database years [12]. Among adults, most HPIV infections All parainfluenza infection reports from England and cause mild disease manifesting as upper respiratory Wales between specimen weeks 1 (1998) and 52 (2013) tract symptoms [2]. Adult patients more frequently were extracted from the Public Health England (PHE) present with influenza-like symptoms compared to national laboratory reporting scheme, the LabBase children [13]. HPIV infections, however, also cause database [24]. This database collects routine labora- more severe disease. One study [14] reported that at tory clinical test results of all microorganism detec- least 2% of cases of community-acquired pneumonia tions from public health and non-public health requiring hospitalization in adults were associated laboratories throughout England, Wales and with an increase in HPIV antibodies. HPIV infections Northern Ireland. All laboratories were required to have also been identified as a cause of nosocomial out- submit their data to the system as soon as and as breaks involving paediatric, geriatric and bone mar- often as they could. Indeed, some laboratories do row transplant wards [15–18]. In addition, HPIV report their data daily. As LabBase has been replaced infections can cause outbreaks of acute respiratory ill- by a new surveillance system called the Second ness in institutionalized elderly people [19, 20]. Generation Surveillance System (SGSS) since 2014, Specific antiviral therapy of proven value for HPIV to avoid any possible inconsistency this change infection is not yet established although immunosup- might bring in, only data up to 2013 were included pressed patients have been given oral ribavirin for in this study. Each record in the database corresponds treatment which showed that use of ribavirin early to an individual episode of illness and contains demo- and at higher doses might improve the outcome graphic and certain clinical information of patients. A [3, 21]. Despite decades of research, there are currently unique organism-patient-illness-episode identification no licensed vaccines available to protect against infec- (OPIE ID) was assigned to each unique record. This tion caused by any of the HPIV types [4, 10]. OPIE ID was used to identify any duplicate records Prevention thus relies on more traditional non- defined as infections within a 6-week period in an indi- pharmaceutical respiratory infection control and pre- vidual within the study dataset. De-duplication was vention packages such as isolation, cohorting, hand carried out before the analysis. The following data hygiene, cough etiquette and face masks. fields were obtained from the database: earliest speci- The last detailed surveillance report [22] on HPIV men date, age, sex, serotype, testing method, specimen in England and Wales was published in 1999 based type, specimen source and clinical features. on the routine laboratory infection reports between Due to multiple testing methods, different specimen 1975 and 1997, which reported that HPIV-3 was the types and specimen sources, and various clinical fea- main HPIV type with a clear annual peak occurring tures were reported in the same patients’ samples; between late spring and summer. The seasonality 1826 individual patients in the extracted dataset had and circulation for other types of HPIV were also multiple records. This in total generated 2715 extra Downloaded from https://www.cambridge.org/core. IP address: 170.106.33.22, on 02 Oct 2021 at 01:01:25, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S095026881600323X 1212 H. Zhao and others records. These extra records were removed when ana- at different levels of aggregation. Overall numbers in lysing by age, sex and serotype as there should only be each age group in the population over time were one value for each patient episode. However the add- included as a denominator in the model, allowing for itional records for each patient were included in the changes in demographics over time, in order to produce analyses of testing methods, clinical features and spe- incidence rate ratios (IRR) between age groups and age- cimen source in order to understand the complete specific trends. Patients with unknown age and labora- picture. tories with fewer than 10 reports over the study period were excluded from these models. The model accounts for the varying
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