Impact of healthcare-associated respiratory virus infections in children

Background: Respiratory viruses can spread within healthcare facilities despite stringent infection prevention measures. Although healthcare-associated respiratory virus infections (HARVIs) pose a significant risk to children, paediatric HARVIs are understudied. This study aimed to evaluate the clinical characteristics of HARVIs and their impact on clinical management. Methods: This retrospective study enrolled paediatric inpatients aged ≤18 years who were hospitalized at Tokyo Metropolitan Children's Medical Center between April 2020 and March 2024. HARVIs were defined based on clinical symptoms and multiplex polymerase chain reaction (FilmArray Respiratory Panel 2.1, BioFire) tested positive for viruses beyond the incubation period following hospitalization. The primary outcome was the 30-day mortality rate. The secondary outcomes included paediatric intensive care unit (PICU) admission, escalation of respiratory support, and the postponement of discharge, planned surgery, or chemotherapy. Results: Among 277 patients, male patients comprised 31% and the median age was 31 months (interquartile range: 12-77). The most common respiratory viruses detected were the rhinovirus-enterovirus (49%), parainfluenza virus type 3 (17%), severe acute respiratory syndrome coronavirus-2 (10%), and coronaviruses HKU1, NL63, 229E, and OC43 (9%). The 30-day mortality rate was 1%. The PICU admission rate was 2%. The rate of respiratory support escalation was 17%. Postponement of discharge occurred in 8%, and surgery in 3% of the cohort. There was no postponement of chemotherapy. Conclusion: HARVIs can lead to mortality and delays in treatment of underlying conditions and postponed discharge in a paediatric hospital, underscoring the importance of implementing infection control measures for prevention.