Carolinas Research Day 2021

A Retrospective Analysis of Human Parainfluenza Virus in the Pediatric Population Sarah Straka, OMS IV 1, ; Diana Vasilakos, OMS IV 1 ; Kristen Turner, PharmD 2 ; Rebecca Raffler, DO 1 ; Darcy Luck, DO 1 ; Hanna S. Sahhar, MD, FAAP, FACOP 1,2

1 Edward Via College of Osteopathic Medicine (VCOM), Spartanburg, SC 2 Spartanburg Regional Healthcare System (SRHS), Spartanburg , SC

CLIN-3

Introduction

Results

Results

Human parainfluenza viruses (HPIVs) are among the most common acute respiratory infections in children and contribute significantly to hospitalizations and emergency room visits in the pediatric population. There are four distinct serotypes of HPIV, numbered 1-4, which vary in clinical symptoms, incidence, disease severity, and seasonal occurrence. While previous research has analyzed the virology and epidemiology of HPIV-1-4, differences in clinical presentation and management requirements among serotypes has not been thoroughly characterized. This describes the clinical symptoms, disease severity, and care demands associated with each of the viral serotypes, which may aid in decision making for the most appropriate available treatment modalities for future pediatric patients and improve quality of care. Objectives 1. Describe and analyze the heterogeneity of HPIV serotypes in clinical presentation and disease outcome in the pediatric population 2. Analyze oxygen requirement, length of stay and potential complications in the context of specific viral serotype 3. Determine whether certain HPIV serotypes are predisposed to a more severe course of infection • Single-center, retrospective, observational study • 40 pediatric patients admitted to Spartanburg Regional Healthcare System • 15 month period (08/2018 – 11/2019) • Inclusion criteria: • All patients less than 18 years of age • Admitted to the general pediatrics ward or pediatric intensive care unit • Diagnosis of parainfluenzavirus serotypes 1-4 confirmed via PCR based respiratory panel called FilmArray • The following information was collected through data management software: HPIV serotype, admission location, length of stay, clinical presentation (croup, pharyngitis, pneumonia, bronchiolitis, URI), presence of concomitant infection, clinical management, complications, and patient outcome • Chi –square tests were conducted to evaluate differences in disease spectrum, and an ANOVA test was used to compare average length of stay among serotypes. Methods

Table 1: Percentage of patients requiring supplemental O 2 for each viral serotype.

Figure 5: Average LOS for each HPIV serotype. The differences in length of stay between viral serotypes were not statistically significant (p = 0.632)

Figure 2: Disease spectrum of all 40 patients. Patients displayed 0, 1, or multiple of the above conditions .

Figure 1: Percentage of patients who tested positive for HPIV serotypes 1-4

Conclusions

References References • Patients with HPIV serotypes 1 and 4 may have greater care demands and warrant closer monitoring • Understanding the differences in symptomatology and severity of each serotype can proactively aid in the proper treatment choices and improve quality of care in pediatric patients diagnosed with parainfluenza virus. • This observational study invites further investigative studies with an increased sample size, multiple sites, and longer duration to support the data and further delineate preemptive actions when caring for the pediatric population with HPIV. 1. Branche AR, Falsey AR. Parainfluenza Virus Infection. Semin Respir Crit Care Med . 2016;37(4):538 ‐ 554. doi:10.1055/s-0036-1584798 2. Pawełczyk M, Kowalski ML. The Role of Human Parainfluenza Virus Infections in the Immunopathology of the Respiratory Tract. Current allergy and asthma reports . 2017;17(3):16. doi:10.1007/s11882-017-0685- 2. 3. DeGroote NP, Haynes AK, Taylor C, et al. Human parainfluenza virus circulation, united states, 2011- 2019. Journal of clinical virology . 2020;124. doi:10.1016/j.jcv.2020.104261 4. Abedi GR, Prill MM, Langley GE, et al. Estimates of Parainfluenza Virus -Associated Hospitalizations and Cost Among Children Aged Less Than 5 Years in the United States, 1998 -2010. J Pediatric Infect Dis Soc. 2016;5(1):7–13. doi:10.1093/jpids/piu047 5. Frost HM, Robinson CC, Dominguez SR. Epidemiology and clinical presentation of parainfluenza type 4 in children: a 3-year comparative study to parainfluenza types 1-3. J Infect Dis. 2014;209(5):695–702. doi:10.1093/infdis/jit552 6. Schomacker H, Schaap- Nutt A, Collins PL, Schmidt AC. Pathogenesis of acute respiratory illness caused by human parainfluenza viruses. CurrOpinVirol . 2012;2(3):294–299. doi:10.1016/j.coviro.2012.02.001

Figure 3: Disease spectrum within HPIV serotypes 1-4. The results demonstrated a significant difference between serotypes and manifestation of croup symptoms (p = 0.015). There were no significant differences between serotypes and whether patients had pharyngitis (p = .545), pneumonia (p = .223), bronchiolitis (p = .891), or URI (p = .251).

Acknowledgements

Figure 4: Patients requiring floor vs. PICU care for each serotype. These differences between serotypes and requirement for general pediatric ward care (p = 0.285) or PICU care (p = 0.238) were not statistically significant

We would like to thank Ning Cheng, PhD biostatistician for performing the statistical analysis of the study

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