Chunyun Fu, Qiang Huang, Xiaoying Chen, Haifeng Huang, Junming Lu, Jia Lu, Jiaqi Wen, Lishai Mo, Wenting Tang, Jiangyang Zhao, Yili Zhang, Xiangjun Lu, Yanhua Feng, Yanqing Tang, Shang Yi, Hao Wei, Huiping Huang, Xuehua Hu, Jie Tan
IBV and IAV show similar age distributions and comparably high polymicrobial detection rates in hospitalized children. Importantly, multivariable analysis unmasked that IBV infection independently predicted a higher requirement for respiratory support than IAV, with younger age and female sex identifying particularly vulnerable cohorts. Clinicians should maintain high vigilance for respiratory progression in pediatric IBV inpatients.
OBJECTIVES: This study aimed to characterize the clinical and epidemiological features of hospitalized children with IBV and compare them with those of influenza A virus (IAV).
METHODS: We enrolled 10,143 pediatric inpatients with ARI between April 2021 and December 2024. Pathogen screening was conducted using targeted next-generation sequencing. Multivariable logistic regression was performed to identify independent predictors for respiratory support requirements.
RESULTS: IBV was detected in 198 children (2.0%). Compared to children with IAV (n = 325), IBV-positive children showed similar age distribution (median: 38 vs. 42 months, p = 0.464) and similarly high polymicrobial detection rates (96.0% vs. 97.2%, p = 0.365). The most frequently co-detected microbes were Haemophilus influenzae, Streptococcus pneumoniae, and Mycoplasma pneumoniae, similar between groups, though the prevalence of H. influenzae was higher in the IBV group than in the IAV group (p = 0.017). Children with IBV required less frequent respiratory support than those with IAV (12.6% vs. 20.6%, p = 0.020). However, multivariable analysis reversed this trend: IBV infection independently predicted a higher risk for respiratory support than IAV (aOR = 1.882, 95% CI: 1.134-3.123, p = 0.014). Younger age (aOR = 0.990, p = 0.009) and female sex (aOR for males = 0.503, p = 0.009) were also independent risk factors. Among IBV cases, 31.3% developed respiratory complications and 46.0% presented with extrapulmonary manifestations. Outcomes were favorable with a median hospitalization of 6 days, low ICU admission rate (4.0%), and no mortality.
CONCLUSION: IBV and IAV show similar age distributions and comparably high polymicrobial detection rates in hospitalized children. Importantly, multivariable analysis unmasked that IBV infection independently predicted a higher requirement for respiratory support than IAV, with younger age and female sex identifying particularly vulnerable cohorts. Clinicians should maintain high vigilance for respiratory progression in pediatric IBV inpatients.