title: Viral etiologies of hospitalized acute lower respiratory infection patients in China, 2009-2013.
abstract: BACKGROUND
  Acute lower respiratory infections (ALRIs) are an important cause of acute illnesses and mortality worldwide and in China. However, a large-scale study on the prevalence of viral infections across multiple provinces and seasons has not been previously reported from China. Here, we aimed to identify the viral etiologies associated with ALRIs from 22 Chinese provinces.
  
  
  RESULTS
  Active surveillance for hospitalized ALRI patients in 108 sentinel hospitals in 24 provinces of China was conducted from January 2009-September 2013. We enrolled hospitalized all-age patients with ALRI, and collected respiratory specimens, blood or serum collected for diagnostic testing for respiratory syncytial virus (RSV), human influenza virus, adenoviruses (ADV), human parainfluenza virus (PIV), human metapneumovirus (hMPV), human coronavirus (hCoV) and human bocavirus (hBoV). We included 28,369 ALRI patients from 81 (of the 108) sentinel hospitals in 22 (of the 24) provinces, and 10,387 (36.6%) were positive for at least one etiology. The most frequently detected virus was RSV (9.9%), followed by influenza (6.6%), PIV (4.8%), ADV (3.4%), hBoV (1.9), hMPV (1.5%) and hCoV (1.4%). Co-detections were found in 7.2% of patients. RSV was the most common etiology (17.0%) in young children aged <2 years. Influenza viruses were the main cause of the ALRIs in adults and elderly. PIV, hBoV, hMPV and ADV infections were more frequent in children, while hCoV infection was distributed evenly in all-age. There were clear seasonal peaks for RSV, influenza, PIV, hBoV and hMPV infections.
  
  
  CONCLUSIONS
  Our findings could serve as robust evidence for public health authorities in drawing up further plans to prevent and control ALRIs associated with viral pathogens. RSV is common in young children and prevention measures could have large public health impact. Influenza was most common in adults and influenza vaccination should be implemented on a wider scale in China.
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Luzhao
authors.initials: L
authors.lastname: Feng
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Zhongjie
authors.initials: Z
authors.lastname: Li
authors.affiliation: Yunnan Provincial Center for Disease Control and Prevention, Kunming, China.
authors.forename: Shiwen
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, United Kingdom; Public Health Foundation of India, New Delhi, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Nair
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Lai
authors.affiliation: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Xu
authors.affiliation: Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Mengfeng
authors.initials: M
authors.lastname: Li
authors.affiliation: State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Wu
authors.affiliation: Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Ren
authors.affiliation: Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Shanghai Public Health Clinical Center, Shanghai, China.
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Wang
authors.affiliation: Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Honglong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Fu
authors.initials: F
authors.lastname: Li
authors.affiliation: Shanghai Public Health Clinical Center, Shanghai, China.
authors.forename: Xianfei
authors.initials: X
authors.lastname: Ye
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Sa
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Daniel
authors.initials: D
authors.lastname: Feikin
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
authors.forename: Weizhong
authors.initials: W
authors.lastname: Yang
mesh_terms: D000256:Adenoviridae / Q000302:isolation & purification / Q000472:pathogenicity; D000293:Adolescent; D000328:Adult; D000368:Aged; D052660:Bocavirus / Q000302:isolation & purification / Q000472:pathogenicity; D002648:Child; D002675:Child, Preschool; D002681:China; D017934:Coronavirus / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D029121:Metapneumovirus / Q000302:isolation & purification / Q000472:pathogenicity; D008875:Middle Aged; D009975:Orthomyxoviridae / Q000302:isolation & purification / Q000472:pathogenicity; D018184:Paramyxoviridae Infections / Q000097:blood / Q000209:etiology / Q000821:virology*; D018357:Respiratory Syncytial Virus Infections / Q000097:blood / Q000209:etiology / Q000821:virology*; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification / Q000472:pathogenicity; D012141:Respiratory Tract Infections / Q000097:blood / Q000209:etiology / Q000821:virology*; D012621:Seasons