N orth– S outh divide: Distribution and outcome of respiratory viral infections in paediatric intensive care units in C ape T own ( S outh A frica) and N ottingham ( U nited K ingdom)

Aim This study aims to describe and compare the spectrum, course, seasonality and outcome of children with virus‐associated respiratory symptoms ( VARS ) admitted to two paediatric intensive care units ( PICU s) in the U nited K ingdom ( UK ) and S outh A frica ( SA ). Methods Cross‐sectional study of routinely collected data on subjects admitted to PICU with respiratory symptoms and positive respiratory viral polymerase chain reaction between J uly 2009 and J uly 2011. Results Six hundred forty‐six samples yielding 765 viral isolates (74% from SA ) from 599 patients (53% male; median (interquartile range) age 6.0 (2.3–16.5) months) were included. Rhinovirus, respiratory syncytial virus and adenovirus were most commonly isolated. Adenovirus was more prevalent in SA (24.3% vs. 16.8%, P = 0.03). Possible or likely nosocomial viral acquisition occurred in 78% of isolates in SA versus 48% in the UK ( P < 0.0001).Total mortality was 13.5%; 17% in SA versus 4% in the UK ( P < 0.0001). Mortality for community acquired VARS was 8.4% versus 16.1% in those with possible nosocomial viral acquisition ( P = 0.009). Factors independently associated with mortality were: SA study site (adjusted odds ratio ( OR ) 3.4, 95% confidence interval ( CI ) 1.4–8.5; P = 0.008); age (months) ( OR 1.0, 95% CI 1.0–1.02; P = 0.001); Paediatric Index of Mortality 2 score (%) ( OR 1.0, 95% CI 1.01–1.03; P = 0.0002) and isolation of adenovirus ( OR 3.0, 95% CI 1.8–5.0; P < 0.0001). Conclusions The outcome of children with VARS was worse in SA compared with the UK PICU . Nosocomial VARS was highlighted as an important concern and requires further investigation.