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Respiratory viruses associated with community-acquired pneumonia in children: matched case–control study
  1. Samuel Rhedin1,
  2. Ann Lindstrand2,3,
  3. Annie Hjelmgren1,
  4. Malin Ryd-Rinder4,
  5. Lars Öhrmalm1,
  6. Thomas Tolfvenstam1,2,
  7. Åke Örtqvist1,5,
  8. Maria Rotzén-Östlund6,7,
  9. Benita Zweygberg-Wirgart6,7,
  10. Birgitta Henriques-Normark6,7,
  11. Kristina Broliden1,
  12. Pontus Naucler1
  1. 1Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
  2. 2The Public Health Agency of Sweden, Stockholm, Sweden
  3. 3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Clinical Science and Education, Karolinska Institutet, Sachs’ Children and Youth Hospital, South General Hospital, Stockholm, Sweden
  5. 5Department of Communicable Disease and Control, Stockholm County Council, Stockholm, Sweden
  6. 6Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
  7. 7Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Samuel Rhedin, Infectious Diseases Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm 171 76, Sweden; samuel.rhedin{at}


Background Community-acquired pneumonia (CAP) is the leading cause of death in children worldwide and a substantial proportion of childhood CAP is caused by viruses. A better understanding of the role of virus infections in this condition is needed to improve clinical management and preventive measures. The aim of the study was therefore to assess the association between specific respiratory viruses and childhood CAP.

Methods A case–control study was conducted during 3 years in Stockholm, Sweden. Cases were children aged ≤5 years with radiological CAP. Healthy controls were consecutively enrolled at child health units during routine visits and matched to cases on age and calendar time. Nasopharyngeal aspirates were obtained and analysed by real-time PCR for 15 viruses. Multivariate conditional logistic regression was used to account for coinfections with other viruses and baseline characteristics.

Results A total of 121 cases, of which 93 cases met the WHO criteria for radiological pneumonia, and 240 controls were included in the study. Viruses were detected in 81% of the cases (n=98) and 56% of the controls (n=134). Influenza virus, metapneumovirus and respiratory syncytial virus were detected in 60% of cases and were significantly associated with CAP with ORs >10. There was no association with parainfluenza virus, human enterovirus or rhinovirus and coronavirus and bocavirus were negatively associated with CAP.

Conclusions Our study indicates viral CAP is an underestimated disease and points out hMPV as a new important target for the prevention of childhood CAP.

  • Pneumonia
  • Viral infection
  • Clinical Epidemiology
  • Paediatric Physician
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