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H600.6 P928 51:11
iexas Preventa e
contents:
National Rest
Physicians' T
TDH Philoso
Frank Bryant, Jr. MD, FAAFP Robert Bernstein. MD. FACP Infectious Dis
Chairman Commissioner STD Training
Texas Board of Health Vaccine-Prev
Immunization
Bureau of Disease Control and Epidemiology,
1100 West 49th Street, Austin, Texas 78756 (512-458-7455)
I ______________________________________
SS STATE
DiCMJENTS COLLECTION
Vol. 51, No. 11
June 1, 1991
piratory Virus Surveillance System
B Conference
phy on Breastfeeding
diseases from the Persian Gulf
g Courses
entable Disease Update
Notes
NATIONAL RESPIRATORY VIRUS SURVEILLANCE SYSTEM
To provide public health
officials and health-care
providers with additional
information about the
epidemiology of respiratory
viruses such as respiratory
syncytial virus (RSV),
parainfluenza, and adeno-
viruses, the Centers for
Disease Control (CDC)
maintains a nationwide
respiratory virus surveillance
system. Nationwide data for
RSV are collected from 94
centers representing 49 states.
Data for parainfluenza and
adenoviruses are collected
from 52 and 44 centers,
respectively.
For the purposes of this
surveillance program, the US
is divided into nine geographic
regions. Texas, Oklahoma,
Arkansas, and Louisiana
constitute the West South
Central Region. In Texas, data
are submitted monthly from
the Medical Virology Section
of the TDH Bureau of
Laboratories and from nine
major hospital laboratories
across the state. * Most of these
laboratories perform enzyme
immunoassay (EIA) and/or
direct fluorescent antibody
(DFA) tests to detect RSV and
DFA and/or indirect fluorescent
antibody (IFA) tests to detect
parainfluenza and adenoviruses.
RSV: RSV is the single most
important respiratory patho-
gen of infancy and early child-
hood worldwide. In temper-
ate climates, RSV causes
yearly outbreaks of pneumo-
nia and bronchiolitis in the
winter and early spring. In the
West South Central Region,
virus activity begins to inten-
sify during the months of Sep-
tember through November,
with peak activity occurring
from December through
March (Figure 1). RSV sea-
son usually precedes influenza
season by at least two months.
Symptoms of RSV infection
in all age groups include fe-
ver, rhinitis, and/or pharyn-
gitis, with minimal involve-
ment of the bronchi. Among
healthy older children and
adults, RSV infection re-
sembles a cold which may or
may not be accompanied by
cough and fever. In younger
children, RSV is an important
cause of otitis media.
RSV infections pose the great-
est risk of severe morbidity
among infants, particularly
those between the ages of 2
and 6 months. Approximately
1 % of infants with severe RSV
infection require hospitaliza-
tion. Symptoms in these se-
vere cases include rhinorrhea,
fever, and cough, progressing
to dyspnea, wheezing, and
cyanosis. Current antiviral
therapy for these severe cases
includes ribavirin adminis-
tered via a nebulizer.
Parainfluenza virus: Al-
though parainfluenza virus
Texas Department of Health
infections occur throughout
the year nationwide, there are
distinct seasonal trends in
many of the geographic re-
gions. In the West South Cen-
tral Region, periods of in-
tense viral activity occur in
the fall during the months of
September through early De-
cember, and in the spring from
late March through June (Fig-
ure 1). Parainfluenza virus
type 1 is most active in the
fall, while parainfluenza vi-
rus type 3 predominates in
spring. (Antigen detection
assays demonstrate that para-
influenza virus type 3 circu-
lates throughout the year at
low levels and peaks in the
spring.) Parainfluenza virus
type 2 circulates in the popu-
lation during both times of the
year, but at less intense lev-
els.
The vast majority (97%) of
parainfluenza virus infections
are relatively mild, with
coryza, pharyngitis, low-
grade fever, and minor
bronchitis as the main
symptoms. As with RSV,
parainfluenza viruses can
cause serious infection in
infants and young children and
* Driscoll Foundation Children's Hospital
- Corpus Christi; Children's Medical Cen-
ter - Dallas; Providence Memorial Hospital
- El Paso; R.E. Thomason General Hospi-
tal - El Paso; University of Texas School of
Medicine - Houston; Mercy Regional Medi-
cal Center- Laredo; University Medical
Center - Lubbock; Methodist Hospital -
Lubbock; Santa Rosa Medical Center - San
Antonio.
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