Research Article
Multiple Viral Infection Detected from Influenza-Like
Illness Cases in Indonesia
Kindi Adam, Krisna Nur Andriana Pangesti, and Vivi Setiawaty
Research and Development Center for Biomedical and Basic Health Technology, Jakarta, Indonesia
Correspondence should be addressed to Vivi Setiawaty; vivisetiawaty@hotmail.com
Received 27 July 2016; Revised 22 November 2016; Accepted 13 December 2016; Published 23 January 2017
Academic Editor: Sumit Sharma
Copyright © 2017 Kindi Adam et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Infuenza is one of the common etiologies of the upper respiratory tract infection (URTI). However, infuenza virus only contributes
about 20 percent of infuenza-like illness patients. Te aim of the study is to investigate the other viral etiologies from ILI cases
in Indonesia. Of the 334 samples, 266 samples (78%) were positive at least for one virus, including 107 (42%) cases of multiple
infections. Infuenza virus is the most detected virus. Te most frequent combination of viruses identifed was adenovirus and
human rhinovirus. Tis recent study demonstrated high detection rate of several respiratory viruses from ILI cases in Indonesia.
Further studies to determine the relationship between viruses and clinical features are needed to improve respiratory disease control
program.
1. Introduction
Lower respiratory tract infection (LRTI) remains one of the
major causes of mortality and morbidity in children under
fve years globally [1]. Viruses have already been recog-
nized as important etiologies of respiratory infections with
infuenza virus which is considered as the main contributor.
Te epidemiology and public health impact of infuenza
infections are relatively well described as many studies and
surveillance have been conducted in part of pandemic pre-
paredness [2–5]. Most of the countries in the world, including
Indonesia, have developed infuenza surveillance, infuenza-
like illness (ILI) surveillance, and severe acute respiratory
illness (SARI), which form the network under WHO through
Global Infuenza Surveillance and Response Systems (GISRS)
[4–8]. Tis network improves infuenza disease control by
providing support on infuenza vaccine recommendation,
laboratory diagnostic tools, antiviral, and public health risk
assessment. As infuenza virus contributed only less than 30
percent of viral respiratory infections, there is an urge to
investigate the contribution of other respiratory viruses for
improving respiratory disease control program [6].
Recent advancement of molecular technology supports
the investigation and characterization of several respiratory
viruses. Te molecular technology improves the capability
to study respiratory viruses, which are previously identi-
fed: rhinovirus, adenovirus, respiratory syncytial viruses,
parainfuenza virus, and also the new emerging viruses/strain
viruses: MERS coronavirus, human metapneumovirus, and
human rhinovirus strain C. Multiple detection platforms,
which recently have been developed, allows relatively inex-
pensive and timely detection of several viruses [9–11]. Te
detection of multiple respiratory viruses will accommodate
the eforts to determine the epidemiology of noninfuenza
respiratory viruses in the community, which will further help
the respiratory disease control program including the use of
antimicrobial agents [12].
Previous results of the investigation on acute respiratory
infection patients in several countries showed the diference
in the prevalence of respiratory viruses among studies [3,
13–15]. Study design including the case defnition, study
population, time of the study, and diagnostic tools being used
have been considered as factors that infuenced the variation
[16]. Each virus has diferent seasonality circulation and an
age-related prevalence that can lead to a specifc pattern of
virus cocirculation in many studies [17–19]. Moreover, the
occurrence of virus coinfection in which two or more viruses
are detected in a single patient has been described in recent
studies using multiple pathogen detection platforms [20–22].
Hindawi
BioMed Research International
Volume 2017, Article ID 9541619, 5 pages
https://doi.org/10.1155/2017/9541619