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Original article
Comparative analysis of acute respiratory infections of viral etiology in children under 6 months with and without nirsevimab in the Balearic Islands (2022–2023 and 2023–2024)
Análisis comparativo de las infecciones respiratorias agudas de etiología viral en menores de 6 meses con y sin nirsevimab en Baleares (2022-2023 y 2023-2024)
Jordi Reinaa,
Corresponding author
jorge.reina@ssib.es

Corresponding author.
, Ane Iturbea, Julia Viana-Ramíreza, Guida Sbertb, Jaume Carrascob, Joaquín Dueñasb
a Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Respiratory syncytial virus &#40;RSV&#41; was discovered in 1955&#44; designated as chimpanzee coryza agent and associated with bronchiolitis in children in 1957&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> It causes acute respiratory diseases &#40;bronchiolitis and pneumonia&#41;&#44; which occur mainly in epidemic form during the winter months&#46; Although it can affect the entire population&#44; its pathological impact is much greater in the paediatric population &#40;aged under five years&#41; and in older adults &#40;over-65&#8239;s&#41;&#46; It is estimated to be responsible for 22&#37; of acute respiratory infections &#40;ARI&#41; in the child population&#46; A 2015 global study estimated that RSV caused 33&#46;1 million ARI per year&#44; resulting in nearly 3&#46;2 million hospitalisations and some 59&#44;000 in-hospital deaths in children under five years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> In children under six months of age&#44; RSV causes around 1&#46;4 million hospitalisations and nearly 27&#44;300 deaths annually&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Until a year ago&#44; there were no preventive measures available to address RSV infections&#44; so most children became infected naturally&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; in 2023&#44; a monoclonal antibody &#40;nirsevimab&#41; was marketed in Spain that specifically targets the &#8220;zero site &#40;&#934;&#41;&#8221; &#40;highly conserved&#41; of the pre-F form of RSV&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> Different clinical trials have demonstrated an efficacy close to 85&#37; in preventing hospital admission and ICU admission of patients infected by RSV&#44; as well as a significant decrease in the overall disease burden &#40;visits to health centres and hospital accident and emergency &#91;A&#38;E&#93; departments&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There are no studies on the viral aetiology of ARI affecting the population immunised with nirsevimab&#46; We therefore decided to analyse the impact of this immunisation on the need for hospital visits &#40;A&#38;E burden&#41; due to ARI in the population under six months of age&#46; We compared the viral aetiology of ARI diagnosed in the 2022&#8211;2023 and 2023&#8211;2024 seasons&#44; and in the latter season&#44; between recipients and non-recipients of the anti-RSV monoclonal antibody&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">In the Balearic Islands&#44; RSV immunisation began late&#44; starting on 27 November 2023 &#40;week 48&#41;&#46; Those born from 1 April to that date were immunised in their local health centres&#44; and those born after that date were immunised after birth in the different hospitals&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> The overall provisional coverage was 77&#37; of the target population&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">From 27 November 2023 to 31 March 2024&#44; all infants under six months of age who attended the A&#38;E with an ARI &#40;bronchiolitis or similar&#41; were prospectively studied&#59; each one had a nasopharyngeal aspirate sample taken and this was transported straight to the laboratory&#46; The different respiratory viruses were detected using a commercial real-time polymerase chain reaction &#40;RT-PCR&#41; &#40;Allplex Respiratory Assay&#44; Seegen&#41;&#44; which simultaneously detects and differentiates 18 different respiratory viruses&#46; In the 2022&#8211;2023 season&#44; SARS-CoV-2 was detected using a different technique&#44; separate from the rest of the respiratory viruses&#44; and the positive results have not been included&#46; The results were compared with those obtained in the 2022&#8211;2023 season&#46; We only studied the viral aetiology of these infections&#44; not looking at any relationship with possible associated hospital admission&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">The epidemiological change over time of RSV detection in the entire paediatric population &#40;&#60;15 years&#41; studied in both seasons is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The 2022&#8211;2023 season lasted 16 weeks and the maximum epidemic peak was 58&#46;8 cases&#47;100&#44;000&#44; while the current season lasted 10 weeks and reached a maximum of 44&#46;1 cases&#47;100&#44;000&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">During the same study period&#44; in the 2022&#8211;2023 season&#44; 303 children under six months of age were detected with an ARI&#44; while in the 2023&#8211;2024 season&#44; the figure was 278 children &#40;19&#37; fewer&#41;&#46; Detection in the first season was 79&#46;9&#37; compared to 70&#46;5&#37; in the current season&#46; Only one virus was detected per patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In the 2022&#8211;2023 season&#44; the predominant virus was RSV &#40;36&#46;6&#41;&#44; followed by rhinovirus &#40;25&#46;7&#37;&#41; and influenza virus &#40;6&#46;2&#37;&#41;&#44; with 10 different viruses detected in total&#46; SARS-CoV-2 has not been included this season&#44; as it was performed using another technique and data on this virus were not obtained in this age group&#46; In the current season&#44; the predominant viruses were rhinovirus &#40;17&#46;6&#37;&#41;&#44; metapneumovirus &#40;14&#37;&#41;&#44; coronavirus OC43 &#40;7&#46;5&#37;&#41;&#44; RSV &#40;6&#46;8&#37;&#41; and influenza virus &#40;6&#46;4&#37;&#41;&#44; with 11 different viruses detected&#44; including SARS-CoV-2 &#40;5&#46;3&#37;&#41;&#46; Of the 242 patients in whom some virus was detected &#40;positive cases&#41; in the 2022&#8211;2023 season&#44; RSV accounted for 45&#46;6&#37; and the influenza virus 7&#46;8&#37;&#44; compared to 9&#46;6&#37; and 9&#46;1&#37;&#44; respectively&#44; in the 2023&#8211;2024 season &#40;196 cases&#41;&#46; A significant difference in RSV detection was observed between the two groups and a decrease of 82&#46;9&#37; in cases in the current season&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Of the 278 cases of children under six months detected in the 2023&#8211;2024 season&#44; 192 &#40;69&#46;1&#37;&#41; were immunised with nirsevimab and 86 &#40;30&#46;9&#37;&#41; were not&#44; either due to refusal or not attending the consultation &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The percentage of positivity in those immunised was 69&#46;3&#37;&#44; compared to 73&#46;3&#37; of those not immunised&#46; The predominant viruses in the immunised group were&#58; rhinovirus &#40;18&#46;2&#37;&#41;&#44; influenza virus &#40;5&#46;7&#37;&#41;&#44; SARS-CoV-2 &#40;5&#46;2&#37;&#41; and RSV &#40;4&#46;1&#37;&#41;&#44; while in the non-immunised group the most commonly detected viruses were&#58; rhinovirus &#40;16&#46;2&#37;&#41;&#44; RSV &#40;12&#46;7&#37;&#41;&#44; influenza virus &#40;8&#46;1&#37;&#41; and SARS-CoV-2 &#40;5&#46;8&#37;&#41;&#46; Significant differences between the two groups were found in the detection of RSV and influenza&#46; The eight cases of RSV in immunised children corresponded to two RSV-A &#40;25&#37;&#41; and six RSV-B &#40;75&#37;&#41;&#44; while in the 11 cases of RSV in non-immunised children&#44; four were RSV-A &#40;36&#46;4&#37;&#41; and seven RSV-B &#40;63&#46;6&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">From an epidemiological point of view&#44; the current RSV season has been quantitatively lower than the 2022&#8211;2023 season&#44; not only in terms of duration but also in community intensity&#59; 501 cases of RSV infection were detected during that season&#44; compared to 280 this season &#40;44&#46;2&#37; fewer cases&#41;&#46; These initial data seem to point to a first impact of universal immunisation with nirsevimab&#44; despite the very late start&#44; already at the peak of the epidemic&#44; and with a vaccination coverage of 77&#37;&#44; well below the national average of 91&#46;9&#37; &#40;range between 85&#46;7&#37; and 96&#46;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; in the previous season&#44; it was predominantly the RSV-A serotype that circulated &#40;70&#46;2&#37;&#41;&#44; while this season it was RSV-B &#40;82&#46;4&#37;&#41;&#59; the RSV-B subtype has been shown to affect the older paediatric population&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> It is therefore difficult to assess this comparative overall decline in cases&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Comparing the viral aetiology of children under six months of age between the two seasons&#44; we found that in the 2022&#8211;2023 season&#44; a respiratory virus was detected in 79&#46;9&#37; of these patients&#44; compared to 70&#46;5&#37; of the current group&#44; without identifying any statistical differences&#46; It is worth noting that in the previous season&#44; without immunisation&#44; RSV was the most predominant virus&#44; with 111 cases &#40;36&#46;6&#37;&#41;&#44; compared to 19 cases &#40;6&#46;8&#37;&#41; in the current season&#44; which is a statistically significant difference&#46; RSV accounted for 45&#46;8&#37; of all viruses detected in the 2022&#8211;2023 season&#44; compared to 9&#46;6&#37; in the current season&#46; The high prevalence of RSV in the previous season barely allowed the circulation of other respiratory viruses&#44; and in the current season the ecological niche left by RSV has been occupied by other viruses&#44; mainly metapneumovirus&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Analysing the group of children aged under six months &#8211; the target of immunisation &#8211; between the two seasons&#44; we found that 278 cases were detected overall this season&#44; which represents a decrease of only 19&#46;1&#37;&#46; These data refer only to this age group&#44; as a 41&#37; increase in cases was observed in the two-to-five age group&#59; that is&#44; there was a shift of RSV infection to older ages&#44; in which the virus does not have the same morbidity as in children under six months of age&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Nirsevimab is a highly-specific monoclonal antibody against the RSV pre-F protein&#59; its administration would not therefore be expected to lead to a decrease or an effect on other respiratory viruses and&#44; as a consequence&#44; on acute respiratory disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> We found that some respiratory virus &#40;including RSV&#41; could be detected in 69&#46;3&#37; of immunised children&#44; compared to 73&#46;3&#37; of non-immunised children&#44; which seems to indicate that immunisation does not prevent or avoid respiratory infection by viruses other than RSV&#46; In their phase 3b HARMONIE study&#44; Drysdale et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported a 58&#37; reduction in the incidence of hospital admissions for lower respiratory tract disease from any cause&#44; including other respiratory viruses&#46; Our study is only aetiological and was carried out with patients who came to the Accident and Emergency department with ARI&#44; without analysing whether or not their hospital admission was determined by other viral respiratory infections&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The respiratory viruses that infected both groups are practically the same&#44; that is&#44; those that circulated in the absence of RSV&#46; Rhinovirus and metapneumovirus were the viruses most frequently detected in both groups&#46; The influenza A virus appears to have infected somewhat more non-immunised patients &#40;8&#46;1&#37; compared to 5&#46;7&#37;&#41;&#44; but not significantly&#46; The greatest impact&#44; as expected&#44; was the detection of RSV and&#44; although the difference between the two groups was only three cases&#44; the percentages of detection &#40;4&#46;1&#37; versus 12&#46;7&#37;&#41; do show statistical significance&#46; In the immunised group&#44; nirsevimab would have a vaccine effectiveness of 95&#46;9&#37;&#46; Of all the positive cases detected in the immunised group&#44; RSV accounted for only 6&#37; &#40;8&#47;133&#41;&#44; compared to 17&#46;4&#37; &#40;11&#47;63&#41; in the non-immunised group&#46; That is to say&#44; late immunisation has led to a significant reduction in the number of cases in that group and also overall since this preventive process began&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The eight cases of children immunised with nirsevimab who developed RSV infection could probably be explained by vaccination failures &#40;viral load cycle threshold &#91;CT&#93; &#60;26&#41;&#44; by the fact that the effectiveness of the monoclonal does not exceed 85&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> or by escape mutants resistant to it&#46; However&#44; studies carried out on these mutants&#44; mainly RSV-B&#44; have shown a circulation below 1&#37; of the total&#44; and that does not appear to have changed in recent seasons&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This is logical&#44; as until now RSV circulated freely without any human immunological pressure&#59; therefore&#44; from now on&#44; the molecular characteristics of RSV detected in the immunised population should be monitored&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite its late implementation&#44; universal immunisation with nirsevimab in children under six months of age in the Balearic Islands has shown a significant reduction in RSV infections compared to the 2022&#8211;2023 season&#46; It does not appear&#44; however&#44; that it can reduce infections by other respiratory viruses&#44; especially by metapneumovirus&#44; which seems to be able to occupy the ecological niche left by RSV after its drastic elimination&#44; and which could be prevented by common immunisation with RSV&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In subsequent seasons&#44; it will be necessary to evaluate whether the new respiratory viruses that are occupying the RSV niche led to hospital admission rates similar to or lower than this virus&#46; In our study&#44; nirsevimab only reduced A&#38;E visits by 19&#37;&#44; since patients came in for other viral aetiologies&#46; To determine the real impact of nirsevimab in the infant population under six months of age&#44; it is very important to continue monitoring subsequent RSV epidemic seasons with complete universal immunisation both epidemiologically and virologically&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0085" class="elsevierStylePara elsevierViewall">No funding was received for the completion of this study&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Since 2023&#44; a monoclonal antibody &#40;nirsevimab&#41; specifically directed against the preF form of RSV has been marketed in Spain&#46; The impact of late immunization in the population &#60;6 months as a cause of other respiratory infections requiring a hospital visit has been analyzed&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The viral etiology of acute respiratory infections &#40;ARIs&#41; diagnosed in the 2022&#8211;2023 and 2023&#8211;2024 seasons has been prospectively compared&#44; and in this last season between recipients and non-recipients of nirsevimab&#46; Global provisional coverage was 77&#37; of the population&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In the 2022&#8211;2023 season&#44; 303&#8239;&#60;&#8239;6 months with an ARI were detected&#44; while in the 2023&#8211;2024 season there were 278 minors &#40;19&#37; less&#41;&#46; The positivity in the first season was 79&#46;9&#37; compared to 70&#46;5&#37; in the current season&#46; A significant difference has been observed in the detection of RSV between both groups and a decrease of 82&#46;9&#37; of cases in the current season&#46; Of the 278 cases &#60;6 months detected in the 2023&#8211;2024 season&#44; 192 &#40;69&#46;1&#37;&#41; received immunization with nirsevimab and 86 &#40;30&#46;9&#37;&#41; did not receive it&#46; The percentage of positivity in those immunized was 69&#46;3&#37;&#44; compared to 73&#46;3&#37; in those not immunized&#46; Significant differences have been observed in the detections of RSV and influenza between both groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Immunization at &#60;6 months with nirsevimab has shown a significant reduction in RSV infections compared to the previous season&#46; It does not seem&#44; however&#44; that it can reduce infections by other respiratory viruses&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Desde 2023 se comercializa en Espa&#241;a un anticuerpo monoclonal &#40;nirsevimab&#41; dirigido espec&#237;ficamente frente a la forma preF del VRS&#46; Se ha analizado el impacto de la inmunizaci&#243;n tard&#237;a en la poblaci&#243;n&#8239;&#60;&#8239;6 meses como causa de otras infecciones respiratorias con necesidad de visita hospitalaria&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se ha comparado de forma prospectiva la etiolog&#237;a viral de las infecciones respiratorias agudas diagnosticadas en las temporadas 2022&#8211;2023 y 2023&#8211;2024&#44; y en esta &#250;ltima temporada entre los receptores y no receptores de nirsevimab&#46; La cobertura provisional global fue del 77&#37; de la poblaci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">En la temporada 2022-2023 se detectaron 303&#8239;&#60;&#8239;6 meses con una infecci&#243;n respiratoria aguda &#40;IRA&#41;&#44; mientras que en la temporada 2023&#8211;2024 fue de 278 menores &#40;un 19&#37; menos&#41;&#46; La positividad en la primera temporada fue del 79&#44;9&#37;&#44; frente al 70&#44;5&#37; de la temporada actual&#46; Se ha observado una diferencia significativa en la detecci&#243;n de VRS entre ambos grupos y una disminuci&#243;n del 82&#44;9&#37; de casos en la temporada actual&#46; De los 278 casos de&#8239;&#60;&#8239;6 meses detectados en la temporada 2023&#8211;2024&#44; 192 &#40;69&#44;1&#37;&#41; recibieron inmunizaci&#243;n con nirsevimab y 86 &#40;30&#44;9&#37;&#41; no la recibieron&#46; El porcentaje de positividad en los inmunizados fue del 69&#44;3&#37;&#44; frente al 73&#44;3&#37; de los no inmunizados&#46; Se han observado diferencias significativas en las detecciones de VRS y gripe entre ambos grupos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La inmunizaci&#243;n a los&#8239;&#60;&#8239;6 meses con nirsevimab ha mostrado una reducci&#243;n significativa de infecciones por VRS en comparaci&#243;n con la temporada anterior&#46; No parece&#44; sin embargo&#44; que pueda disminuir las infecciones por otros virus respiratorios&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#8239;&#61;&#8239;303&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#8239;&#61;&#8239;278&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rhinovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metapneumovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coronavirus OC43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RSV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111 &#40;36&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;6&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SARS-CoV-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parainfluenzavirus 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bocavirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enterovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parainfluenzavirus 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;20&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;29&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">242 &#40;79&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">196 &#40;70&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparison between viruses detected in children under six months of age with acute respiratory infection&#46;</p>"
        ]
      ]
      2 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Number of patients &#40;&#37;&#41;&#46; There was only one virus per patient&#46;</p>"
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            0 => array:2 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">With nirsevimab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Without nirsevimab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#8239;&#61;&#8239;192&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#8239;&#61;&#8239;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rhinovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metapneumovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Coronavirus OC43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SARS-CoV-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parainfluenzavirus 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RSV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenovirus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bocavirus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enterovirus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Parainfluenzavirus 4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">59 &#40;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">133 &#40;69&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63 &#40;73&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Detection of respiratory viruses in patients under six months of age with acute respiratory infection &#40;2023&#8211;2024&#41;&#46;</p>"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;J&#46; Muller"
                            1 => "S&#46;A&#46; Madhi"
                            2 => "B&#46; Seoane Nu&#241;ez"
                            3 => "M&#46; Baca Cots"
                            4 => "M&#46; Bosheva"
                            5 => "R&#46; Dagan"
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                            0 => "S&#46;B&#46; Drysdale"
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                            3 => "M&#46; Knuf"
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                      "titulo" => "Nirsevimab for the prevention of respiratory syncytial virus disease in children&#46; Statement of Spanish Society of Paediatric Infectious Disease &#40;SEIP&#41;"
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                        0 => array:2 [
                          "etal" => true
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Original language: English
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