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Nisar M, Kerai S, Shahid S, Qazi M, Rehman S, Aziz F, Jehan F. Predictors of Respiratory Syncytial Virus, Influenza Virus, and Human Metapneumovirus Carriage in Children Under 5 Years With WHO-Defined Fast-Breathing Pneumonia in Pakistan. Influenza Other Respir Viruses 2024; 18:e13285. [PMID: 38616564 PMCID: PMC11016811 DOI: 10.1111/irv.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality in children < 5 years. We describe nasopharyngeal carriage of respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus among children with fast-breathing pneumonia in Karachi, Pakistan. METHODS We performed a cross-sectional analysis of nasopharyngeal swabs from children aged 2-59 months with fast-breathing pneumonia, enrolled in the randomized trial of amoxicillin versus placebo for fast-breathing pneumonia (RETAPP) (NCT02372461) from 2014 to 2016. Swabs were collected using WHO standardized methods, processed at the Aga Khan University, Pakistan. Viral detection was performed using LUMINEX xTAG respiratory viral panel assay and logistic regression identified clinical and sociodemographic predictors. FINDINGS Of the 1000 children tested, 92.2% (n = 922) were positive for viral carriage. RSV, hMPV, and influenza virus were detected in 59 (6.4%), 56 (6.1%), and 58 (6.3%) children and co-infections in three samples (two RSV-hMPV and one influenza-hMPV). RSV carriage was common in infants (56%), we observed a higher occurrence of fever in children with hMPV and influenza virus (80% and 88%, respectively) and fast breathing in RSV (80%) carriage. RSV carriage was positively associated with a history of fast/difficulty breathing (aOR: 1.96, 95% CI 1.02-3.76) and low oxygen saturation (aOR: 2.52, 95% CI 1.32-4.82), hMPV carriage was positively associated with a complete vaccination status (aOR: 2.22, 95% CI 1.23-4.00) and body temperature ≥ 37.5°C (aOR: 2.34, 95% CI 1.35-4.04) whereas influenza viral carriage was associated with body temperature ≥ 37.5°C (aOR: 4.48, 95% CI 2.53-7.93). CONCLUSION We observed a high nasopharyngeal viral carriage among children with WHO-defined fast-breathing pneumonia in Pakistan. Fever, difficulty in breathing, hypoxia and vaccination status are important clinical predictors for viral nonsevere community-acquired pneumonia.
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Affiliation(s)
| | - Salima Kerai
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Shahira Shahid
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | | | - Sarah Rehman
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Fatima Aziz
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
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2
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Mertens A, Benjamin-Chung J, Colford JM, Coyle J, van der Laan MJ, Hubbard AE, Rosete S, Malenica I, Hejazi N, Sofrygin O, Cai W, Li H, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Jilek W, Subramoney V, Hafen R, Häggström J, Norman T, Brown KH, Christian P, Arnold BF. Causes and consequences of child growth faltering in low-resource settings. Nature 2023; 621:568-576. [PMID: 37704722 PMCID: PMC10511328 DOI: 10.1038/s41586-023-06501-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/31/2023] [Indexed: 09/15/2023]
Abstract
Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | | | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
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3
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Mertens A, Benjamin-Chung J, Colford JM, Hubbard AE, van der Laan MJ, Coyle J, Sofrygin O, Cai W, Jilek W, Rosete S, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Malenica I, Hejazi N, Li H, Hafen R, Subramoney V, Häggström J, Norman T, Christian P, Brown KH, Arnold BF. Child wasting and concurrent stunting in low- and middle-income countries. Nature 2023; 621:558-567. [PMID: 37704720 PMCID: PMC10511327 DOI: 10.1038/s41586-023-06480-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/25/2023] [Indexed: 09/15/2023]
Abstract
Sustainable Development Goal 2.2-to end malnutrition by 2030-includes the elimination of child wasting, defined as a weight-for-length z-score that is more than two standard deviations below the median of the World Health Organization standards for child growth1. Prevailing methods to measure wasting rely on cross-sectional surveys that cannot measure onset, recovery and persistence-key features that inform preventive interventions and estimates of disease burden. Here we analyse 21 longitudinal cohorts and show that wasting is a highly dynamic process of onset and recovery, with incidence peaking between birth and 3 months. Many more children experience an episode of wasting at some point during their first 24 months than prevalent cases at a single point in time suggest. For example, at the age of 24 months, 5.6% of children were wasted, but by the same age (24 months), 29.2% of children had experienced at least one wasting episode and 10.0% had experienced two or more episodes. Children who were wasted before the age of 6 months had a faster recovery and shorter episodes than did children who were wasted at older ages; however, early wasting increased the risk of later growth faltering, including concurrent wasting and stunting (low length-for-age z-score), and thus increased the risk of mortality. In diverse populations with high seasonal rainfall, the population average weight-for-length z-score varied substantially (more than 0.5 z in some cohorts), with the lowest mean z-scores occurring during the rainiest months; this indicates that seasonally targeted interventions could be considered. Our results show the importance of establishing interventions to prevent wasting from birth to the age of 6 months, probably through improved maternal nutrition, to complement current programmes that focus on children aged 6-59 months.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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4
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Ahmed S, Ariff S, Muhammed S, Rizvi A, Ahmed I, Soofi SB, Bhutta ZA. Community case management of fast-breathing pneumonia with 3 days oral amoxicillin vs 5 days cotrimoxazole in children 2-59 months of age in rural Pakistan: A cluster randomized trial. J Glob Health 2022; 12:04097. [PMID: 36579494 PMCID: PMC9798244 DOI: 10.7189/jogh.12.04097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Pneumonia is the leading cause of mortality in under-five children and most of these deaths occur in South-East Asia and Africa. Fast breathing pneumonia if not treated can progress to lower chest indrawing pneumonia. Treatment recommendation by the World Health Organization (WHO) for fast-breathing pneumonia includes oral amoxicillin and cotrimoxazole (as an alternative). Due to limited access to health care facilities and skilled health care workers, many children are unable to receive antibiotics. Algorithm-based community case management of pneumonia through trained community health workers has resulted in a decline in morbidity and mortality in low- and middle-income countries (LMIC). Methods It was a cluster-randomized, unblinded, community-based trial conducted in the Matiari district of Sindh province, Pakistan. Lady Health Workers (LHWs) were trained in assessing, classifying, and managing fast-breathing pneumonia cases (Respiratory rate of >50 breaths/min) at home with oral amoxicillin for three days and with co-trimoxazole for five days in the intervention and control arms respectively. Children with fast-breathing pneumonia were screened by LHWs and were validated by the study by Community Health Workers (CHWs) within 48 hours. They were followed by the LHWs on days 2, 4, and 14 in intervention and on days 2, 6, and 14 in the control arm. Primary treatment failure was assessed on day 4 in intervention and day 6 in the control arm. A severe pneumonia trial was registered with ClinicalTrials.gov, number NCT01192789. Results From February 2008 to March 2010, a total of 5876 children were enrolled by Lady Health Workers as fast breathing pneumonia. On validation visits of the CHWs, 728 (12%) children were excluded. A total of 4984 children were analysed as per protocol: 2480 in intervention and 2504 in control. There were 72 (2.9%) primary treatment failures in the intervention arm as compared to 102 (4%) in the control arm with a risk difference of -0.94 (-2.84%, 0.96%). Secondary treatment failures were almost equal in both arms (4 vs 7 cases). No deaths or serious adverse events were recorded. Conclusions This study shows that amoxicillin can be as effective as cotrimoxazole to treat fast-breathing pneumonia cases at the domiciliary level. Registration NCT01192789.
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Affiliation(s)
- Sheraz Ahmed
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shabina Ariff
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid Muhammed
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Arjumand Rizvi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid Bashir Soofi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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5
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von Mollendorf C, Berger D, Gwee A, Duke T, Graham SM, Russell FM, Mulholland EK. Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review. J Glob Health 2022; 12:10009. [PMID: 35866332 PMCID: PMC9305023 DOI: 10.7189/jogh.12.10009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries. Methods We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830]. Results We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria - 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis. Conclusions Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.
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Affiliation(s)
- Claire von Mollendorf
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Daria Berger
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen M Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fiona M Russell
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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6
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Lassandro G, Palladino V, Amoruso A, Palmieri VV, Russo G, Giordano P. Children in Coronaviruses' Wonderland: What Clinicians Need to Know. Mediterr J Hematol Infect Dis 2020; 12:e2020042. [PMID: 32670520 PMCID: PMC7340228 DOI: 10.4084/mjhid.2020.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/13/2020] [Indexed: 01/08/2023] Open
Abstract
Human coronaviruses (HCoVs) commonly cause mild upper-respiratory tract illnesses but can lead to more severe and diffusive diseases. A variety of signs and symptoms may be present, and infections can range in severity from the common cold and sore throat to more serious laryngeal or tracheal infections, bronchitis, and pneumonia. Among the seven coronaviruses that affect humans (SARS)-CoV, the Middle East respiratory syndrome (MERS)-CoV, and the most recent coronavirus disease 2019 (COVID-19) represent potential life-threatening diseases worldwide. In adults, they may cause severe pneumonia that evolves in respiratory distress syndrome and multiorgan failure with a high mortality rate. Children appear to be less susceptible to develop severe clinical disease and present usually with mild and aspecific symptoms similar to other respiratory infections typical of childhood. However, some children, such as infants, adolescents, or those with underlying diseases may be more at-risk categories and require greater caution from clinicians. Available data on pediatric coronavirus infections are rare and scattered in the literature. The purpose of this review is to provide to clinicians a complete and updated panel useful to recognize and characterize the broad spectrum of clinical manifestations of coronavirus infections in the pediatric age.
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Affiliation(s)
- Giuseppe Lassandro
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Valentina Palladino
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Anna Amoruso
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Viviana Valeria Palmieri
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
| | - Giovanna Russo
- Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paola Giordano
- Department of Biomedical Science and Human Oncology-Pediatric Unit, University of Bari “Aldo Moro,” Bari, Italy
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7
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Khan EA, Raja MH, Chaudhry S, Zahra T, Naeem S, Anwar M. Outcome of upper respiratory tract infections in healthy children: Antibiotic stewardship in treatment of acute upper respiratory tract infections. Pak J Med Sci 2020; 36:642-646. [PMID: 32494248 PMCID: PMC7260936 DOI: 10.12669/pjms.36.4.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The objective of the study was to assess the outcome of upper respiratory tract infections (URTI) in healthy children. Methods This descriptive study was conducted on 314 children aged 3-36 months in the paediatric outpatient clinic and emergency department with symptoms of URTI (fever, cough, rhinorrhoea) for ≤5 days. Patient's demographics, clinical features, laboratory data and outcome were recorded. Follow up phone calls were made to parents on day 7 (response 93.6%) and day 14 (response 94.6%) to record outcome. Results A total of 314 children with URTIs were included. Majority (57.6%) were males and <1year of age (40%). Common manifestations of URTI were fever (89%), cough (79%), rhinorrhoea (62%), pharyngitis (79%) and conjunctivitis (46%). More than half (53%) had history of contact with URTI in a family member. Mean duration of symptoms was 2.7±1.3 days. Majority (93%) of children were given supportive treatment and only 6.7% received antibiotics initially. Most of children (76%) recovered within one week and 91.8% within two weeks with supportive care only. Only 4% children were hospitalized and 12% required follow up visit of which 16% needed oral antibiotics. Complications or deaths did not occur. Conclusions Majority of URTIs in healthy children resolved with supportive treatment and do not require antibiotics. Antibiotic stewardship in simple URTIs should be practiced using awareness and advocacy campaigns.
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Affiliation(s)
- Ejaz Ahmed Khan
- Ejaz Ahmed Khan, MBBS, MD. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Mazhar Hussain Raja
- Mazhar Hussain Raja, MRCP, MRCPC. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shehla Chaudhry
- Shehla Chaudhry, FCPS. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Tehreem Zahra
- Tehreem Zahra, MBBS. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Salman Naeem
- Salman Naeem, MBBS. Department of Emergency Medicine, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Masuma Anwar
- Masuma Anwar, MBBS. Department of Pediatrics, Shifa International Hospital Ltd, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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8
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Pham HT, Nguyen TNT, Tran QA, Ngo TT. Prevalence and Associated Factors with Mixed Coinfections among under 5-Year-Old Children with Severe Viral Pneumonia in Vietnam. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1713623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractCommunity-acquired pneumonia (CAP) is well-recognized as a leading cause of disease burden in children. This study aimed to identify the prevalence of coinfection and associated factors in Vietnamese children ages 1 month to 5 years with viral pneumonia. We performed a cross-sectional study of children who were diagnosed with severe viral pneumonia. Demographic, clinical, and subclinical characteristics were compared between children with viral alone and bacterial coinfection. Multivariate logistic regression was used to determine which factors were associated with risk of coinfection. Of 202 children with severe viral pneumonia, the most common causative agent was respiratory syncytial virus (respiratory syncytial virus [RSV]: 36.1%), followed by influenza virus A (24.3%) and adenovirus (19.8%). Fifty-three children (26.2%) had bacterial superinfection and/or coinfection with other viruses. Haemophilus influenza was the most common bacterium (9.4%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (with 4.0%). In infants (toddlers), ages 12 to 24 months with severe viral pneumonia, (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.22–9.33), the higher concentrations of procalcitonin (PCT; OR = 1.16; 95% CI: 1.00–1.34), and neutrophils (OR = 1.13; 95% CI: 1.04–1.22) were associated with a higher risk of coinfection. This study underlined the pervasiveness of coinfections among young children with severe viral pneumonia. Provision of effective antiviral treatment, especially for RSV, as well as the advancement of sensitive and rapid diagnostic tools for screening pathogens of pneumonia, is critical to reducing the burden of this disease.
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Affiliation(s)
- Hien T. Pham
- International Outpatient Department, National Children’s Hospital, Hanoi, Vietnam
| | - Tran N. T. Nguyen
- Respiratory Department, National Children’s Hospital, Hanoi, Vietnam
| | - Quynh A. Tran
- Surgical Department, National Children’s Hospital, Hanoi, Vietnam
| | - Tam T. Ngo
- Faculty of Health Sciences, Thang Long University, Hanoi, Vietnam
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Uddin SMI, Englund JA, Kuypers JY, Chu HY, Steinhoff MC, Khatry SK, LeClerq SC, Tielsch JM, Mullany LC, Shrestha L, Katz J. Burden and Risk Factors for Coronavirus Infections in Infants in Rural Nepal. Clin Infect Dis 2019; 67:1507-1514. [PMID: 29668900 PMCID: PMC6206108 DOI: 10.1093/cid/ciy317] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/12/2018] [Indexed: 12/12/2022] Open
Abstract
Background Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal. Methods Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression. Results Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3–286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52–4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01–1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December–February) and 1 autumn (September–November). Conclusions HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.
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Affiliation(s)
- S M Iftekhar Uddin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jane Y Kuypers
- Molecular Virology Laboratory, School of Medicine, Seattle
| | - Helen Y Chu
- Harborview Medical Center, University of Washington, Seattle
| | - Mark C Steinhoff
- Global Health Center, Cincinnati Children's Hospital Medical Center, Ohio
| | | | - Steve C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Nepal Nutrition Intervention Project-Sarlahi, Kathmandu
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, D.C
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laxman Shrestha
- Department of Pediatrics and Child Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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10
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Krishnan A, Kumar R, Broor S, Gopal G, Saha S, Amarchand R, Choudekar A, Purkayastha DR, Whitaker B, Pandey B, Narayan VV, Kabra SK, Sreenivas V, Widdowson MA, Lindstrom S, Lafond KE, Jain S. Epidemiology of viral acute lower respiratory infections in a community-based cohort of rural north Indian children. J Glob Health 2019; 9:010433. [PMID: 31131104 PMCID: PMC6513504 DOI: 10.7189/jogh.09.010433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In India, community-based acute lower respiratory infections (ALRI) burden studies are limited, hampering development of prevention and control strategies. Methods We surveyed children <10 years old at home weekly from August 2012-August 2014, for cough, sore throat, rhinorrhoea, ear discharge, and shortness of breath. Symptomatic children were assessed for ALRI using World Health Organization definitions. Nasal and throat swabs were obtained from all ALRI cases and asymptomatic controls and tested using polymerase chain reaction for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza viruses (PIV), and influenza viruses (IV). We estimated adjusted odds ratios (aOR) using logistic regression to calculate etiologic fractions (EF). We multiplied agent-specific ALRI incidence rates by EF to calculate the adjusted incidence as episodes per child-year. Results ALRI incidence was 0.19 (95% confidence interval (CI) = 0.18-0.20) episode per child-year. Association between virus and ALRI was strongest for RSV (aOR = 15.9; 95% CI = 7.3-34.7; EF = 94%) and least for IV (aOR = 4.6; 95% CI = 2.0-10.6; EF = 78%). Adjusted agent-specific ALRI incidences were RSV (0.03, 95% CI = 0.02-0.03), hMPV (0.02, 95% CI = 0.01-0.02), PIV (0.02, 95% CI = 0.01-0.02), and IV (0.01, 95% CI = 0.01-0.01) episode per child-year. Conclusions ALRI among children in rural India was high; RSV was a significant contributor.
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Affiliation(s)
- Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Broor
- SGT Medical College, Hospital & Research Institute, Gurgaon, India
| | - Giridara Gopal
- All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India
| | | | | | | | - Brett Whitaker
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharti Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Marc-Alain Widdowson
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stephen Lindstrom
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Seema Jain
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India.,US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Naz R, Gul A, Javed U, Urooj A, Amin S, Fatima Z. Etiology of acute viral respiratory infections common in Pakistan: A review. Rev Med Virol 2019; 29:e2024. [PMID: 30548740 PMCID: PMC7169323 DOI: 10.1002/rmv.2024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 01/22/2023]
Abstract
Respiratory infections, especially those of the lower respiratory tract, remain a foremost cause of mortality and morbidity of children greater than 5 years in developing countries including Pakistan. Ignoring these acute-level infections may lead to complications. Particularly in Pakistan, respiratory infections account for 20% to 30% of all deaths of children. Even though these infections are common, insufficiency of accessible data hinders development of a comprehensive summary of the problem. The purpose of this study was to determine the prevalence rate in various regions of Pakistan and also to recognize the existing viral strains responsible for viral respiratory infections through published data. Respiratory viruses are detected more frequently among rural dwellers in Pakistan. Lower tract infections are found to be more lethal. The associated pathogens comprise respiratory syncytial virus (RSV), human metapneumovirus (HMPV), coronavirus, enterovirus/rhinovirus, influenza virus, parainfluenza virus, adenovirus, and human bocavirus. RSV is more dominant and can be subtyped as RSV-A and RSV-B (BA-9, BA-10, and BA-13). Influenza A (H1N1, H5N1, H3N2, and H1N1pdm09) and Influenza B are common among the Pakistani population. Generally, these strains are detected in a seasonal pattern with a high incidence during spring and winter time. The data presented include pneumonia, bronchiolitis, and influenza. This paper aims to emphasise the need for standard methods to record the incidence and etiology of associated pathogens in order to provide effective treatment against viral infections of the respiratory tract and to reduce death rates.
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Affiliation(s)
- Riffat Naz
- Department of Bioinformatics and BiotechnologyInternational Islamic UniversityIslamabadPakistan
| | - Asma Gul
- Department of Bioinformatics and BiotechnologyInternational Islamic UniversityIslamabadPakistan
| | - Urooj Javed
- Department of Bioinformatics and BiotechnologyInternational Islamic UniversityIslamabadPakistan
| | - Alina Urooj
- Department of Bioinformatics and BiotechnologyInternational Islamic UniversityIslamabadPakistan
| | - Sidra Amin
- Department of Bioinformatics and BiotechnologyInternational Islamic UniversityIslamabadPakistan
| | - Zareen Fatima
- Department of Bioinformatics and BiotechnologyInternational Islamic UniversityIslamabadPakistan
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12
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Fell DB, Johnson J, Mor Z, Katz MA, Skidmore B, Neuzil KM, Ortiz JR, Bhat N. Incidence of laboratory-confirmed influenza disease among infants under 6 months of age: a systematic review. BMJ Open 2017; 7:e016526. [PMID: 28882916 PMCID: PMC5595206 DOI: 10.1136/bmjopen-2017-016526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to assess incidence rates of laboratory-confirmed influenza (LCI) outcomes among infants under 6 months of age. DESIGN Systematic literature search and review of indexed studies in PubMed, EMBASE, the Cochrane Library and CINAHL Plus from inception to 19 April 2017. SETTING Population-based estimates from community or hospital settings. PARTICIPANTS Infants under 6 months of age. PRIMARY AND SECONDARY OUTCOME MEASURES LCI illness in ambulatory care settings, LCI hospitalisation, LCI intensive care unit admission and LCI death. Only studies with population-based incidence data were included. RESULTS We identified 27 primary studies, 11 of which were from the USA, four were from other non-US high-income settings and the remaining were from lower-middle-income or upper-middle-income countries. Most studies (n=23) assessed incidence of LCI hospitalisation, but meta-analysis to pool study-specific rates was not possible due to high statistical and methodological heterogeneity. Among US studies, the reported incidence of LCI hospitalisation ranged from 9.3 to 91.2 per 10 000 infants under 6 months for seasonal influenza, while the only US-based estimate for pandemic H1N1 influenza was 20.2 per 10 000 infants. Reported rates for LCI hospitalisation for seasonal influenza from other countries ranged from 6.2 to 73.0 per 10 000 infants under 6 months, with the exception of one study with an estimated rate of 250 per 10 000 infants. No events were reported in five of the nine studies that evaluated LCI death among infants under 6 months. CONCLUSION Our review of published studies found limited data on LCI outcomes for infants under 6 months, particularly from non-US settings. Globally representative and reliable incidence data are necessary to fully evaluate influenza disease burden and the potential impact of maternal influenza immunisation programme on morbidity and mortality in young infants.
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Affiliation(s)
- Deshayne B Fell
- University of Ottawa and Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Jeanene Johnson
- Independent Epidemiology Consultant, Los Gatos, California, USA
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Katz
- Medical School for International Health and Department of Health Systems Management, Ben Gurion University in the Negev, Beersheba, Israel
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Kathleen M Neuzil
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Justin R Ortiz
- Initiative for Vaccine Research, WHO, Geneva, Switzerland
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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13
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Bai D, Cong S, Zhu LP. Attenuation of Focal Adhesion Kinase Reduces Lipopolysaccharide-Induced Inflammation Injury through Inactivation of the Wnt and NF-κB Pathways in A549 Cells. BIOCHEMISTRY (MOSCOW) 2017; 82:446-453. [PMID: 28371601 DOI: 10.1134/s0006297917040058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Overall analysis and understanding of mechanisms are of great importance for treatment of infantile pneumonia due to its high morbidity and mortality worldwide. In this study, we preliminarily explored the function and mechanism of focal adhesion kinase (FAK) in regulation of inflammatory response induced by lipopolysaccharides in A549 cells. Flow cytometry, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, quantitative reverse transcription polymerase chain reaction, and Western blot analysis were used to explore the correlation of FAK expression with cell apoptosis, viability, and the inflammatory cytokine activity in A549 cells. The results showed that knockdown of FAK enhanced cell viability, suppressed apoptosis, and decreased inflammatory cytokine activity. In addition, downregulation of FAK could activate the Wnt and nuclear factor κB signaling pathways. These findings suggest that FAK might be involved in progression of infantile pneumonia and could be a new therapeutic target for this disease.
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Affiliation(s)
- D Bai
- Jining No. 1 People's Hospital, Department of Pediatrics, Jining, 272011, China.
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