Viruses in families

Acute respiratory illness in the first year of primary school related to previous attendance at child care

The aim of this study was to assess the relationship between previous child care outside the home (day care or family care) and acute respiratory illness in the first year at primary school. Participants were 445 Adelaide school children (mean age 5 years 2 months), 73 per cent of those eligible. Information about early childhood, family, child care arrangements and illness history was obtained from a questionnaire completed by parents. A respiratory illness score was calculated from the parental reports of respiratory illness experience in the winter months of the second school term in 1992. Absences from school owing to respiratory illness were counted from school records. Children who had attended child care before commencing school had fewer episodes of acute respiratory illness and had fewer absences from school than children with no child care experience. Children who had attended child care prior to commencing school experienced half as many episodes of asthma as those children who had never attended child care. Children who attend day care before age five tend to experience less acute respiratory illness than their peers on school entry. Possible explanations include selection of illness-prone children into home care, protection against respiratory illness as a result of early exposure, and a shift in the age-related peak of illness.

Prospective controlled survey of viral infections in children with acute lymphoblastic leukemia during chemotherapy

BACKGROUND

Infections cause significant morbidity in children with acute lymphoblastic leukemia (ALL). The incidence of viral infections commonly occurring in children with ALL receiving chemotherapy was compared with viral infections in control children and the spread of infections in families was traced.

METHODS

Fifteen families of children with ALL receiving chemotherapy (62 members) and 26 matched control families (106 members) were monitored for a total of 36,197 and 36,583 days, respectively, from November/ 1987 to December/1989 for the occurrence of infections.

RESULTS

The children with ALL had more infections than their control counterparts (P < 0.01) with respiratory infections the most common in both groups. Viral etiology was verified for 47 episodes [5.2/1000 days at risk, 95% confidence interval (CI) 3.9-7.0] in the children with ALL and 22 (2.4/1000 days at risk, 95% CI 1.5-3.7) in the control subjects (P < 0.01 for the difference). Parainfluenza viruses, enteroviruses, and adenoviruses were the most common agents in both groups. The infections of the other members of the patients' families were similar to those of their controls. The children most commonly fell ill first, and although children with ALL had more infections, they did not appear to spread the infections to their family members.

CONCLUSIONS

The children with ALL had more infections than their controls, but they managed to recover well from viral infections caused by common respiratory viruses. The children with ALL did not change the spread of infections among family members.

Selective infection of lower respiratory tract by respiratory viruses in children with recurrent respiratory tract infections

Thirty preschool children presenting with recurrent respiratory infections and their unaffected siblings were observed prospectively for a year. The index children experienced more episodes of acute respiratory infection than their siblings. Respiratory viruses were the major cause of respiratory infections. The index children had lower respiratory tract disease, predominantly wheeze, during 34% of proved respiratory virus infections compared with 11% of such infections experienced by the control children (p less than 0.02). Atopic children had an increased tendency to wheeze that did not reach significance, but atopy was not associated with increased susceptibility to respiratory infections.

Respiratory syncytial virus infection in north-east England

During a period covering four winter epidemics 987 respiratory syncytial (RS) virus infections were identified in the children's wards that served a total population of about 875 000 in north-east England. The incidence of admission to hospital with RS virus infection tended to be twice as high among children in Tyneside as that among children from the rest of the catchment area. The risk of hospital admission with RS virus infection in the first year of life for city children was about 1 in 50. The risk tended to be increased when there was a high proportion of children in the population, overcrowded housing, and unemployment. There was no clear relation between climatic changes and the onset or progress of epidemics. Thirteen deaths associated with RS virus infection were identified, four of them sudden and unexpected at home, and nine of them in children with congenital or acquired abnormalities. Twelve children were admitted twice with distinct RS virus infections; the relative severity of their two illnesses depended on age. Hospital cross-infection accounted for 60 of the 987 illnesses. Large families and overcrowding among poorer families seem to lead to a higher incidence of RS virus infection, and measures to reduce overcrowding and improve housing should help to reduce the spread of infection. Breast-feeding also protects infants from infection, but further information is needed to pinpoint the infants at greater risk and how they may best be protected.

Respiratory viral infection in childhood. A survey in general practice, Roehampton 1967-1972

The role of viruses and M. pneumoniae in episodes of acute respiratory illness in childhood has been studied in a London general practice. The total isolation rate was 31-7 per cent, but the rate varied from 32-6 per cent in upper respiratory infections to 64-0 per cent in pneumonia. The clinical features associated with infection were influenced not only by the type of agent but also by age and other host factors in infected children. Rhinoviruses were more commonly isolated than any other agent and were frequently associated with wheezy bronchitis.

Significance of respiratory virus isolations. A study in primary schoolchildren

This study was undertaken in a primary school to determine how frequently viruses, Mycoplasma pneumoniae, and pathogenic bacteria could be isolated from children in whom there was no evidence of acute respiratory infection. The clinical status was firmly established before the virological and bacteriological results were recorded. Respiratory illness was found during 79 out of 224 interviews (35%). Specimens were taken at 112 of these interviews and children were re-examined 6 days later to ensure that no symptoms had developed during the intervening period. Viruses were isolated from 2 out of 65 (3%) of the investigations performed in asymptomatic children, compared with 11 out of 47 (23%) in those who had episodes of mild respiratory illnesses. Haemophilus influenzae and Streptococcus pneumoniae were more commonly isolated in the 47 children with symptoms than in those without. There was a close correlation between the virological findings of this study and those in children attending a nearby general practice, where the isolation rate in episodes of respiratory illness was 23% during the same period.

Respiratory syncytial virus in hospital cross-infection

During an epidemic of respiratory syncytial (R.S.) virus in Newcastle upon Tyne 13 children developed R.S. virus infections while in hospital with other conditions. R.S. virus infection was also noted in four members of the staff. In two of the hospital wards outbreaks developed. All children infected with R.S. virus developed symptoms. The symptoms varied with age; two children aged 2 months or less developed colds, as did five children over 1 year of age. One child of 15 months with Werdnig-Hoffman disease, though suffering from a cold, later developed pulmonary collapse. All five children aged 3 to 8 months developed bronchiolitis. The effectiveness of special nursing in cubicles was probably diminished because adults with mild colds were excreting virus. The dangers of R.S. virus infection to other children in the ward, especially those with congenital heart disease, is emphasized.