Acute lower respiratory infections in hospitalized children over a 6 year period in Tokyo

Bordetella pertussis in School-Age Children, Adolescents, and Adults: A Systematic Review of Epidemiology, Burden, and Mortality in Asia

Cyclic epidemics of pertussis (whooping cough) have been observed globally over the past twenty years despite high infant vaccine coverage. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity in older children and adults, as well as better surveillance and diagnostics. Moreover, in adolescents and adults, pertussis symptoms are mild and similar to common cough syndromes, meaning that it is under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE, and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology, burden of illness, and mortality in school-aged children, adolescents, and adults in Asia. Studies identified for inclusion were reviewed narratively because a statistical comparison was not possible due to the mix of methodologies used. The results showed that in East Asia, including Japan, South Korea, China, and Taiwan, pertussis is circulating in older children and adults. Diphtheria-tetanus-pertussis (DTP4) coverage is high in East Asia, yet outbreaks observed in Japan and South Korea suggest that vaccine-acquired immunity had waned in adolescents and adults. Several school outbreaks in China show that pertussis is circulating in young children, with continued circulation in adolescents and adults. There was a lack of information from Southeast/South Asian countries, although pan-Asian serosurveys showed that recent pertussis infection was common in adolescents and in adults with persistent cough. To conclude, the circulation of pertussis in Asian countries with high DTP4 coverage supports the expansion of routine vaccination to include booster doses for children at school entry and adolescents. However, surveillance is weak or absent in many countries, meaning that the true burden of pertussis, particularly among older populations, is unknown.

Epidemiology of human respiratory viruses in children with acute respiratory tract infections in Jinan, China

The viral etiologies of UTRIs and LTRIs in children in Jinan city were investigated between July 2009 and June 2010. Nasal and throat swabs were collected from 397 children with URTIs and bronchoalveolar lavage fluid specimens were collected from 323 children with LRTIs. RT-PCR/PCR was used to examine all samples for IFV, PIV, RSV, RV, hMPV, HBoV, CoV, ADV, RSV, and EV. Viral pathogens were detected in 47.10% of URTI samples and 66.57% samples, and the incidence of viral coinfection was 5.29% and 21.05%, respectively. IFV was the most common virus in URTIs, with a detection rate of 19.40%, followed by PIV (10.83%), RV (10.58%), and EV (6.30%). For LRTIs, PIV and RV were both detected in 27% of samples, followed by RSV (9.91%), HBoV (8.36%), IFV (5.57%), and hMPV (5.57%). RSV and HBoV were more prevalent in the youngest children of no more than six months. Meanwhile, RV, PIV, and RSV were the most frequent viruses combined with bacterial pathogens in LRTIs. In conclusion, the spectrum of respiratory virus infections in URTIs and LRTIs differed in terms of the most common pathogens, seasonal distribution, and coinfection rate.

Intensive care unit admissions for community-acquired pneumonia are seasonal but are not associated with weather or reports of influenza-like illness in the community

PURPOSE

The aims of this study were to determine if there is seasonal variation in the number of intensive care unit (ICU) admissions for community-acquired pneumonia (CAP) and if there is a relationship between these admissions and weather or reports of influenza-like illness in the community.

MATERIALS AND METHODS

In this time series analysis in 3 medical-surgical ICUs (8, 13, and 20 beds) in the Vancouver region, we included patients admitted to adult ICUs for CAP between January 2002 and March 2006. We used Poisson regression to analyze the association between weekly number of ICU admissions for CAP, and average temperature, range in temperature, total precipitation, and cases of influenza-like illness/100 physician visits reported by sentinel physicians in the community.

RESULTS

In 740 patients admitted to ICUs for CAP, admissions peaked each year in the winter-spring months. In multivariate models, a sine function with a single annual peak was independently associated with number of patients admitted to ICU for CAP (rate ratio [95% confidence interval], 1.12 [1.00, 1.26]), but neither the weather measurements nor the weekly rate of reported influenza-like illness was significantly associated.

CONCLUSION

Intensive care unit admissions for CAP are seasonal, but neither weather measurements nor weekly rate of reported influenza-like illness in the community is associated with these admissions.

The burden of influenza in East and South-East Asia: a review of the English language literature

Abstract  While human infections with avian influenza A (H5NI) viruses in Asia have prompted concerns about an influenza pandemic, the burden of human influenza in East and Southeast Asia has received far less attention. We conducted a review of English language articles on influenza in 18 countries in East and Southeast Asia published from 1980 to 2006 that were indexed on PubMed. Articles that described human influenza‐associated illnesses among outpatients or hospitalized patients, influenza‐associated deaths, or influenza‐associated socioeconomic costs were reviewed. We found 35 articles from 9 countries that met criteria for inclusion in the review. The quality of articles varied substantially. Significant heterogeneity was noted in case definitions, sampling schemes and laboratory methods. Early studies relied on cell culture, had difficulties with specimen collection and handling, and reported a low burden of disease. The recent addition of PCR testing has greatly improved the proportion of respiratory illnesses diagnosed with influenza. These more recent studies reported that 11–26% of outpatient febrile illness and 6‐14% of hospitalized pneumonia cases had laboratory‐confirmed influenza infection. The influenza disease burden literature from East and Southeast Asia is limited but expanding. Recent studies using improved laboratory testing methods and indirect statistical approaches report a substantial burden of disease, similar to that of Europe and North America. Current increased international focus on influenza, coupled with unprecedented funding for surveillance and research, provide a unique opportunity to more comprehensively describe the burden of human influenza in the region.

Undiagnosed respiratory viruses in children

OBJECTIVE

An estimated 12 to 32 million upper respiratory infections occur in young children each year. In addition, 20% to 53% of infants will have > or = 1 episode of lower respiratory infection in the first year of life. The current methods of diagnosing respiratory viruses are limited in scope and sensitivity. Polymerase chain reaction is a more sensitive method than antigen detection and is often used for newly discovered viruses. Using polymerase chain reaction, we sought to diagnose adenoviruses, human bocavirus, and human metapneumovirus at our children's hospital.

METHODS

Nasal-swab specimens submitted for antigen detection of respiratory viruses were collected and processed by using polymerase chain reaction to detect adenoviruses, human bocavirus, and human metapneumovirus. Inpatient and emergency department records were reviewed for clinical and demographic data.

RESULTS

Approximately 1500 specimens were collected over 21 months; they contained adenoviruses, human bocavirus, and human metapneumovirus in 5.9%, 5.6%, and 5.2% of children, respectively. Using polymerase chain reaction and antigen detection, a viral agent was identified in as many as 62% of the specimens. Lower respiratory tract disease was present most frequently in patients infected with human metapneumovirus (63%) and least frequently in those infected with adenoviruses (45%). We detected adenoviruses by polymerase chain reaction in 59 patients for whom the antigen-detection test results were negative. A paroxysmal cough led to clinical suspicion of Bordetella pertussis infection in 19% of patients infected with human bocavirus.

CONCLUSIONS

Adenoviruses, human bocavirus, and human metapneumovirus were each present in approximately 5% of specimens submitted for respiratory virus rapid testing. The lower respiratory tract was more commonly affected in patients with human bocavirus and human metapneumovirus infections. Adenovirus was often undiagnosed by antigen detection. Other findings included the presence of a pertussis-like illness associated with human bocavirus.

Serodiagnosis of acute respiratory infections in children in Georgia

OBJECTIVE

To investigate the etiology of acute respiratory infections in hospitalized children.

METHODS

A total of 808 children were studied. Investigation of RSV, Adenovirus, Parainfluenza, Influenza A and B, C.trachomatis, C.pneumoniae, M. pneumonia and Legionella were performed with an ELISA for IgM, IgG and IgA antibodies detection.

RESULTS

There were 496 males and 312 females giving a male: female ratio of 1.6:1. Ages range from 1 month to 15 years. The overall detection rate was 57.9%. The most frequently detected were: parainfluenza 12.6%, adenovirus 11.2%, influenza A 7.3%, RSV 6%, M. pneumoniae 5.4%, C.trachomatis 3.5% and mixed-infections 9.2%. Pneumonia was associated most frequently with adenovirus and mixed-infections; wheezing bronchitis--with adenovirus, RSV and M. pneumoniae; bronchitis--with parainfluenza and adenovirus, diseases of upper respiratory tract--with parainfluenza and adenovirus. Peak of the virus activity was during winter (influenza, parainfluenza, adenovirus, RSV) and autumn (parainfluenza, RSV).

CONCLUSION

Viruses are the main causes of ARI in Georgian children. A better understanding of the etiology of ARI in all of the regions of the world may be helpful for timely decision of specific therapy, which can help pediatricians to estimate and manage children with ARI.

The burden of pneumonia in children in the developed world

There are few comprehensive epidemiological studies of pneumonia in the developed world. Ascertainment and definition are important variables in the estimation of pneumonia incidence both in primary care and from hospital data. The available figures suggest a burden of disease in the order of 10-15 cases/1000 children per year and a hospital admission rate of 1-4/1000 per year. Both incidence and hospital admission are greatest in the youngest children and rapidly fall after the age of 5 years. In a majority of cases of community acquired pneumonia an organism is not identified. Viral infections are common and influenza A, B, respiratory syncitial virus (RSV) and parainfluenza 1, 2 and 3 are the most common viruses identified. Streptococcus pneumoniae is the most common bacterial cause. Broad brush calculations suggest that the NHS cost of childhood pneumonia in England is 6-8 million pound sterling per annum. This does not include family and social costs. There is potential for new vaccine strategies to decrease childhood pneumonia.