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Wang H, Zhao J, Xie N, Wang W, Qi R, Hao X, Liu Y, Sevalie S, Niu G, Zhang Y, Wu G, Lv X, Chen Y, Ye Y, Bi S, Moseray M, Cellessy S, Kalon K, Baika DI, Luo Q. A Prospective Study of Etiological Agents Among Febrile Patients in Sierra Leone. Infect Dis Ther 2021; 10:1645-1664. [PMID: 34173960 PMCID: PMC8234757 DOI: 10.1007/s40121-021-00474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Sierra Leone has one of the highest burdens of febrile illnesses in the world. As the incidence of malaria diminishes, a better understanding of the spectrum of etiological agents was important for accurate diagnosis and empirical treatment of febrile illness. Methods Blood, nasopharyngeal, and fecal specimens were collected from febrile patients for serological, molecular detection, and microbiologic culture to identify potential pathogens. Results For this prospective study, 142 febrile patients were enrolled. The prevalence of malaria was higher in children aged 5–15 years old (P = 0.185) and adults (P = 0.018). Acute respiratory infection (ARI) presented more commonly in the under 5 years old group (P = 0.009). For diarrhea, all children groups (P = 0.024) were predominant. A total of 22.5% of the febrile patients had malaria infection, 19.7% had typhoid infection, and 2.8% were coinfected with malaria and typhoid. ARI was the most common causes of fever, accounting for 31.7% of patients, influenza A virus, Mycoplasma pneumoniae, and five other respiratory pathogens were found. Diarrhea accounted for 16.2%, and seven kinds of diarrhea bacteria were isolated. Hepatitis B accounted for 8.5%, including five cases of spontaneous bacterial peritonitis, and ascites smear staining were both Gram-negative bacteria. Tuberculous encephalitis, parasitic diseases (ascaris and filariasis), and skin infection caused by Staphylococcus aureus accounted for 0.7%, 2.1%, and 0.7%, respectively. Conclusions Evidence of a wide spectrum of febrile etiological agents other than malaria was identified. The spread of malaria rapid diagnostic tests (RDTs) out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. Antibiotics against Gram-negative bacteria are helpful for empirical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00474-y. Sierra Leone has one of the highest burdens of febrile illnesses in the world. Evidence of a wide spectrum of febrile pathogens other than malaria has been proven in this study. We considered that the etiology of febrile patients was closely related to local geography, heredity, immune features, economic industry, living habits, air pollution, medical and health conditions, and this was fully analyzed and discussed. The screening process used in this study can further simplify and identify the etiological agents of fever in more than 70% of the study population. This laid the foundation for the establishment of a more simplified and efficient diagnosis and treatment process in the local area. We also found the characteristics of age distribution of different febrile diseases. Children were an important susceptible population to fever. This study indicated the importance of reliable diagnostic tests for febrile pathogens and provided the necessary information for RDT requirements. The spread of malaria RDTs out of hospital and establishment of a national standard for Widal test will reduce the misdiagnosis of febrile diseases. For empirical treatment, antimalarial treatment was still targeted at falciparum malaria in Sierra Leone. Antibiotics against Gram-negative bacteria contributed to the empirical treatment of febrile diseases. For patients with acute respiratory tract infection, Gram-positive coccal antibiotics could be candidates for treatment. In addition, systematic and professional treatment of liver diseases should be promoted to reduce infection complications.
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Affiliation(s)
- Han Wang
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China.
| | - Jing Zhao
- Department of Clinical Diagnostic Centre, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, The People's Republic of China
| | - Na Xie
- Department of Inpatient and Medical Record Management, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Wanxue Wang
- Nursing Department, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Ruping Qi
- Department of Radiology, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, The People's Republic of China
| | - Xiaogang Hao
- Department of Inpatient and Medical Record Management, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yan Liu
- Department of Clinical Diagnostic Centre, North Hospital District, The Third Hospital of Peking University, Beijing, The People's Republic of China
| | - Stephen Sevalie
- Headquarters, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Guotao Niu
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yangli Zhang
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Ge Wu
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Xiaona Lv
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yuhao Chen
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Yanfei Ye
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Sheng Bi
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China
| | - Moses Moseray
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Saidu Cellessy
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Ksaidu Kalon
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Dawud Ibrahim Baika
- Department of Clinical Diagnostic Centre, 34 Military Hospital of Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Qun Luo
- Department of Transfusion Medicine, The Fifth Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, People's Republic of China.
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Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infections: Evidence from an Indonesian Cohort. Viruses 2021; 13:v13020331. [PMID: 33669911 PMCID: PMC7924644 DOI: 10.3390/v13020331] [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] [Received: 12/31/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Although risk factors for hospitalization from a respiratory syncytial virus (RSV) are well known, RSV lower respiratory tract infections (LRIs) in the community are much less studied or understood, especially in developing countries. In a prospective, cohort study we studied factors predisposing Indonesian infants and children under 5 years of age to developing RSV LRIs. Subjects were enrolled in two cohorts: a birth cohort and a cross-sectional cohort of children <48 months of age. Subjects were visited weekly at home to identify any LRI, using the World Health Organization’s criteria. RSV etiology was determined through analysis of nasal washings by enzyme immunoassay and polymerase chain reaction. Risk factors for the development of the first documented RSV LRI were identified by multivariate analysis using logistic regression and Cox proportional hazard modeling. Of the 2014 children studied, 999 were enrolled within 30 days of birth. There were 149 first episodes of an RSV. Risk factors for an RSV LRI were poverty (p < 0.01), use of kerosene as a cooking fuel (p < 0.05), and household ownership of rabbits and chickens (p < 0.01). Our findings suggested that in a middle-income country such as Indonesia, with a substantial burden of RSV morbidity and mortality, lower socioeconomic status, environmental air quality, and animal exposure are predisposing factors for developing an RSV LRI.
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Lassi ZS, Padhani ZA, Das JK, Salam RA, Bhutta ZA. Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze. Cochrane Database Syst Rev 2021; 1:CD009576. [PMID: 33469915 PMCID: PMC8092454 DOI: 10.1002/14651858.cd009576.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Worldwide, pneumonia is the leading cause of death amongst children under five years of age, and accounts for approximately two million deaths annually. Pneumonia can be classified according to the World Health Organization (WHO) guidelines. Classification includes assessment of certain clinical signs and symptoms, and the severity of the disease. Treatment is then tailored according to the classification. For non-severe pneumonia, the WHO recommends treatment with oral antibiotics. We used the 2014 WHO definition of non-severe pneumonia for this review: an acute episode of cough, or difficulty in breathing, combined with fast breathing and chest indrawing. The WHO recommends treating non-severe pneumonia with oral antibiotics. Pneumonia is more commonly caused by viruses that do not require antibiotic treatment, but pneumonia caused by bacteria needs management with antibiotics to avoid complications. There is no clear way to quickly distinguish between viral and bacterial pneumonia. It is considered safe to give antibiotics, however, this may lead to the development of antibiotic resistance, and thus, limit their use in future infections. Therefore, it is essential to explore the efficacy of antibiotics for children with WHO-defined non-severe pneumonia and wheeze. OBJECTIVES To evaluate the efficacy of antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers (December 2020). SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the efficacy of antibiotic therapy versus no antibiotic therapy for children, aged 2 to 59 months, with non-severe pneumonia and wheeze. We defined non-severe pneumonia as 'a cough or difficulty in breathing, with rapid breathing (a respiratory rate of 50 breaths per minute or more for children aged 2 to 12 months, or a respiratory rate of 40 breaths per minute or more for children aged 12 to 59 months), chest indrawing and wheeze'. We excluded trials involving children with severe or very severe pneumonia, and non-RCTs. DATA COLLECTION AND ANALYSIS Our primary outcomes were clinical cure and treatment failure; secondary outcomes were relapse, mortality, and treatment harms. We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Two review authors independently assessed the search results, extracted data, assessed risk of bias and the certainty of the evidence. We contacted the authors of two included trials and the author of the trial awaiting classification to obtain missing numerical outcome data. MAIN RESULTS We included three trials involving 3256 children aged between 2 to 59 months, who exhibited features of non-severe pneumonia with wheeze. The included trials were multi-centre, double-blind, randomised, placebo-controlled trials carried out in Malawi, Pakistan, and India. The children were treated with a three-day course of amoxicillin or placebo, and were followed up for a total of two weeks. We assessed the included trials at overall low risk of bias for random sequence generation, allocation concealment, blinding, attrition bias, and selective reporting. Only one trial was assessed to be at high risk for blinding of outcome assessors. One trial is awaiting classification Antibiotic therapy may result in a reduction of treatment failure by 20% (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.68 to 0.94; three trials; 3222 participants; low-certainty evidence). Antibiotic therapy probably results in little or no difference to clinical cure (RR 1.02, 95% CI 0.96 to 1.08; one trial; 456 participants; moderate-certainty evidence), and in little or no difference to relapse (RR 1.00, 95% CI 0.74 to 1.34; three trials; 2795 participants; low-certainty evidence), and treatment harms (RR 0.81, 95% CI 0.60 to 1.09; three trials, 3253 participants; low-certainty evidence). Two trials (2112 participants ) reported on mortality; no deaths occurred in either group. One trial reported cases of hospitalisation, diarrhoea (with and without dehydration), rash (without itch), tremors, mild nausea and vomiting. AUTHORS' CONCLUSIONS We do not currently have enough evidence to support or challenge the continued use of antibiotics for the treatment of non-severe pneumonia. There is a clear need for RCTs to address this question in children aged 2 to 59 months with 2014 WHO-defined non-severe pneumonia and wheeze.
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Affiliation(s)
- Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Zahra Ali Padhani
- Department of Women's and Children's Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Chadha M, Hirve S, Bancej C, Barr I, Baumeister E, Caetano B, Chittaganpitch M, Darmaa B, Ellis J, Fasce R, Kadjo H, Jackson S, Leung V, Pisareva M, Moyes J, Naguib A, Tivane A, Zhang W. Human respiratory syncytial virus and influenza seasonality patterns-Early findings from the WHO global respiratory syncytial virus surveillance. Influenza Other Respir Viruses 2020; 14:638-646. [PMID: 32163226 PMCID: PMC7578323 DOI: 10.1111/irv.12726] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Human respiratory syncytial virus (RSV) causes illnesses among all age groups and presents a burden to healthcare services. To better understand the epidemiology and seasonality of RSV in different geographical areas, the World Health Organization (WHO) coordinated a pilot initiative to access the feasibility of establishing RSV surveillance using the existing Global Influenza Surveillance and Response System (GISRS) platform. Objectives To describe and compare RSV and influenza seasonality in countries in the northern andsouthern temperate, and tropics during the period January 2017 to April 2019. Methods Fourteen countries in six WHO regions participating in the GISRS were invited for the pilot. Hospitalized patients presenting with severe acute respiratory illness (SARI), SARI without fever and outpatients presenting with acute respiratory illness (ARI) were enrolled from January 2017 to April 2019. The expected minimum sample size was 20 samples per week, year‐round, per country. Real‐time RT‐PCR was used to detect RSV and influenza viruses. Results were uploaded to the WHO FluMart platform. Results Annual seasonality of RSV was observed in all countries, which overlapped to a large extent with the influenza activity. In countries, in temperate regions RSV peaked in the autumn/winter months. In Egypt, a subtropical country, RSV activity peaked in the cooler season. In the tropical regions, RSV peaked during the rainy seasons. Conclusion Early findings from the WHO RSV surveillance pilot based on the GISRS suggest annual seasonal patterns for of RSV circulation that overlap with influenza. RSV surveillance needs to be continued for several more seasons to establish seasonality patterns to inform prevention and control strategies.
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Affiliation(s)
- Mandeep Chadha
- National Institute of Virology, Indian Council of Medical Research, Pune, India
| | | | - Christina Bancej
- Centre for Immunization and Respiratory Infections, Public Health Agency of Canada, Ottawa, Canada
| | - Ian Barr
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Elsa Baumeister
- Departamento Virologia, INEI-ANLIS "Carlos G Malbrán", Buenos Aires, Argentina
| | | | | | - Badarch Darmaa
- Virology Laboratory, National Center for Communicable Diseases, Ulan baatar, Mongolia
| | - Joanna Ellis
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Rodrigo Fasce
- Sub-department of Viral Diseases, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Herve Kadjo
- Department of Epidemic Viruses, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Sandra Jackson
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
| | - Vivian Leung
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Maria Pisareva
- Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Jocelyn Moyes
- Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health, Cairo, Egypt
| | - Almiro Tivane
- Laboratório de Isolamento Viral, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Wenqing Zhang
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
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Althouse BM, Flasche S, Minh LN, Thiem VD, Hashizume M, Ariyoshi K, Anh DD, Rodgers GL, Klugman KP, Hu H, Yoshida LM. Seasonality of respiratory viruses causing hospitalizations for acute respiratory infections in children in Nha Trang, Vietnam. Int J Infect Dis 2018; 75:18-25. [PMID: 30118916 PMCID: PMC7110808 DOI: 10.1016/j.ijid.2018.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 01/21/2023] Open
Abstract
Hospitalizations for respiratory viruses are seasonal in Vietnam Respiratory syncytial virus peaks in the late summer months, and inuenza A in April to June No clear seasonality is seen for human rhinovirus Human parainuenza 3 and human rhinovirus are positively associated with dew point This work can inform the timing of inuenza and RSV vaccination and the judicious use of antibiotics in Vietnam
Background Acute respiratory infections (ARIs) are the most common causes of death in children under 5 years of age. While the etiology of most pneumonia and ARI episodes is undiagnosed, a broad range of ARI-causing viruses circulate widely in South East Asia. However, the patterns and drivers of the seasonal transmission dynamics are largely unknown. Here we identify the seasonal patterns of multiple circulating viruses associated with hospitalizations for ARIs in Nha Trang, Vietnam. Methods Hospital based enhanced surveillance of childhood ARI is ongoing at Khanh Hoa General Hospital in Nha Trang. RT-PCR was performed to detect 13 respiratory viruses in nasopharyngeal samples from enrolled patients. Seasonal patterns of childhood ARI hospital admissions of various viruses were assessed, as well as their association with rainfall, temperature, and dew point. Results Respiratory syncytial virus peaks in the late summer months, and influenza A in April to June. We find significant associations between detection of human parainfluenza 3 and human rhinovirus with the month's mean dew point. Using a cross-wavelet transform we find a significant out-of-phase relationship between human parainfluenza 3 and temperature and dew point. Conclusions Our results are important for understanding the temporal risk associated with circulating pathogens in Southern Central Vietnam. Specifically, our results can inform timing of routing seasonal influenza vaccination and for when observed respiratory illness is likely viral, leading to judicious use of antibiotics in the region.
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Affiliation(s)
- Benjamin M Althouse
- Institute for Disease Modeling, Bellevue, WA, USA; University of Washington, Seattle, WA, USA; New Mexico State University, Las Cruces, NM, USA.
| | - Stefan Flasche
- London School of Hygiene and Tropical Medicine, London, UK, USA
| | - Le Nhat Minh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Vu Dinh Thiem
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Japan
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Hao Hu
- Institute for Disease Modeling, Bellevue, WA, USA
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Brüggmann D, Köster C, Klingelhöfer D, Bauer J, Ohlendorf D, Bundschuh M, Groneberg DA. Respiratory syncytial virus: a systematic scientometric analysis of the global publication output and the gender distribution of publishing authors. BMJ Open 2017; 7:e013615. [PMID: 28751483 PMCID: PMC5577886 DOI: 10.1136/bmjopen-2016-013615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Worldwide, the respiratory syncytial virus (RSV) represents the predominant viral agent causing bronchiolitis and pneumonia in children. To conduct research and tackle existing healthcare disparities, RSV-related research activities around the globe need to be described. Hence, we assessed the associated scientific output (represented by research articles) by geographical, chronological and socioeconomic criteria and analysed the authors publishing in the field by gender. Also, the 15 most cited articles and the most prolific journals were identified for RSV research. DESIGN Retrospective, descriptive study. SETTING The NewQIS (New Quality and Quantity Indices in Science) platform was employed to identify RSV-related articles published in the Web of Science until 2013. We performed a numerical analysis of all articles, and examined citation-based aspects (eg, citation rates); results were visualised by density equalising mapping tools. RESULTS We identified 4600 RSV-related articles. The USA led the field; US-American authors published 2139 articles (46.5%% of all identified articles), which have been cited 83 000 times. When output was related to socioeconomic benchmarks such as gross domestic product or Research and Development expenditures, Guinea-Bissau, The Gambia and Chile were ranked in leading positions. A total of 614 articles on RSV (13.34% of all articles) were attributed to scientific collaborations. These were primarily established between high-income countries. The gender analysis indicated that male scientists dominated in all countries except Brazil. CONCLUSIONS The majority of RSV-related research articles originated from high-income countries whereas developing nations showed only minimal publication productivity and were barely part of any collaborative networks. Hence, research capacity in these nations should be increased in order to assist in addressing inequities in resource allocation and the clinical burden of RSV in these countries.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Corinna Köster
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Doris Klingelhöfer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Jan Bauer
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Matthias Bundschuh
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
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7
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Muro F, Reyburn R, Reyburn H. Acute respiratory infection and bacteraemia as causes of non-malarial febrile illness in African children: a narrative review. Pneumonia (Nathan) 2015; 6:6-17. [PMID: 26594615 PMCID: PMC4650196 DOI: 10.15172/pneu.2015.6/488] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 03/13/2015] [Indexed: 12/16/2022] Open
Abstract
The replacement of "presumptive treatment for malaria" by "test before treat" strategies for the management of febrile illness is raising awareness of the importance of knowing more about the causes of illness in children who are suspected to have malaria but return a negative parasitological test. The most common cause of non-malarial febrile illness (NMFI) in African children is respiratory tract infection. Whilst the bacterial causes of NMFI are well known, the increasing use of sensitive techniques such as polymerase chain reaction (PCR) tests is revealing large numbers of viruses that are potential respiratory pathogens. However, many of these organisms are commonly present in the respiratory tract of healthy children so causality and risk factors for pneumonia remain poorly understood. Infection with a combination of viral and bacterial pathogens is increasingly recognised as important in the pathogenesis of pneumonia. Similarly, blood stream infections with organisms typically grown by aerobic culture are well known but a growing number of organisms that can be identified only by PCR, viral culture, or serology are now recognised to be common pathogens in African children. The high mortality of hospitalised children on the first or second day of admission suggests that, unless results are rapidly available, diagnostic tests to identify specific causes of illness will still be of limited use in guiding the potentially life saving decisions relating to initial treatment of children admitted to district hospitals in Africa with severe febrile illness and a negative test for malaria. Malaria control and the introduction of vaccines against Haemophilus influenzae type b and pneumococcal disease are contributing to improved child survival in Africa. However, increased parasitological testing for malaria is associated with increased use of antibiotics to which resistance is already high.
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Affiliation(s)
- Florid Muro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Rita Reyburn
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria Australia
- New Vaccine Evaluation Project, Colonial War Memorial Hospital, Suva, Fiji
| | - Hugh Reyburn
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St London, WICE7HT UK
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8
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Affiliation(s)
- Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI and Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia School of Medicine & Health Science, University of Papua New Guinea, Papua New Guinea
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Lanaspa M, Annamalay AA, LeSouëf P, Bassat Q. Epidemiology, etiology, x-ray features, importance of co-infections and clinical features of viral pneumonia in developing countries. Expert Rev Anti Infect Ther 2014; 12:31-47. [PMID: 24410617 PMCID: PMC7103723 DOI: 10.1586/14787210.2014.866517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pneumonia is still the number one killer of young children globally, accounting for 18% of mortality in children under 5 years of age. An estimated 120 million new cases of pneumonia occur globally each year. In developing countries, management and prevention efforts against pneumonia have traditionally focused on bacterial pathogens. More recently however, viral pathogens have gained attention as a result of improved diagnostic methods, such as polymerase chain reaction, outbreaks of severe disease caused by emerging pathogens, discovery of new respiratory viruses as well as the decrease in bacterial pneumonia as a consequence of the introduction of highly effective conjugate vaccines. Although the epidemiology, etiology and clinical characterization of viral infections are being studied extensively in the developed world, little data are available from low- and middle-income countries. In this paper, we review the epidemiology, etiology, clinical and radiological features of viral pneumonia in developing countries.
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Affiliation(s)
- Miguel Lanaspa
- Barcelona Center for International Health Research, Hospital Clinic, University of Barcelona, Rosello 132, 08036 Barcelona, Spain
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10
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Lassi ZS, Kumar R, Das JK, Salam RA, Bhutta ZA. Antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with WHO-defined non-severe pneumonia and wheeze. Cochrane Database Syst Rev 2014:CD009576. [PMID: 24859388 DOI: 10.1002/14651858.cd009576.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Worldwide, pneumonia is the leading cause of death among children under five years of age and accounts for approximately two million deaths annually. The World Health Organization (WHO) has developed case management guidelines based on simple clinical signs to help clinicians decide on the appropriate pneumonia treatment. Children and infants who exhibit fast breathing (50 breaths per minute or more in infants two months to 12 months of age and 40 or more in children 12 months to five years of age) and cough are presumed to have non-severe pneumonia and the WHO recommends antibiotics. Implementation of these guidelines to identify and manage pneumonia at the community level has been shown to reduce acute respiratory infection (ARI)-related mortality by 36%, although apprehension exists regarding these results due to the questionable quality of evidence. As WHO guidelines do not make a distinction between viral and bacterial pneumonia, these children continue to receive antibiotics because of the concern that it may not be safe to do otherwise. Therefore, it is essential to explore the role of antibiotics in children with WHO-defined non-severe pneumonia and wheeze and to develop effective guidelines for initial antibiotic treatment. OBJECTIVES To evaluate the efficacy of antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with WHO-defined non-severe pneumonia and wheeze. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (1946 to March week 3, 2014), EMBASE (January 2010 to March 2014), CINAHL (1981 to March 2014), LILACS (1982 to March 2014), Networked Digital Library of Theses and Dissertations (23 July 2013) and Web of Science (1985 to March 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating the efficacy of antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with non-severe pneumonia and wheeze. We considered studies that defined non-severe pneumonia as cough or difficulty in breathing with a respiratory rate above the WHO-defined age-specific values (respiratory rate of 50 breaths per minute or more for children aged two to 12 months, or a respiratory rate of 40 breaths per minute or more for children aged 12 to 59 months) and wheeze for inclusion. We have excluded non-RCTs (quasi-RCTs). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results and extracted data. MAIN RESULTS We did not identify any study that completely fulfilled our inclusion criteria. AUTHORS' CONCLUSIONS There is a clear need for RCTs to address this question in representative populations. We do not currently have evidence to support or challenge the continued use of antibiotics for the treatment of non-severe pneumonia, as suggested by WHO guidelines.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan, 74800
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Bradley BD, Howie SRC, Chan TCY, Cheng YL. Estimating oxygen needs for childhood pneumonia in developing country health systems: a new model for expecting the unexpected. PLoS One 2014; 9:e89872. [PMID: 24587089 PMCID: PMC3930752 DOI: 10.1371/journal.pone.0089872] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/25/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Planning for the reliable and cost-effective supply of a health service commodity such as medical oxygen requires an understanding of the dynamic need or 'demand' for the commodity over time. In developing country health systems, however, collecting longitudinal clinical data for forecasting purposes is very difficult. Furthermore, approaches to estimating demand for supplies based on annual averages can underestimate demand some of the time by missing temporal variability. METHODS A discrete event simulation model was developed to estimate variable demand for a health service commodity using the important example of medical oxygen for childhood pneumonia. The model is based on five key factors affecting oxygen demand: annual pneumonia admission rate, hypoxaemia prevalence, degree of seasonality, treatment duration, and oxygen flow rate. These parameters were varied over a wide range of values to generate simulation results for different settings. Total oxygen volume, peak patient load, and hours spent above average-based demand estimates were computed for both low and high seasons. FINDINGS Oxygen demand estimates based on annual average values of demand factors can often severely underestimate actual demand. For scenarios with high hypoxaemia prevalence and degree of seasonality, demand can exceed average levels up to 68% of the time. Even for typical scenarios, demand may exceed three times the average level for several hours per day. Peak patient load is sensitive to hypoxaemia prevalence, whereas time spent at such peak loads is strongly influenced by degree of seasonality. CONCLUSION A theoretical study is presented whereby a simulation approach to estimating oxygen demand is used to better capture temporal variability compared to standard average-based approaches. This approach provides better grounds for health service planning, including decision-making around technologies for oxygen delivery. Beyond oxygen, this approach is widely applicable to other areas of resource and technology planning in developing country health systems.
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Affiliation(s)
- Beverly D. Bradley
- Centre for Global Engineering, University of Toronto, Toronto, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - Stephen R. C. Howie
- Child Survival Theme, Medical Research Council Unit, The Gambia, Banjul, The Gambia
| | - Timothy C. Y. Chan
- Centre for Global Engineering, University of Toronto, Toronto, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Yu-Ling Cheng
- Centre for Global Engineering, University of Toronto, Toronto, Canada
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
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McNamara PS, Van Doorn HR. Respiratory Viruses and Atypical Bacteria. MANSON'S TROPICAL INFECTIOUS DISEASES 2014. [PMCID: PMC7149583 DOI: 10.1016/b978-0-7020-5101-2.00020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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The incidence and clinical burden of respiratory syncytial virus disease identified through hospital outpatient presentations in Kenyan children. PLoS One 2012; 7:e52520. [PMID: 23300695 PMCID: PMC3530465 DOI: 10.1371/journal.pone.0052520] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/15/2012] [Indexed: 11/09/2022] Open
Abstract
Background There is little information that describe the burden of respiratory syncytial virus (RSV) associated disease in the tropical African outpatient setting. Methods We studied a systematic sample of children aged <5 years presenting to a rural district hospital in Kenya with acute respiratory infection (ARI) between May 2002 and April 2004. We collected clinical data and screened nasal wash samples for RSV antigen by immunofluorescence. We used a linked demographic surveillance system to estimate disease incidence. Results Among 2143 children tested, 166 (8%) were RSV positive (6% among children with upper respiratory tract infection and 12% among children with lower respiratory tract infection (LRTI). RSV was more likely in LRTI than URTI (p<0.001). 51% of RSV cases were aged 1 year or over. RSV cases represented 3.4% of hospital outpatient presentations. Relative to RSV negative cases, RSV positive cases were more likely to have crackles (RR = 1.63; 95% CI 1.34–1.97), nasal flaring (RR = 2.66; 95% CI 1.40–5.04), in-drawing (RR = 2.24; 95% CI 1.47–3.40), fast breathing for age (RR = 1.34; 95% CI 1.03–1.75) and fever (RR = 1.54; 95% CI 1.33–1.80). The estimated incidence of RSV-ARI and RSV-LRTI, per 100,000 child years, among those aged <5 years was 767 and 283, respectively. Conclusion The burden of childhood RSV-associated URTI and LRTI presenting to outpatients in this setting is considerable. The clinical features of cases associated with an RSV infection were more severe than cases without an RSV diagnosis.
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Kwofie TB, Anane YA, Nkrumah B, Annan A, Nguah SB, Owusu M. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana. Virol J 2012; 9:78. [PMID: 22490115 PMCID: PMC3364910 DOI: 10.1186/1743-422x-9-78] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 04/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute respiratory tract infections are one of the major causes of morbidity and mortality among young children in developing countries. Information on the viral aetiology of acute respiratory infections in developing countries is very limited. The study was done to identify viruses associated with acute lower respiratory tract infection among children less than 5 years. METHOD Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques. RESULTS Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2%) were positive for one or more viruses. Respiratory Syncytial Virus (RSV) was detected in 18(14.1%, 95%CI: 8.5% to 21.3%) patients followed by Adenoviruses (AdV) in 13(10.2%, 95%CI: 5.5% to 16.7%), Parainfluenza (PIV type: 1, 2, 3) in 4(3.1%, 95%CI: 0.9% to 7.8%) and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3). Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36) of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant. CONCLUSION The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection.
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Affiliation(s)
- Theophilus B Kwofie
- School of Medical, Sciences, Kumasi, Department of Clinical Microbiology Kwame, Nkrumah University of Science and Technology, Kumasi, Ghana.
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Resch B, Kurath S, Manzoni P. Epidemiology of respiratory syncytial virus infection in preterm infants. Open Microbiol J 2011; 5:135-43. [PMID: 22262986 PMCID: PMC3258570 DOI: 10.2174/1874285801105010135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 10/12/2011] [Accepted: 10/27/2011] [Indexed: 01/10/2023] Open
Abstract
This review focuses on the burden of respiratory syncytial virus (RSV) infection in preterm infants with and without chronic lung disease (bronchopulmonary dysplasia, BPD). The year-to-year and seasonal variations in RSV activity are key aspects of RSV epidemiology, and knowledge/monitoring of local RSV activity is mandatory for guidance of prophylaxis with the monoclonal antibodies palivizumab and in the near future motavizumab. Morbidity expressed in rates of hospitalizations attributable to RSV illness revealed a mean of 10 percent in preterm infants without and 19 percent (p=0.016) with BPD. Mortality rates diverged widely, and case fatality rates have been reported to range from 0 to 12 percent. The typical clinical picture of lower respiratory tract infection is not different in term and preterm infants, but rates of apnoeas are significantly increased in preterms, ranging from 4.9 to 37.5 percent with decreasing rates observed in more recent studies. Until a RSV vaccine is developed and will be available, prophylaxis with palivizumab is the only preventative strategy other than hand hygiene and contact measures that significantly reduces RSV hospitalization rates in preterm infants both with and without BPD.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Pediatric Department, Medical University Graz, Austria
| | - Stefan Kurath
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Pediatric Department, Medical University Graz, Austria
| | - Paolo Manzoni
- Division of Neonatology and NICU, S. Anna Hospital. AO O.I.R.M-S. Anna, Torino, Italy
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Mtove G, Hendriksen IC, Amos B, Mrema H, Mandia V, Manjurano A, Muro F, Sykes A, Hildenwall H, Whitty CJM, Reyburn H. Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses. Malar J 2011; 10:290. [PMID: 21978238 PMCID: PMC3210100 DOI: 10.1186/1475-2875-10-290] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
Background WHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT). However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa. Methods Children 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days. Results Over the course of one year, 965 children were enrolled; 158 (16.4%) were RDT-positive and treated with artemether-lumefantrine and 807 (83.4%) were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6%) children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2%) children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9%) children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were ≤12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7) and specificity of 96.3% (95%CI 96.3-98.4). Conclusions Use of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive bacterial disease is uncommon in children with non-severe illness and most cases occurred in infants with a current fever.
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Affiliation(s)
- George Mtove
- 1National Institute for Medical Research, Amani Centre, Muheza, Tanga,Tanzania
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The epidemiology of respiratory syncytial virus lower respiratory tract infections in children less than 5 years of age in Indonesia. Pediatr Infect Dis J 2011; 30:778-84. [PMID: 21487330 DOI: 10.1097/inf.0b013e318218ab9e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the epidemiology of respiratory syncytial virus (RSV) lower respiratory tract infections (LRI) is well known in industrialized countries, the burden in developing Asian countries is not well studied. METHODS To define the burden of RSV disease in children <5 years of age in rural and urban Indonesia, infants and children were enrolled from peri-urban and rural subdistricts, in the following 2 cohorts: (a) a cross-sectional cohort of approximately 100 children from each of 2 subdistricts in the following 5 age groups: 3 to 5, 6 to 8, 9 to 11, 12 to 23, and 24 to 48 months; (b) a birth cohort of all newborns in both subdistricts during the 28 months of the study. All subjects were visited weekly at home. Children with World Health Organization-defined LRI or wheezing had a nasal wash for detection of RSV using an enzyme immunoassay and polymerase chain reaction. RESULTS Of the 2014 children studied, 1074 were in the cross-sectional and 940 in the newborn cohorts. Of the 802 episodes of LRI, 163 were caused by RSV. The RSV LRI incidence per 1000 child-years (C-Y) was higher in rural areas (57.25 vs. 38.54), P < 0.05. No RSV LRI occurred in the first 2 months of life and the peak incidence was in the 6- to 8-month-old infants (103/1000 C-Y). The rates were lowest in those <6 months, 16.5 per 1000 C-Y, compared with 83.1 per 1000 C-Y in those 6 to 11 months of age (P < 0.001), 66.99 in those 12 to 23 months of age, and 28.1 in 2- to 5-year-olds. CONCLUSIONS In Indonesia, the incidence of RSV LRI in the first 6 months of life is relatively low with most disease occurring in older children.
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Hazir T, Nisar YB, Abbasi S, Ashraf YP, Khurshid J, Tariq P, Asghar R, Murtaza A, Masood T, Maqbool S. Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2-59 months: a multicenter, double-blind, randomized, placebo-controlled trial in pakistan. Clin Infect Dis 2010; 52:293-300. [PMID: 21189270 DOI: 10.1093/cid/ciq142] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND world Health Organization (WHO) acute respiratory illness case management guidelines classify children with fast breathing as having pneumonia and recommend treatment with an antibiotic. There is concern that many of these children may not have pneumonia and are receiving antibiotics unnecessarily. This could increase antibiotic resistance in the community. The aim was to compare the clinical outcome at 72 h in children with WHO-defined nonsevere pneumonia when treated with amoxicillin, compared with placebo. METHODS we performed a double-blind, randomized, equivalence trial in 4 tertiary hospitals in Pakistan. Nine hundred children aged 2-59 months with WHO defined nonsevere pneumonia were randomized to receive either 3 days of oral amoxicillin (45mg/kg/day) or placebo; 873 children completed the study. All children were followed up on days 3, 5, and 14. The primary outcome was therapy failure defined a priori at 72 h. RESULTS in per-protocol analysis at day 3, 31 (7.2%) of the 431 children in the amoxicillin arm and 37 (8.3%) of the 442 in placebo group had therapy failure. This difference was not statistically significant (odds ratio [OR], .85; 95%CI, .50-1.43; P = .60). The multivariate analysis identified history of difficult breathing (OR, 2.86; 95% CI, 1.29-7.23; P = .027) and temperature >37.5°C 100°F at presentation (OR, 1.99; 95% CI, 1.37-2.90; P = .0001) as risk factors for treatment failure by day 5. CONCLUSION clinical outcome in children aged 2-59 months with WHO-defined nonsevere pneumonia is not different when treated with an antibiotic or placebo. Similar trials are needed in countries with a high burden of pneumonia to rationalize the use of antibiotics in these communities.
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Affiliation(s)
- Tabish Hazir
- ARI Research Cell, Children's Hospital, Pakistan Institute of Medical Sciences, Pakistan.
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Vieira RA, Diniz EMDA, Ceccon MEJR. Correlation between inflammatory mediators in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection caused by respiratory syncytial virus and disease severity. J Bras Pneumol 2010; 36:59-66. [PMID: 20209309 DOI: 10.1590/s1806-37132010000100011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 10/22/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine whether the concentrations of inflammatory mediators (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-alpha, IL-6 and IL-10) in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) correlate with the clinical markers of disease severity. METHODS Between July of 2004 and December of 2005, 30 children less than three months of age, diagnosed with LRTI caused by RSV and admitted to a neonatal ICU, were included in this study. RESULTS The severity of disease at hospital admission, as determined with a modified clinical scoring system, presented a significant positive correlation with sICAM-1 and IL-10 concentrations in the nasopharyngeal secretion, as well as with IL-6 concentrations in the serum, of the patients. In addition, serum IL-6 concentrations presented a significant positive correlation with the duration of oxygen therapy and with the length of hospital stay. CONCLUSIONS At hospital admission, the concentrations of sICAM-1 and IL-10 in the nasopharyngeal secretion, as well as the concentration of IL-6 in the serum, could be used as markers of severity in patients with LRTI caused by RSV. The serum levels of IL-6 determined at admission could also be used to predict prolonged oxygen supplementation and hospital stay.
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Affiliation(s)
- Renata Amato Vieira
- Neonatal Intensive Care Unit - University of São Paulo School of Medicine, Institute for Children, São Paulo, Brazil.
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Kaur C, Chohan S, Khare S, Puliyel JM, Gupta P, Faridi MMA, Dev G. Respiratory viruses in acute bronchiolitis in Delhi. Indian Pediatr 2010. [DOI: 10.1007/s13312-010-0058-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Findley S, Medina D, Sogoba N, Guindo B, Doumbia S. Seasonality of childhood infectious diseases in Niono, Mali. Glob Public Health 2010; 5:381-94. [DOI: 10.1080/17441690903352572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khuri-Bulos N, Williams JV, Shehabi AA, Faouri S, Al Jundi E, Abushariah O, Chen Q, Ali SA, Vermund S, Halasa NB. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan. ACTA ACUST UNITED AC 2010; 42:368-74. [PMID: 20100116 DOI: 10.3109/00365540903496544] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute respiratory infections (ARI) play a major role in hospitalizations in the Middle East, but the specific viral causes are unknown. We conducted prospective viral surveillance in children <5 y of age admitted with ARI and/or fever at 2 dissimilar hospitals in Amman, Jordan during peak respiratory syncytial virus (RSV) season. We collected prospective clinical and demographic data and obtained nose/throat swabs for testing for RSV by real-time polymerase chain reaction (RT-PCR). We obtained clinical and laboratory data for 728/743 (98%) subjects enrolled. The children's median age was 4.3 months, 58.4% were males, 87% were breastfed, 4% attended day care, 67% were exposed to smokers, 7% were admitted to the intensive care unit, and 0.7% died (n = 5). Out of 728 subjects, 467 (64%) tested positive by RT-PCR for RSV. Comparing RSV-positive with RSV-negative subjects, the RSV-positive subjects had lower median age (3.6 vs 6.4 months, p < 0.001) and fewer males (55% vs 64%, p = 0.02). RSV-positive children had higher rates of oxygen use (72% vs 42%, p < 0.001), a longer hospital stay (5 vs 4 days, p = 0.001), and higher hospital charges (US$538 vs US$431, p < 0.001) than RSV-negative children. In young hospitalized Jordanian infants, the medical and financial burden of RSV was found to be high. Effective preventive measures, such as an RSV vaccine, would have a significant beneficial impact.
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Affiliation(s)
- Najwa Khuri-Bulos
- Department of Paediatrics and Pathology-Microbiology, Jordan University, Amman, Jordan
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Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, O'Brien KL, Roca A, Wright PF, Bruce N, Chandran A, Theodoratou E, Sutanto A, Sedyaningsih ER, Ngama M, Munywoki PK, Kartasasmita C, Simões EAF, Rudan I, Weber MW, Campbell H. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010; 375:1545-55. [PMID: 20399493 PMCID: PMC2864404 DOI: 10.1016/s0140-6736(10)60206-1] [Citation(s) in RCA: 2045] [Impact Index Per Article: 146.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The global burden of disease attributable to respiratory syncytial virus (RSV) remains unknown. We aimed to estimate the global incidence of and mortality from episodes of acute lower respiratory infection (ALRI) due to RSV in children younger than 5 years in 2005. METHODS We estimated the incidence of RSV-associated ALRI in children younger than 5 years, stratified by age, using data from a systematic review of studies published between January, 1995, and June, 2009, and ten unpublished population-based studies. We estimated possible boundaries for RSV-associated ALRI mortality by combining case fatality ratios with incidence estimates from hospital-based reports from published and unpublished studies and identifying studies with population-based data for RSV seasonality and monthly ALRI mortality. FINDINGS In 2005, an estimated 33.8 (95% CI 19.3-46.2) million new episodes of RSV-associated ALRI occurred worldwide in children younger than 5 years (22% of ALRI episodes), with at least 3.4 (2.8-4.3) million episodes representing severe RSV-associated ALRI necessitating hospital admission. We estimated that 66 000-199 000 children younger than 5 years died from RSV-associated ALRI in 2005, with 99% of these deaths occurring in developing countries. Incidence and mortality can vary substantially from year to year in any one setting. INTERPRETATION Globally, RSV is the most common cause of childhood ALRI and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b. The development of novel prevention and treatment strategies should be accelerated as a priority. FUNDING WHO; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
- Public Health Foundation of India, New Delhi, India
| | - D James Nokes
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Department of Biological Sciences, University of Warwick, Coventry, UK
| | | | - Mukesh Dherani
- Division of Public Health, University of Liverpool, Liverpool, UK
| | - Shabir A Madhi
- Medical Research Council Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation in Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Rosalyn J Singleton
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
- Arctic Investigations Program, National Center for Preparedness, Detection and Control of Infectious Disease, CDC, Anchorage, AK, USA
| | - Katherine L O'Brien
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Roca
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Ministerio de Saúde, Maputo, Mozambique
| | - Peter F Wright
- Division of Infectious Disease and International Health, Dartmouth Medical School, Lebanon, NH, USA
| | - Nigel Bruce
- Division of Public Health, University of Liverpool, Liverpool, UK
| | - Aruna Chandran
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Evropi Theodoratou
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
| | | | | | - Mwanajuma Ngama
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Patrick K Munywoki
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Cissy Kartasasmita
- Medical Faculty, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Eric AF Simões
- University of Colorado Denver and The Children's Hospital, Denver, CO, USA
| | - Igor Rudan
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
- Croatian Centre for Global Health, Faculty of Medicine, University of Split, Split, Croatia
| | | | - Harry Campbell
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
- Correspondence to: Prof Harry Campbell, Professor of Public Health and Genetic Epidemiology, Centre for Population Health Sciences, Public Health Sciences, Medical School, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
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Nokes DJ, Ngama M, Bett A, Abwao J, Munywoki P, English M, Scott JAG, Cane PA, Medley GF. Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance. Clin Infect Dis 2009; 49:1341-9. [PMID: 19788358 PMCID: PMC2762474 DOI: 10.1086/606055] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resource-poor settings remains poorly defined. METHODS We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated for the well-defined population. RESULTS Of 25,149 hospital admissions, 7359 patients (29%) had severe or very severe pneumonia, of whom 6026 (82%) were enrolled. RSV prevalence was 15% (20% among infants) and 27% during epidemics (32% among infants). The proportion of case patients aged 3 months was 65%, and the proportion aged 6 months was 43%. Average annual hospitalization rates were 293 hospitalizations per 100,000 children aged <5 years (95% confidence interval, 271-371 hospitalizations per 100,000 children aged <5 years) and 1107 hospitalizations per 100,000 infants (95% confidence interval, 1012-1211 hospitalizations per 100,000 infants). Hospital admission rates were double in the region close to the hospital. Few patients with RSV infection had life-threatening clinical features or concurrent serious illnesses, and the associated mortality was 2.2%. CONCLUSIONS In this low-income setting, rates of hospital admission with RSV-associated pneumonia are substantial; they are comparable to estimates from the United States but considerably underestimate the burden in the full community. An effective vaccine for children aged >2 months (outside the age group of poor responders) could prevent a large portion of RSV disease. Severity data suggest that the justification for RSV vaccination will be based on the prevention of morbidity, not mortality.
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Affiliation(s)
- D James Nokes
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
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Abstract
AIM The aim of this study was to develop a clinical prediction model that identifies respiratory syncytial virus (RSV) infection in infants and young children. METHODS Children < or = 36 months of age with respiratory illness, who were suspected of having RSV infection, were enrolled in this prospective cohort study during the study period between January and February 2002. RSV testing was performed on all patients. RESULTS Of the 197 patients enrolled in the study, 126 (64%) were positive for RSV and 71 (36%) patients were either negative for RSV or had a positive culture for viruses other than RSV. The mean age of patients was 5 months and 57% were male. Backwards stepwise logistic regression analysis identified cough (p = 0.000), wheezing (p = 0.002), and retractions (p = 0.008) as independent variables predictive of RSV infection. The prediction model had a sensitivity of 80% (95% CI, 71-87%), specificity of 68% (95% CI, 54-79%), positive predictive value 82% (95% CI, 74-89%), negative predictive value 66% (95% CI, 52-77), positive likelihood ratio 2.5 (95% CI, 1.8-3.7) and post-test probability of 82%. CONCLUSION The combination of cough, wheezing and retractions predicts RSV infection in infants and young children.
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Affiliation(s)
- Yamini Durani
- Division of Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware, USA.
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Okiro EA, Ngama M, Bett A, Cane PA, Medley GF, James Nokes D. Factors associated with increased risk of progression to respiratory syncytial virus-associated pneumonia in young Kenyan children. Trop Med Int Health 2008; 13:914-26. [PMID: 18482199 PMCID: PMC2635480 DOI: 10.1111/j.1365-3156.2008.02092.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To identify factors associated with developing severe respiratory syncytial virus (RSV) pneumonia and their commonality with all-cause lower respiratory tract infection (LRTI), in order to isolate those risk factors specifically associated with RSV-LRTI and identify targets for control. Methods A birth cohort of rural Kenyan children was intensively monitored for acute respiratory infection (ARI) over three RSV epidemics. RSV was diagnosed by immunofluorescence of nasal washings collected at each ARI episode. Cox regression was used to determine the relative risk of disease for a range of co-factors. Results A total of 469 children provided 937 years of follow-up, and experienced 857 all-cause LRTI, 362 RSV-ARI and 92 RSV-LRTI episodes. Factors associated with RSV-LRTI, but not RSV-ARI, were severe stunting (z-score ≤−2, RR 1.7 95%CI 1.1–2.8), crowding (increased number of children, RR 2.6, 1.0–6.5) and number of siblings under 6 years (RR 2.0, 1.2–3.4). Moderate and severe stunting (z-score ≤−1), crowding and a sibling aged over 5 years sleeping in the same room as the index child were associated with increased risk of all-cause LRTI, whereas higher educational level of the primary caretaker was associated with protection. Conclusion We identify factors related to host nutritional status (stunting) and contact intensity (crowding, siblings) which are distinguishable in their association with RSV severe disease in infant and young child. These factors are broadly in common with those associated with all-cause LRTI. The results support targeted strategies for prevention.
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Affiliation(s)
- Emelda A Okiro
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
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Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics 2008; 121:470-5. [PMID: 18310194 DOI: 10.1542/peds.2007-1135] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to establish the final supportive therapy determinants of hospital length of stay for bronchiolitis. METHODS A retrospective case study of a randomly selected 25% of subjects <1 year of age who were hospitalized with bronchiolitis between April 1, 2003, and June 15, 2005 (n = 129), was performed. Records of 102 admissions to the general wards were reviewed (77 respiratory syncytial virus positive). Length of stay, pulse oxygen saturation profile, oxygen supplementation, feeding support, and nasal suction were determined. Infants admitted to the PICU (27 admissions) were excluded. RESULTS The majority of patients presented with feeding difficulties (82% at admission). Oxygen supplementation was not indicated initially for the majority of infants (22% with mean pulse oxygen saturation of 94%). However, oxygen treatment was required by 70% of infants by 6 hours, whereas the mean pulse oxygen saturation decreased by an average of only 2%. Feeding problems were resolved for 98% of infants by 96 hours, followed by oxygen supplementation resolving with an average lag of 66 hours. The mean pulse oxygen saturation at discharge was 95%. There was no significant correlation between pulse oxygen saturation at arrival at the emergency department and subsequent oxygen requirements or length of stay. CONCLUSIONS Oxygen supplementation is the prime determinant of the length of hospitalization for infants with bronchiolitis. Infants remaining in the hospital for oxygen supplementation once feeding difficulties had resolved did not experience deterioration to the extent of needing PICU support.
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Affiliation(s)
- Stefan Unger
- Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children Edinburgh, Sciennes Rd, Edinburgh, EH9 1LF, United Kingdom
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Climatic, temporal, and geographic characteristics of respiratory syncytial virus disease in a tropical island population. Epidemiol Infect 2008; 136:1319-27. [PMID: 18177515 DOI: 10.1017/s0950268807000015] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
Respiratory syncytial virus (RSV) is an important cause of morbidity in children worldwide, although data from equatorial regions are limited. We analysed climatic, spatial, and temporal data for children presenting to hospitals in Lombok island, Indonesia with clinical pneumonia. During the study period, 2878 children presented and 741 RSV cases were identified. In multivariate analysis with an 8-day lag, occurrence of rain was associated with 64% higher incidence of RSV disease [incidence rate ratio (IRR) 1.64, 95% confidence interval (CI) 1.13-2.38]. A 1% rise in mean relative humidity and 1 degree C increase in mean air temperature was associated with a 6% (IRR 1.06, 95% CI 1.03-1.10) and 44% (IRR 1.44, 95% CI 1.24-1.66) increase in RSV cases, respectively. Four statistically significant local clusters of RSV pneumonia were identified within the annual island-wide epidemics. This study demonstrates statistical association of monsoon-associated weather in equatorial Indonesia with RSV. Moreover, within the island-wide epidemics, localized RSV outbreaks suggest local factors influence RSV disease.
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YUSUF S, PIEDIMONTE G, AUAIS A, DEMMLER G, KRISHNAN S, VAN CAESEELE P, SINGLETON R, BROOR S, PARVEEN S, AVENDANO L, PARRA J, CHAVEZ-BUENO S, DE SIERRA TMURGUÍA, SIMOES E, SHAHA S, WELLIVER R. The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect 2007; 135:1077-90. [PMID: 17346359 PMCID: PMC2870672 DOI: 10.1017/s095026880600776x] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2006] [Indexed: 11/07/2022] Open
Abstract
Our aim was to obtain knowledge of how meteorological conditions affect community epidemics of respiratory syncytial virus (RSV) infection. To this end we recorded year-round RSV activity in nine cities that differ markedly in geographic location and climate. We correlated local weather conditions with weekly or monthly RSV cases. We reviewed similar reports from other areas varying in climate. Weekly RSV activity was related to temperature in a bimodal fashion, with peaks of activity at temperatures above 24-30 degrees C and at 2-6 degrees C. RSV activity was also greatest at 45-65% relative humidity. RSV activity was inversely related to UVB radiance at three sites where this could be tested. At sites with persistently warm temperatures and high humidity, RSV activity was continuous throughout the year, peaking in summer and early autumn. In temperate climates, RSV activity was maximal during winter, correlating with lower temperatures. In areas where temperatures remained colder throughout the year, RSV activity again became nearly continuous. Community activity of RSV is substantial when both ambient temperatures and absolute humidity are very high, perhaps reflecting greater stability of RSV in aerosols. Transmission of RSV in cooler climates is inversely related to temperature possibly as a result of increased stability of the virus in secretions in the colder environment. UVB radiation may inactivate virus in the environment, or influence susceptibility to RSV by altering host resistance.
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Affiliation(s)
- S. YUSUF
- Division of Infectious Diseases, Department of Pediatrics, State University of New York at Buffalo and Women and Children's Hospital, Buffalo, NY, USA
| | - G. PIEDIMONTE
- Batchelor Children's Research Institute, Pediatric Pulmonology and Cystic Fibrosis Center, University of Miami School of Medicine, Miami, FL, USA
| | - A. AUAIS
- Batchelor Children's Research Institute, Pediatric Pulmonology and Cystic Fibrosis Center, University of Miami School of Medicine, Miami, FL, USA
| | - G. DEMMLER
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, and Diagnostic Virology Laboratory, Texas Children's Hospital, Houston, TX, USA
| | - S. KRISHNAN
- Department of Microbiology and Immunology, University of Arizona, Tucson, AZ, USA
| | | | - R. SINGLETON
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - S. BROOR
- Virology Section, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S. PARVEEN
- Virology Section, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - L. AVENDANO
- Programa de Virología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - J. PARRA
- Programa de Virología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - S. CHAVEZ-BUENO
- Division of Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Branch, Dallas, TX, USA
| | | | - E. A. F. SIMOES
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA
| | - S. SHAHA
- Center for Pediatric Quality, Women and Children's Hospital, Buffalo, NY, USA
| | - R. WELLIVER
- Division of Infectious Diseases, Department of Pediatrics, State University of New York at Buffalo and Women and Children's Hospital, Buffalo, NY, USA
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Bruce N, Weber M, Arana B, Diaz A, Jenny A, Thompson L, McCracken J, Dherani M, Juarez D, Ordonez S, Klein R, Smith KR. Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings. Bull World Health Organ 2007; 85:535-44. [PMID: 17768502 PMCID: PMC2636369 DOI: 10.2471/blt.06.035832] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 02/07/2007] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Trials of environmental risk factors and acute lower respiratory infections (ALRI) face a double challenge: implementing sufficiently sensitive and specific outcome assessments, and blinding. We evaluate methods used in the first randomized exposure study of pollution indoors and respiratory effects (RESPIRE): a controlled trial testing the impact of reduced indoor air pollution on ALRI, conducted among children METHODS Case-finding used weekly home visits by fieldworkers trained in integrated management of childhood illness methods to detect ALRI signs such as fast breathing. Blindness was maintained by referring cases to study physicians working from community centres. Investigations included oxygen saturation (SaO2), respiratory syncytial virus (RSV) antigen test and chest X-ray (CXR). FINDINGS Fieldworkers referred > 90% of children meeting ALRI criteria, of whom about 70% attended a physician. Referrals for cough without respiratory signs and self-referrals contributed 19.0% and 17.9% of physician-diagnosed ALRI cases respectively. Intervention group attendance following ALRI referral was 7% higher than controls, a trend also seen in compliance with RSV tests and CXR. There was no evidence of bias by intervention status in fieldworker classification or physician diagnosis. Incidence of fieldworker ALRI (1.12 episodes/child/year) is consistent with high sensitivity and low specificity; incidence of physician-diagnosed ALRI (0.44 episodes/child/year) is consistent with comparable studies. CONCLUSION The combination of case-finding methods achieved good sensitivity and specificity, but intervention cases had greater likelihood of reaching the physician and being investigated. There was no evidence of bias in fieldworkers classifications despite lack of concealment at home visits. Pulse oximetry offers practical, objective severity assessment for field studies of ALRI.
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Affiliation(s)
- Nigel Bruce
- Division of Public Health, Whelan Building, University of Liverpool, England.
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31
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Welliver TP, Garofalo RP, Hosakote Y, Hintz KH, Avendano L, Sanchez K, Velozo L, Jafri H, Chavez-Bueno S, Ogra PL, McKinney L, Reed JL, Welliver RC. Severe human lower respiratory tract illness caused by respiratory syncytial virus and influenza virus is characterized by the absence of pulmonary cytotoxic lymphocyte responses. J Infect Dis 2007; 195:1126-36. [PMID: 17357048 PMCID: PMC7109876 DOI: 10.1086/512615] [Citation(s) in RCA: 311] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 11/03/2006] [Indexed: 11/08/2022] Open
Abstract
Background. Respiratory syncytial virus (RSV) and influenza virus are common causes of infantile lower respiratory tract infection (LRTI). It is widely believed that both viral replication and inappropriately enhanced immune responses contribute to disease severity. In infants, RSV LRTI is known to be more severe than influenza virus LRTI. Methods. We compared cytokines and chemokines in secretions of infants surviving various forms of respiratory illness caused by RSV or influenza viruses, to determine which mediators were associated with more-severe illness. We analyzed lung tissue from infants with fatal cases of RSV and influenza virus LRTI to determine the types of inflammatory cells present. Autopsy tissues were studied for the lymphotoxin granzyme and the apoptosis marker caspase 3. Results. Quantities of lymphocyte-derived cytokines were minimal in secretions from infants with RSV infection. Concentrations of most cytokines were greater in influenza virus, rather than RSV, infection. Lung tissues from infants with fatal RSV and influenza virus LRTI demonstrated an extensive presence of viral antigen and a near absence of CD8-positive lymphocytes and natural killer cells, with marked expression of markers of apoptosis. Conclusions. Severe infantile RSV and influenza virus LRTI is characterized by inadequate (rather than excessive) adaptive immune responses, robust viral replication, and apoptotic crisis.
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Affiliation(s)
- Timothy P. Welliver
- MedImmune, Inc., Gaithersburg, Maryland
- Reprints or correspondence: Dr. Robert C. Welliver, Div. of Infectious Diseases, Women and Children's Hospital, 219 Bryant St., Buffalo, NY 14222 ()
| | - Roberto P. Garofalo
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Dallas
| | - Yashoda Hosakote
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Dallas
| | - Karen H. Hintz
- Department of Pediatrics, Women and Children's Hospital, State University of New York at Buffalo, Buffalo
| | | | | | - Luis Velozo
- Unidad de Anatomía Patológica, Hospital Roberto del Río, Santiago, Chile
| | - Hasan Jafri
- University of Texas Southwestern Medical Center, Dallas
| | | | - Pearay L. Ogra
- Department of Pediatrics, Women and Children's Hospital, State University of New York at Buffalo, Buffalo
| | | | | | - Robert C. Welliver
- Department of Pediatrics, Women and Children's Hospital, State University of New York at Buffalo, Buffalo
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Everard ML. The role of the respiratory syncytial virus in airway syndromes in childhood. Curr Allergy Asthma Rep 2006; 6:97-102. [PMID: 16566858 DOI: 10.1007/s11882-006-0046-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The majority of infants admitted to hospital in infancy with lower respiratory tract infections (LRTIs) have been infected with the respiratory syncytial virus (RSV). Infants and young children experiencing RSV LRTIs experience increased respiratory morbidity in subsequent years, although the prevalence falls rapidly in early childhood. Recent data support the suggestion that in most subjects, this recurrent morbidity is not attributable to atopic asthma and that in most respects, the acute and long-term outcomes with RSV infections are similar in nature to those attributable to other viruses. The phenotype of the acute illness probably provides better prognostic information than the type of virus.
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Affiliation(s)
- Mark L Everard
- Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield, UK.
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Savón C, Goyenechea A, Valdés O, Aguilar J, González G, Palerm L, Gonzalez G, Pérez Breña P. Respiratory Syncytial Virus Group A and B Genotypes and Disease Severity among Cuban Children. Arch Med Res 2006; 37:543-7. [PMID: 16624656 DOI: 10.1016/j.arcmed.2005.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 08/24/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of serious lower tract infections in infants. Comorbid conditions such as chronic diseases and prematurity have been associated with greater severity illness, but virus genotypes and disease severity is still unknown. METHODS Forty selected strains of RSV group A and B from Cuban infants with acute respiratory disease (ARD) over five seasons were studied. Viral RNA was extracted and polymerase chain reaction (PCR) was carried out using direct primers directed to parts of the nucleoprotein (N) and fusion (F) genes, respectively. Amplicons were digested using restriction fragment length polymorphism (RFLP) to define the association between virus and disease severity. Disease severity was assessed as very mild, mild, moderate, and severe. RESULTS Three of six known N genotypes were detected. NP4 and NP3 were found more frequently; moreover, it was difficult to establish a relationship between N genotypes and disease severity. Five genotypes in F gene were found: F1, F2, F5, F9 and F11; F9 and F11 were associated with very mild disease, but F1 genotype appears to be associated with moderate to severe disease. CONCLUSIONS At least five combinations of N and F genotypes circulated in the studied infants in Cuba. Patients with F1NP4 genotype showed moderate to severe disease. Relationship between genotypes and disease severity was established.
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Affiliation(s)
- Clara Savón
- Instituto de Medicina Tropical Pedro Kourí, Havana, Cuba.
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Junge S, Palmer A, Greenwood BM, Kim Mulholland E, Weber MW. The spectrum of hypoxaemia in children admitted to hospital in The Gambia, West Africa. Trop Med Int Health 2006; 11:367-72. [PMID: 16553917 DOI: 10.1111/j.1365-3156.2006.01570.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hypoxia predicts mortality in children with acute lower respiratory infections (ALRIs). We investigated the prevalence and predictive value of hypoxia in ALRI and other acute infectious diseases. METHODS We studied the spectrum of hypoxaemia in 4,047 children admitted to a tertiary hospital in The Gambia. Oxygen saturation was measured shortly after admission. Severe hypoxaemia was defined as an oxygen saturation below 90%. RESULTS 5.8% of all admissions had severe hypoxaemia. Prevalence of hypoxaemia varied between disease groups: it was 11.7% in ALRI cases, 16.5% in neonates; 2.9% in malaria cases overall but 6.5% in cerebral malaria patients; and 2.7% in children with meningitis. Hypoxaemia predicted a poor outcome; the odds ratio for death among paediatric admissions overall was 7.45 [95% confidence intervals (CI) 5.40-10.29]. Surprisingly, it was lowest for children with ALRI [OR 3.53 (95% CI 1.13-10.59)], and higher for those with malaria 9.90 [95% CI 4.39-22.35]. CONCLUSION Hypoxaemia is common among Gambian children admitted to hospital and it is often associated with a poor outcome. A similar situation is likely in many other developing countries. Thus, equipment for measuring oxygen saturation, and facilities and equipment for effective oxygen delivery need to be made available in developing countries.
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Affiliation(s)
- Sonja Junge
- University Children's Hospital, Zurich, Switzerland
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Arbiza J, Delfraro A, Frabasile S. Molecular epidemiology of human respiratory syncytial virus in Uruguay: 1985-2001--a review. Mem Inst Oswaldo Cruz 2005; 100:221-30. [PMID: 16113858 DOI: 10.1590/s0074-02762005000300001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The variability of the G glycoprotein from human respiratory syncytial viruses (HRSV) (groups A and B) isolated during 17 consecutive epidemics in Montevideo, Uruguay have been analyzed. Several annual epidemics were studied, where strains from groups A and B circulated together throughout the epidemics with predominance of one of them. Usually, group A predominates, but in some epidemics group B is more frequently detected. To analyse the antigenic diversity of the strains, extracts of cells infected with different viruses of group A were tested with a panel of anti-G monoclonal antibodies (MAbs). The genetic variability of both groups was analyzed by sequencing the C-terminal third of the G protein gene. The sequences obtained together with previously published sequences were used to perform phylogenetic analyses. The data from Uruguayan isolates, together with those from the rest of the world provide information regarding worldwide strain circulation. Phylogenetic analyses of HRSV from groups A and B show a model of evolution analogous to the one proposed for influenza B viruses providing information that would be beneficial for future immunization programs and to design safe vaccines.
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Affiliation(s)
- Juan Arbiza
- Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo, Uruguay.
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Bhatt JM, Everard ML. Do environmental pollutants influence the onset of respiratory syncytial virus epidemics or disease severity? Paediatr Respir Rev 2004; 5:333-8. [PMID: 15531259 DOI: 10.1016/j.prrv.2004.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The trigger for annual epidemics of respiratory syncytial virus (RSV) infections and the factors contributing to the disappearance of RSV infections in late winter remain obscure. Similarly, there is no adequate explanation for the higher morbidity and admission rates in industrialised as compared with rural areas. It has been suggested that a variety of environmental factors such as temperature, daylight and humidity may influence the onset and waning of the epidemics. However, the few studies assessing these variables fail to support such a link. In many tropical countries the annual epidemic occurs in the summer or autumn, arguing against temperature having a direct influence. A number of studies have suggested that indoor pollutants, including cigarette smoke, are associated with an increased likelihood of being admitted to hospital with severe lower respiratory tract disease. One study exploring the potential role of outdoor pollutants on the pattern of RSV related illness in infancy was unable to identify a clear link between a variety of pollutants and the timing of the epidemic. Nitric oxide levels were higher in winter than during the summer and much higher winter peaks of NO were observe in industrialised areas as compared with urban and rural areas. Whether this or other environmental pollutants contribute to the higher incidence of severe disease in industrialised areas is unclear. Further work is required to explore the possible influence of NO and other environmental pollutants on both the timing and severity of epidemics.
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Affiliation(s)
- Jayesh M Bhatt
- Pediatric Respiratory Unit, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK
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Abstract
Pneumonia has been a leading cause of death in both developed and developing countries as long as health indicators have been available. Yet the issues of concern for this syndrome are far from static. Improvements in access to health services have lowered infant mortality rates, benefiting children around the world and lowering the fraction of child deaths caused by pneumonia. However, progress has been interrupted repeatedly by the emergence of new pathogens. Landmark randomized controlled trials have now demonstrated the effectiveness of Haemophilus influenzae type b (Hib) and multivalent pneumococcal conjugate vaccines against childhood pneumonia, as well as meningitis and bacteremic disease. Momentum has gathered to tackle long-standing economic obstacles to expand access to new vaccines and programs for the poorest countries of the world. A pressing challenge for the control of pneumonia in developing countries is to identify better metrics for pneumonia. Surveillance tools are needed that will bridge studies of interventions, establish preventable disease burden, and serve as indicators for monitoring new programs.
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Affiliation(s)
- Anne Schuchat
- Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Moura FEA, Blanc A, Frabasile S, Delfraro A, de Sierra MJ, Tome L, Ramos EAG, Siqueira MM, Arbiza J. Genetic diversity of respiratory syncytial virus isolated during an epidemic period from children of northeastern Brazil. J Med Virol 2004; 74:156-60. [PMID: 15258982 DOI: 10.1002/jmv.20159] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Outbreaks of human respiratory syncytial virus (HRSV) are the leading cause of serious acute lower respiratory viral disease in many countries in different continents. Data on clinical and epidemiological aspects of HRSV infections in this country have been reported, but there is lack of data regarding the molecular epidemiology of this virus in Salvador. The genetic variability of HRSV isolated during an outbreak in Salvador, Brazil (1999) has been analysed. Partial sequences of the G protein gene of 13 isolates from antigenic group A and 4 isolates from antigenic group B of HRSV were determined. Nucleotide sequences of C-terminal G gene were compared to sequences of HRSV isolates from countries of South America and from the rest of the world available at the GenBank. Brazilian group A and B isolates were clustered into previously characterised genotypes: GA5, GA2, GA7, and GB3, SAB3, respectively. This is the first study of GA7 and SAB3 genotypes circulation in South American countries. It is interesting to point out that viruses isolated in Salvador appear to be closer related with those from Montevideo-Uruguay and Buenos Aires, Argentina strains, suggesting circulation of similar strains among different South American countries in different seasons. Moreover, viruses closely related genetically circulated in the same year in Salvador and distant places such as Mozambique, supporting the previous suggestion on the complexity of HRSV strain circulation patterns, and the high capability of HRSV spreading world-wide.
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Affiliation(s)
- Fernanda Edna Araújo Moura
- Laboratório de Patología e Doenças Virais, Centro de Pesquisa Gonçalo Moniz, FIOCRUZ, Rua Waldemar Falcão, Brotas, Salvador, Bahia, Brazil
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Abstract
OBJECTIVE To critically review the literature examining risk factors for development of severe respiratory syncytial virus lower respiratory tract infection (RSV LRI). STUDY DESIGN A literature review was performed with the use of a MedLine search strategy. Clinical evidence of putative risk factors was rated by means of the US Preventive Services Task Force recommendations, and the quality of the data was critically assessed. Nonmedical risk factors examined included race/ethnicity, age of acquisition of RSV, sex, birth during the first half of the RSV season, breast-feeding, malnutrition, maternal education, socioeconomic status, crowding/siblings, day care, and tobacco smoke exposure. RESULTS There was sufficient evidence available to conclude that (1) male sex, (2) age <6 months, (3) birth during the first half of the RSV season, (4) crowding/siblings, and (5) day care exposure are significant risk factors for severe RSV LRI. There was insufficient evidence to evaluate the effect of race/ethnicity on severe RSV LRI. The evidence for tobacco smoke exposure is mixed. Low maternal education (as a proxy for lower socioeconomic status), lack of breast-feeding, and malnutrition did not appear to increase the risk of severe RSV LRI or RSV hospitalization. CONCLUSIONS Male sex, young age, birth in the first half of the RSV season, day care attendance, and crowding/siblings are independent risk factors for the development of severe RSV LRI.
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Affiliation(s)
- Eric A F Simoes
- Section of Infectious Diseases, The University of Colorado School of Medicine and The Children's Hospital, Denver, Colorado 80218, USA.
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41
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Moura FEA, Borges LC, Portes SAR, Ramos EAG, Siqueira MM. Respiratory syncytial virus infections during an epidemic period in Salvador, Brazil. Viral antigenic group analysis and description of clinical and epidemiological aspects. Mem Inst Oswaldo Cruz 2003; 98:739-43. [PMID: 14595448 DOI: 10.1590/s0074-02762003000600005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute respiratory infections (ARI) caused by respiratory syncytial virus (RSV) were studied in 482 children from Salvador, BA, Brazil, over a period of 12 months. The epidemic period of RSV infections in Salvador occurred from February (summer) to August (winter), with peaks in May, June, and July. The grouping characteristics of 84 RSV present in nasopharyngeal secretions of children seen at a reference university hospital were analyzed. RSV represented 17.4% of all cases and 54.5% of the positive samples. Sixty-four RSV strains were assigned to group A and 14 to group B. Both groups circulated in the five months of the epidemic period studied. Infections by both groups of RSV were more frequent in children up to one year of age. The incidence of RSV ARI was slightly more frequent in males, although group B had more infected females.
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Affiliation(s)
- Fernanda Edna Araújo Moura
- Laboratório de Patologia e Doenças Virais, Centro de Pesquisas Gonçalo Moniz-Fiocruz, 40295-001 Salvador, BA, Brasil.
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42
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Tsolia MN, Kafetzis D, Danelatou K, Astral H, Kallergi K, Spyridis P, Karpathios TE. Epidemiology of respiratory syncytial virus bronchiolitis in hospitalized infants in Greece. Eur J Epidemiol 2003; 18:55-61. [PMID: 12705624 DOI: 10.1023/a:1022556215190] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
New therapies have been introduced for the prophylaxis and treatment of respiratory syncytial virus (RSV) infection in recent years. The aim of the study was to determine the epidemiological and clinical characteristics of infants hospitalized with bronchiolitis in our area. All patients under 1 year of age admitted with acute bronchiolitis during four consecutive RSV seasons from February 1, 1997 to June 30, 2000 were enrolled in the study. The records of patients admitted during the first season were reviewed retrospectively while the rest were followed prospectively. A total of 636 infants with bronchiolitis were admitted and RSV infection was documented in 61% of those tested. Admission to intensive care unit (ICU) was required for 6.2% of them and was more common in premature infants (26%) (p < 0.001). Case fatality rate was 0.7% (overall 0.3%). RSV bronchiolitis accounted for about 12% of all infant admissions during the 5 months of the yearly outbreak. Patients with documented RSV infection had a more severe illness with a higher ICU admission rate (6 vs. 1%, p = 0.008) and longer duration of hospitalization (mean 6.3 vs. 5.3 days, p < 0.001) compared to those who tested negative. Although none of the patients had a positive blood culture on admission a considerable number of them (210/636, 33%) were treated with antibiotics. RSV infection has a significant impact on infant morbidity in our settings which is more serious among those born prematurely. Documentation of RSV infection may be a marker of more severe illness in infants hospitalized with bronchiolitis. Antibiotic use has to be restricted since the occurrence of a serious bacteraemic illness on admission is a very rare event.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Bacteremia/drug therapy
- Bacteremia/epidemiology
- Bronchiolitis, Viral/complications
- Bronchiolitis, Viral/diagnosis
- Bronchiolitis, Viral/epidemiology
- Female
- Greece/epidemiology
- Hospitals, Pediatric/statistics & numerical data
- Humans
- Infant
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/virology
- Intensive Care Units, Neonatal/statistics & numerical data
- Length of Stay/statistics & numerical data
- Male
- Prospective Studies
- Respiratory Syncytial Virus Infections/complications
- Respiratory Syncytial Virus Infections/diagnosis
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Viruses/isolation & purification
- Retrospective Studies
- Seasons
- Severity of Illness Index
- Utilization Review
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Affiliation(s)
- M N Tsolia
- Second Department of Pediatrics, School of Medicine, University of Athens, pital, Athens, Greece.
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43
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Abstract
Acute viral respiratory tract infections are a significant cause of morbidity worldwide. Information on the epidemiology and seasonality of these infections is important in planning vaccination and treatment strategies. In temperate climes, there are distinct seasonal peaks in the winter months. This paper reviews the seasonal trends of respiratory viral infections in the tropics. Despite the absence of a winter season, consistent seasons of infection, albeit less distinct, have been observed. With few exceptions, respiratory syncytial virus and influenza infections have been observed mainly during the rainy seasons in Asian, African and South American countries.
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Affiliation(s)
- Lynette Pei-Chi Shek
- Department of Paediatrics, National University of Singapore, Lower Kent Ridge Road, Singapore 119074
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44
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Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: the ups and downs of a seasonal virus. Pediatr Infect Dis J 2003; 22:S21-32. [PMID: 12671449 DOI: 10.1097/01.inf.0000053882.70365.c9] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common pathogen causing lower respiratory tract infections in infants worldwide. Lower respiratory tract infections caused by RSV occur epidemically, and the appearance of epidemics seems to vary with latitude, altitude and climate. This study uses a review of the literature on RSV seasonality to investigate whether a global pattern in RSV epidemics can be found. A comparison of morbidity and mortality caused by RSV in developed vs. developing countries is also presented. The seasons in which RSV epidemics occur typically depend on geographic location and altitude. During these seasons the epidemics tend to appear in clusters. Although the appearance pattern of these epidemics varies from one continent to another, they usually begin in coastal areas. RSV is the cause of one-fifth of lower respiratory infections worldwide. Generally RSV mortality is low, with a median value of zero. However, RSV mortality in developing countries is significantly higher than RSV mortality in developed countries.
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Affiliation(s)
- Lone Graff Stensballe
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Copenhagen, Denmark
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45
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Abstract
Respiratory syncytial virus is the leading cause of hospital admission for lower respiratory tract infection in young children and appears to be responsible for a significant burden of disease in adults, particularly the elderly and the immunocompromised. In this review, we describe the epidemiology, diagnosis and clinical manifestations of infection attributed to this virus. We also consider current therapeutic and prophylactic options and appraise strategies for vaccination that are in clinical trials.
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Affiliation(s)
- C L Collins
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Level 4, John Radcliffe Hospital, Oxford OX3 9DU, UK
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46
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Affiliation(s)
- Pedro A Piedra
- Department of Molecular Virology, Baylor College of Medicine, Houston, TX 77030, USA.
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47
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Loscertales MP, Roca A, Ventura PJ, Abacassamo F, Dos Santos F, Sitaube M, Men ndez C, Greenwood BM, Saiz JC, Alonso PL. Epidemiology and clinical presentation of respiratory syncytial virus infection in a rural area of southern Mozambique. Pediatr Infect Dis J 2002; 21:148-55. [PMID: 11840083 DOI: 10.1097/00006454-200202000-00013] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) in infants throughout most of the world, but little is known about RSV infection in Africa where LRTI are among the leading causes of infant and childhood death. METHODS The study took place in a rural district hospital in southern Mozambique between October, 1998, and May, 2000. From all children (n = 5635) <1 year of age presenting to an outpatient department with cough or nasal secretion and all children (n = 1307) <5 years of age admitted to hospital with a LRTI, a nasopharyngeal aspirate was collected and tested for RSV by enzyme-linked immunosorbent assay (Abbott). RESULTS RSV infection was found in 8.6% of study infants in the outpatient department and 10.6% of admitted children with LRTI. Cases presented in predictable yearly outbreaks during the warm and rainy season. Lower respiratory tract involvement was frequent (59.7%). Cough, chest indrawing and increased respiratory rate were all independently related to RSV infection. Wheezing was infrequent. Bacterial coinfection (4.6%) and the case-fatality rate (3.4%) were low. CONCLUSIONS There is a substantial burden of disease attributable to RSV infection in this rural African setting, with the highest incidence and severity occurring in young infants.
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Affiliation(s)
- Maria P Loscertales
- Centro de Investigaçao em Saúde da Manhiça, Ministerio de Saúde, Maputo, Mozambique
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48
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Abstract
Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection in children. In this paper we use models of RSV transmission to interpret the pattern of seasonal epidemics of RSV disease observed in different countries, and to estimate epidemic and eradication thresholds for RSV infection. We compare the standard SIRS model with a more realistic model of RSV transmission in which individuals acquire immunity gradually after repeated exposure to infection. The models are fitted to series of monthly hospital case reports of RSV disease from developed and developing countries. The models can explain many of the observed patterns: regular yearly outbreaks in some countries, and in other countries cycles of alternating larger and smaller annual epidemics, with shifted maxima in alternate years. Previously these patterns have been attributed to the transmission of different strains of RSV. In some countries the timing of epidemics is not consistent with increased social contact among school children during term time being the major driving mechanism. Climatic factors appear to be more important. Qualitatively different models gave equally good fits to the data series, but estimates of the transmission parameter were different by a factor of 4. Estimates of the basic reproduction number (R(0)) ranged from 1.2 to 2.1 with the SIRS model, and from 5.4 to 7.1 with the model with gradual acquisition of partial immunity.
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Affiliation(s)
- A Weber
- Institut für Informatik II, Universität Bonn, Römerstrasse 164, 53117 Bonn, Germany.
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49
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Abstract
Human respiratory syncytial virus (RSV) is the major cause of lower respiratory tract disease in infants. It is unusual in that it causes repeated infections throughout life. Despite considerable efforts there is as yet no satisfactory vaccine available. This paper reviews the molecular epidemiology of the RSV and describes the complex genotypic structure of RSV epidemics. The evolution of the virus is discussed, with particular reference to the antigenic and genetic variability of the attachment glycoprotein.
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Affiliation(s)
- P A Cane
- Division of Immunity and Infection, University of Birmingham Medical School, Birmingham B15 2TT, UK.
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50
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Madhi SA, Venter M, Madhi A, Petersen MK, Klugman KP. Differing manifestations of respiratory syncytial virus-associated severe lower respiratory tract infections in human immunodeficiency virus type 1-infected and uninfected children. Pediatr Infect Dis J 2001; 20:164-70. [PMID: 11224836 DOI: 10.1097/00006454-200102000-00010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes increased morbidity and mortality in immunocompromised children. The outcome of RSV-associated lower respiratory tract infections (LRTI) in HIV-infected children, is less well described. METHODS Children from a prospective study evaluating the etiology of
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Affiliation(s)
- S A Madhi
- South African Institute for Medical Research/University of the Witwatersrand/Medical Research Council Pneumococcal Diseases Research Unit, Johannesburg
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