Avoiding hypothermia, an intervention to prevent morbidity and mortality from pneumonia in young children

An Emerging Health Crisis in Turkey and Syria after the Earthquake Disaster on 6 February 2023: Risk Factors, Prevention and Management of Infectious Diseases

On 6 February 2023, Turkey and Syria were hit by two major earthquakes that caused extremely heavy structural damage to buildings and infrastructure in one of the most densely populated areas of Anatolia. The authors visited the devastated area shortly after the earthquakes in the frame of search and rescue and scientific missions in order to check whether the newly formed conditions have the potential to further affect public health. Based on the collected disaster-related field data, it is revealed that risk factors associated with and favoring emergence of infectious diseases are present in the affected residential areas from the first hours of the emergency state. The coexistence and synergy of many collapsed health facilities, cold winter conditions, destruction of lifeline infrastructures, overcrowding in emergency shelters, poor sanitation and adverse socio-economic conditions along with evolving crises and disasters (conflicts, pandemic and epidemics) may further aggravate the already fragile public health situation and cause considerable delays in the recovery process. Efficient disease surveillance at local and regional levels is a crucial requirement for early warning and protection against emerging infectious diseases in the earthquake-affected areas among other proposed measures for prevention and management of infectious diseases.

Respiratory Infections Following Earthquake-Induced Tsunamis: Transmission Risk Factors and Lessons Learned for Disaster Risk Management

Earthquake-induced tsunamis have the potential to cause extensive damage to natural and built environments and are often associated with fatalities, injuries, and infectious disease outbreaks. This review aims to examine the occurrence of respiratory infections (RIs) and to elucidate the risk factors of RI transmission following tsunamis which were induced by earthquakes in the last 20 years. Forty-seven articles were included in this review and referred to the RIs emergence following the 2004 Sumatra-Andaman, the 2009 Samoa, and the 2011 Japan earthquakes. Polymicrobial RIs were commonly detected among near-drowned tsunami survivors. Influenza outbreaks were commonly detected during the influenza transmission period. Overcrowded conditions in evacuation centers contributed to increased acute RI incidence rate, measles transmission, and tuberculosis detection. Destruction of health care infrastructures, overcrowded evacuation shelters, exposure to high pathogen densities, aggravating weather conditions, regional disease endemicity, and low vaccination coverage were the major triggering factors of RI occurrence in post-tsunami disaster settings. Knowledge of risk factors underlying RIs emergence following earthquake-induced tsunami can contribute to the implementation of appropriate disaster prevention and preparedness plans characterized by sufficient environmental planning, resistant infrastructures, resilient health care facilities, and well-established evacuation centers. Global and local disease surveillance is a key prerequisite for early warning and protection against RIs’ emergence and transmission in tsunami-prone areas.

Epidemiology and outcomes of children with accidental hypothermia: A propensity-matched study

BACKGROUND

The purpose of this study was to explore the epidemiology and outcomes of hospitalized children with a diagnosis of accidental hypothermia.

METHODS

The 2012 Kids' Inpatient Database, detailing discharge diagnoses in children admitted to US hospitals, was analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification codes to filter out relevant patients. Children ages 1 month to 17 years were included in the analysis. Demographic and outcome variables in the hypothermia group were compared with the rest of the patients. In a separate analysis, children with hypothermia were matched 1:1 using a correlative propensity score using sex, age, hospital region, income quartiles, race, ventilation status, coagulopathy, drowning, and All Patient Refined Diagnosis Related Groups severity score and their outcomes were compared with controls. The sample data were weighted to get a national estimate.

RESULTS

Accidental hypothermia was present in 1,028 cases out of 1,915,435 discharges. Children with hypothermia were more likely to be males (54.7% vs. 50.9%; p < 0.05) and infants (32.6% vs. 17.5%); they were less likely to be teens (30% vs. 37.8%). Children with hypothermia were more likely to be admitted in the Southern region (48.3% vs. 38.4%; p < 0.05) and have a higher mortality rate compared to all other discharges (8.5% vs. 0.3%; p < 0.05) or when compared with the matched controls (8.9% vs. 4.4%).

CONCLUSIONS

The diagnosis of accidental hypothermia significantly increased mortality in hospitalized children. Interestingly, accidental hypothermia was more common in Southern states compared to the other areas of the United States.

LEVEL OF EVIDENCE

Prognostic/epidemiological study, level III.

Cold stress aggravates inflammatory responses in an LPS-induced mouse model of acute lung injury

Although the relationship between environmental cold temperature and susceptibility to respiratory infection is generally accepted, the effect of ambient cold temperature on host reactivity in lung inflammation has not been fully studied. To examine the function of ambient cold temperature on lung inflammation, mice were exposed to 4 °C for 8 h each day for 14 days. In the lungs of mice exposed to cold stress, inflammatory cells in bronchoalveolar lavage (BAL) fluid and lung tissues were slightly increased by about twofold. However, the structures of pulmonary epithelial cells were kept within normal limits. Next, we examined the effect of cold stress on the inflammatory responses in a lipopolysaccharide (LPS)-induced acute lung injury (ALI) mouse model. The infiltration of neutrophils and inflammation of lung tissue determined by histology were significantly increased by exposure to ambient cold temperature. In addition, the production of pro-inflammatory cytokines including interleukin (IL)-12, IL-17, and monokine induced by gamma interferon (MIG) was elevated by exposure to cold stress. Therefore, we suggest that cold stress is a factor that exacerbates lung inflammation including ALI. To our knowledge, this is the first report on the relationship between cold stress and severity of lung inflammation.

Temperature variation and heat wave and cold spell impacts on years of life lost among the urban poor population of Nairobi, Kenya

Weather extremes are associated with adverse health outcomes, including mortality. Studies have investigated the mortality risk of temperature in terms of excess mortality, however, this risk estimate may not be appealing to policy makers assessing the benefits expected for any interventions to be adopted. To provide further evidence of the burden of extreme temperatures, we analyzed the effect of temperature on years of life lost (YLL) due to all-cause mortality among the population in two urban informal settlements. YLL was generated based on the life expectancy of the population during the study period by applying a survival analysis approach. Association between daily maximum temperature and YLL was assessed using a distributed lag nonlinear model. In addition, cold spell and heat wave effects, as defined according to different percentiles, were investigated. The exposure-response curve between temperature and YLL was J-shaped, with the minimum mortality temperature (MMT) of 26 °C. An average temperature of 21 °C compared to the MMT was associated with an increase of 27.4 YLL per day (95% CI, 2.7-52.0 years). However, there was no additional effect for extended periods of cold spells, nor did we find significant associations between YLL to heat or heat waves. Overall, increased YLL from all-causes were associated with cold spells indicating the need for initiating measure for reducing health burdens.

Impact of the Tohoku earthquake and tsunami on pneumonia hospitalisations and mortality among adults in northern Miyagi, Japan: a multicentre observational study

Background

On 11 March 2011, the Tohoku earthquake and tsunami struck off the coast of northeastern Japan. Within 3 weeks, an increased number of pneumonia admissions and deaths occurred in local hospitals.

Methods

A multicentre survey was conducted at three hospitals in Kesennuma City (population 74 000), northern Miyagi Prefecture. All adults aged ≥18 years hospitalised between March 2010 and June 2011 with community-acquired pneumonia were identified using hospital databases and medical records. Segmented regression analyses were used to quantify changes in the incidence of pneumonia.

Results

A total of 550 pneumonia hospitalisations were identified, including 325 during the pre-disaster period and 225 cases during the post-disaster period. The majority (90%) of the post-disaster pneumonia patients were aged ≥65 years, and only eight cases (3.6%) were associated with near-drowning in the tsunami waters. The clinical pattern and causative pathogens were almost identical among the pre-disaster and post-disaster pneumonia patients. A marked increase in the incidence of pneumonia was observed during the 3-month period following the disaster; the weekly incidence rates of pneumonia hospitalisations and pneumonia-associated deaths increased by 5.7 times (95% CI 3.9 to 8.4) and 8.9 times (95% CI 4.4 to 17.8), respectively. The increases were largest among residents in nursing homes followed by those in evacuation shelters.

Conclusions

A substantial increase in the pneumonia burden was observed among adults after the Tohoku earthquake and tsunami. Although the exact cause remains unresolved, multiple factors including population aging and stressful living conditions likely contributed to this pneumonia outbreak.

Evaluation of risk factors for severe pneumonia in children: the Pneumonia Etiology Research for Child Health study

As a case-control study of etiology, the Pneumonia Etiology Research for Child Health (PERCH) project also provides an opportunity to assess the risk factors for severe pneumonia in hospitalized children at 7 sites. We identified relevant risk factors by literature review and iterative expert consultation. Decisions for inclusion in PERCH were based on comparability to published data, analytic plans, data collection costs and logistic feasibility, including interviewer time and subject fatigue. We aimed to standardize questions at all sites, but significant variation in the economic, cultural, and geographic characteristics of sites made it difficult to obtain this objective. Despite these challenges, the depth of the evaluation of multiple risk factors across the breadth of the PERCH sites should furnish new and valuable information about the major risk factors for childhood severe and very severe pneumonia, including risk factors for pneumonia caused by specific etiologies, in developing countries.

Effect of altered core body temperature on glottal closing force

OBJECTIVES

A basic function of the larynx is to provide sphincteric protection of the lower airway, initiated by a brain stem-mediated glottal closure reflex. Glottal closing force is defined as the measured pressure generated between the vocal folds during glottal closure. One of the factors thought to affect the glottal closure reflex is a variation in core body temperature.

METHODS

Four adult male Yorkshire pigs were used in this study. The subjects were studied under control conditions (37 degreesC), hyperthermic conditions (38 degrees C to 41 degrees C), and hypothermic conditions (36 degrees C to 34 degrees C).

RESULTS

We demonstrated that the glottal closing force increased significantly with an increase in core body temperature and also decreased significantly with decreased core body temperature. These results are supported by neurophysiological changes demonstrated by other studies in pups and adult dogs in response to altered core body temperatures. The mechanism for these responses is thought to reside centrally, rather than in the peripheral nervous system.

CONCLUSIONS

We hope that a better understanding of these aspects of glottal closure will alter the care of many patients with postanesthesia hypothermia and many sedated inmates and will also further enhance preventive measures needed to decrease the incidence of sudden infant death syndrome in overheated or febrile infants.