PARAINFLUENZA INFECTIONS IN THE COMMUNITY

Secondary household transmission of conjunctivitis in children

Among surveyed households, the transmission rate of pediatric conjunctivitis was 12%. Rates did not differ when the index child did or did not use an ophthalmic antibiotic (14% vs 11% [P = 0.6]). Transmission rates were lower than for other infections where children are not routinely excluded from school or daycare.

Transmissibility and transmission of respiratory viruses

Human respiratory virus infections lead to a spectrum of respiratory symptoms and disease severity, contributing to substantial morbidity, mortality and economic losses worldwide, as seen in the COVID-19 pandemic. Belonging to diverse families, respiratory viruses differ in how easy they spread (transmissibility) and the mechanism (modes) of transmission. Transmissibility as estimated by the basic reproduction number (R₀) or secondary attack rate is heterogeneous for the same virus. Respiratory viruses can be transmitted via four major modes of transmission: direct (physical) contact, indirect contact (fomite), (large) droplets and (fine) aerosols. We know little about the relative contribution of each mode to the transmission of a particular virus in different settings, and how its variation affects transmissibility and transmission dynamics. Discussion on the particle size threshold between droplets and aerosols and the importance of aerosol transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus is ongoing. Mechanistic evidence supports the efficacies of non-pharmaceutical interventions with regard to virus reduction; however, more data are needed on their effectiveness in reducing transmission. Understanding the relative contribution of different modes to transmission is crucial to inform the effectiveness of non-pharmaceutical interventions in the population. Intervening against multiple modes of transmission should be more effective than acting on a single mode.

Human parainfluenza virus-associated hospitalizations among children less than five years of age in the United States

BACKGROUND

Human parainfluenza viruses 1 through 3 (HPIV-1-3) are important causes of respiratory tract infections in young children. This study sought to provide current estimates of HPIV-1-3-associated hospitalizations among US children.

METHODS

Hospitalizations for bronchiolitis, bronchitis, croup and pneumonia among children age <5 years were determined for the years 1979 through 1997 using the National Hospital Discharge Survey. Average annual hospitalizations during the last 4 years of the study for each of these four diseases were multiplied by the proportions of each disease associated with HPIV-1-3 infection (as previously reported in hospital-based studies) to estimate hospitalizations potentially associated with HPIV-1-3 infections. Seasonal trends in HPIV-1-3-associated hospitalizations were compared with HPIV detections in the National Respiratory and Enteric Virus Surveillance System, which prospectively monitors respiratory viral detections throughout the United States.

RESULTS

The proportions of hospitalizations associated with HPIV infection for each disease varied widely in the 6 hospital-based studies we selected. Consequently our annual estimated rates of hospitalization were broad: HPIV-1, 0.32 to 1.59 per 1,000 children; HPIV-2, 0.10 to 0.86 per 1,000 children; and HPIV-3, 0.48 to 2.6 per 1,000 children. Based on these data HPIV-1 may account for 5,800 to 28,900 annual hospitalizations; HPIV-2 for 1,800 to 15,600 hospitalizations; and HPIV-3 for 8,700 to 52,000 hospitalizations.

CONCLUSIONS

We provide broad, serotype-specific estimates of US childhood hospitalizations associated with HPIV infections. More precise estimates of HPIV-associated hospitalizations would require large prospective studies of HPIV-associated diseases by more sensitive viral testing methods, such as polymerase chain reaction techniques.

VIRUSES IN ACUTE RESPIRATORY INFECTION IN A GENERAL COMMUNITY

The aetiology of acute respiratory infections between September 1962 and August 1963 was studied in two general practices in Cambridge. These practices were reasonably representative of the permanent community of Cambridge.

There were 592 spells of acute respiratory infection in the combined practices, representing an incidence of 11·4 spells per 100 persons. Children aged 0–4 had the highest rates (51·6 spells per 100 persons).

It was possible to establish a diagnosis in 62·5% of cases investigated. Influenza and parainfluenza infections featured prominently, being responsible between them for 46·6% of all respiratory infections investigated. From September 1962 to January 1963, parainfluenza viruses were prevalent, causing acute laryngo-tracheo-bronchitis in children (croup), and an influenza-like illness in adults. From February to April 1963, influenza A (Asian) was epidemic, a clinical diagnosis of influenza being frequently confirmed by laboratory studies at this time. There were nine cases of Eaton agent infection, seven of which had PAP, the other two being family contacts who later developed influenza-like illnesses.

Adenovirus (four cases), and RS virus (three cases) were not prevalent to any large extent in Cambridge during the survey.

Parainfluenza virus infections

Parainfluenza viruses types 1, 2 and 3 were found in 2·5%, 0·8% and 1·6% respectively of patients examined in the MRC/PHLS general practice survey and in 2·2%, 0·7% and 2·7% of those in the hospital survey. Type 3 infections were found earlier in life than type 1, while type 2 infections tended to be detected in older children. These viruses were found most frequently in croup and laryngitis but were also common causes of coryza and lower respiratory infections, especially in general practice. The epidemiology and diagnosis of parainfluenza virus infections are discussed briefly.

Observations on clinical and immunofluorescent diagnosis of parainfluenza virus infections

Immunofluorescent techniques have been applied to nasopharyngeal secretions for the rapid diagnosis of parainfluenza virus types 1, 2, and 3 infections. Seventy-five infections were found by isolation techniques; 55 of these had nasopharyngeal secretions taken and 53 were positive by direct examination. A comparison of the results of 60 neutralization tests with immunofluorescence applied to monkey kidney isolations showed complete agreement. Immunofluorescence appeared to be a satisfactory method for differentiating the various haemadsorption viruses. The importance of parainfluenza viruses and respiratory syncytial virus in croup was noted and the association of the parainfluenza viruses with acute respiratory virus infection was confirmed. The clinical relationship between respiratory syncytial virus and parainfluenza virus type 3 is discussed.

Virus infections and respiratory disease of childhood

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Asian influenza in 1963 in two general practices in Cambridge, England

A clinical, epidemiological and virological investigation was conducted on patients in two general practices in Cambridge, England, during an influenza epidemic between February and April 1963. The epidemiological pattern differed from that of the 1957-58 Asian influenza epidemic in that the overall incidence was considerably lower (3.2%) and that the highest attack rates were not in school children but in pre-school children (71.5 per 1000 persons).Virological investigation confirmed the diagnosis of Influenza A2 infection in 56 of 63 patients (89%). Isolations were made in 29 of 51 specimens tested. Serological studies revealed that the complement fixation test was more reliable than hemagglutination - inhibition or neutralization tests. Clinical features resembled those reported in previous epidemics, cough, headache and limb pains being prominent features.