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Akhtar Z, Ghosh P, Bhuiyan M, Sturm‐Ramirez K, Rahman M, Howlader M, Dawood F, Chowdhury F, Iuliano D. Influenza-associated respiratory illness among five cohorts of pregnant women and their young infants (0-6 months), Bangladesh, 2013-2017. Influenza Other Respir Viruses 2023; 17:e13175. [PMID: 37583917 PMCID: PMC10423715 DOI: 10.1111/irv.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023] Open
Abstract
Background Pregnant women with their infants are considered at higher risk for influenza-associated complications, and the World Health Organization (WHO) recommends influenza vaccination during pregnancy to protect them, including their infants (0-6 months). There are limited data on the influenza burden among pregnant women and their infants (0-6 months), and there are no routine influenza vaccinations in Bangladesh. Methods Five annual cohorts (2013-2017) of pregnant women were enrolled from the eight sub-districts of Bangladesh before the influenza season (May-September); they were contacted weekly to identify new onset of influenza-like illness (ILI) (subjective or measured fever and cough) and acute respiratory illness (ARI) (at least two of these symptoms: cough, rhinorrhea, or difficulty in breathing) among their infants from birth to 6 months of age. We collected nasopharyngeal swabs from ILI and ARI cases, tested by real-time reverse transcription polymerase chain reaction (rRT-PCR) for influenza virus (including types and subtypes) and estimated influenza incidence (95% CI)/10000 pregnant women-months or infant-months, respectively. Results We enrolled 9020 pregnant women, followed for 26,709 pregnancy-months, and detected 1241 ILI episodes. We also followed 8963 infants for 51,518 infant-months and identified 5116 ARI episodes. Influenza positivity was 23% for ILI and 3% for ARI cases. The overall incidence (2013-2017) of influenza among pregnant women was 158.5/10000 pregnant women-months (95% CI: 141.4-177.6) and that among infants was 21.9/10000 infant-months (95% CI: 18.2-26.5). Conclusions Although the data was collected more than 5 years ago, as the only baseline data, our findings illustrate evidence of influenza burden among pregnant women and infants (0-6 months), which may support preventive policy decisions in Bangladesh.
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Affiliation(s)
- Zubair Akhtar
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Probir Ghosh
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b)DhakaBangladesh
| | | | | | - Mohammed Rahman
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Md. Howlader
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Fatimah Dawood
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Danielle Iuliano
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
- US Public Health Service (USPHS)WashingtonDistrict of ColumbiaUSA
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Azziz-Baumgartner E, Duca LM, González R, Calvo A, Kaydos-Daniels SC, Olson N, MacNeil A, Veguilla V, Domínguez R, Vicari A, Rauda R, Vuong N, Ropero AM, Armero J, Porter R, Franco D, Pascale JM. Incidence of respiratory virus illness and hospitalizations in a Panama and El Salvador birth cohort, 2014-2018. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:None. [PMID: 36189114 PMCID: PMC9485193 DOI: 10.1016/j.lana.2022.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Respiratory viruses remain a key cause of early childhood illness, hospitalization, and death globally.The recent pandemic has rekindled interest in the control of respiratory viruses among paediatric populations. We estimate the burden of such viruses among children <2 years. Methods Enrolled neonates were followed until two years of age. Weekly active symptom monitoring for the development of acute respiratory illnesses (ARI) defined as cough, rhinorrhoea, difficulty breathing, asthenia, anorexia, irritability, or vomiting was conducted. When the child had ARI and fever, nasopharyngeal swabbing was performed, and samples were tested through singleplex RT-PCR. Incidence of respiratory viruses was calculated by dividing the number of laboratory-confirmed detections by the person-time accrued during weeks when that virus was detectable through national surveillance then corrected for under-ascertainment among untested children. Findings During December 2014-November 2017, 1567 enrolled neonates contributed 2,186.9 person-years (py). Six in ten (64·4%) children developed ARI (total 2493 episodes). Among children <2 years, incidence of respiratory syncytial virus (RSV)-associated ARI episodes (21·0, 95%CI 19·3-22·8, per 100py) and rhinovirus-associated (20·5, 95%CI 20·4-20·7) were similar and higher than parainfluenza 1-3-associated (14·2, 95%CI 12·2-16·1), human metapneumovirus-associated (9·2, 95%CI 7·7-10·8), influenza-associated (5·9, 95%CI 4·4-7·5), and adenovirus-associated ARI episodes (5·1, 95%CI 5·0-5·2). Children aged <3 months had the highest rates of RSV ARI (49·1, 95%CI 44·0-54·1 per 100py) followed by children aged 3-5 (25·1, 95%CI 20·1-30·0), 6-11 (17·6, 95%CI 13·2-21·9), and 12-23 months (11·9, 95%CI 10·8-12·9). One in ten children with RSV was referred to the hospital (2·5, 95%CI 2·1-2·8, per 100py). Interpretation Children frequently developed viral ARI and a substantive proportion required hospital care. Such findings suggest the importance of exploring the value of new interventions and increasing uptake of existing prevention measures to mitigate burden of epidemic-prone respiratory viruses. Funding The study was supported by the Centers for Disease Control and Prevention.
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Affiliation(s)
| | - Lindsey M Duca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Arlene Calvo
- Gorgas Institute, Panama City, Panama
- University of South Florida, Panama
| | | | - Natalie Olson
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam MacNeil
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Vic Veguilla
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Rafael Rauda
- National Institute of Health of El Salvador, El Salvador
| | - Nga Vuong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Julio Armero
- National Institute of Health of El Salvador, El Salvador
| | - Rachael Porter
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Koul PA, Saha S, Kaul KA, Mir H, Potdar V, Chadha M, Iuliano D, Lafond KE, Lal RB, Krishnan A. Respiratory syncytial virus among children hospitalized with severe acute respiratory infection in Kashmir, a temperate region in northern India. J Glob Health 2022; 12:04050. [PMID: 35976005 PMCID: PMC9288648 DOI: 10.7189/jogh.12.04050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Severe acute respiratory infections (SARI) are a leading cause of hospitalizations in children, especially due to viral pathogens. We studied the prevalence of respiratory viruses among children aged <5 years hospitalized with severe acute respiratory infections (SARI) in Kashmir, India. Methods We conducted a prospective observational study in two tertiary care hospitals from October 2013 to September 2014, systematically enrolling two children aged <5 years with SARI per day. We defined SARI as history of fever or measured fever (≥38°C) and cough with onset in the last 7 days requiring hospitalization for children aged 3-59 months and as physician-diagnosed acute lower respiratory infection for children aged <3 months. Trained study staff screened children within 24 hours of hospitalization for SARI and collected clinical data and nasopharyngeal swabs from enrolled participants. We tested for respiratory syncytial virus (RSV) A and B, influenza viruses, rhinoviruses (HRV)/enteroviruses, adenovirus (AdV), bocavirus (BoV), human metapneumovirus (hMPV) A and B, coronaviruses (OC43, NL65, C229E), and parainfluenza viruses (PIV) 1, 2, 3 and 4 using standardized duplex real-time polymerase chain reaction. Results Among 4548 respiratory illness admissions screened from October 2013 to September 2014, 1026 met the SARI case definition, and 412 were enrolled (ages = 5 days to 58 months; median = 12 months). Among enrolees, 256 (62%) were positive for any virus; RSV was the most commonly detected (n = 118, 29%) followed by HRV/enteroviruses (n = 88, 21%), PIVs (n = 31, 8%), influenza viruses (n = 18, 4%), BoV (n = 15, 4%), coronaviruses (n = 16, 4%), AdV (n = 14, 3%), and hMPV (n = 9, 2%). Fifty-four children had evidence of virus co-detection. Influenza-associated SARI was more common among children aged 1-5 years (14/18, 78%) while most RSV detections occurred in children <12 months (83/118, 70%). Of the RSV viruses typed (n = 116), the majority were type B (94, 80%). Phylogenetic analysis of G gene of RSV showed circulation of the BA9 genotype with 60bp nucleotide duplication. Conclusions Respiratory viruses, especially RSV, contributed to a substantial proportion of SARI hospitalizations among children <5 years in north India. These data can help guide clinicians on appropriate treatment and prevention strategies.
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Affiliation(s)
- Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Siddhartha Saha
- Influenza Program, US Centers for Disease Control and Prevention – Delhi office, India
| | | | - Hyder Mir
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | - Danielle Iuliano
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Renu B Lal
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
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Raynes-Greenow C, Billah SM, Islam S, Rokonuzzaman SM, Tofail F, Kirkwood EK, Alam A, Chartier R, Ferdous TE, El Arifeen S, Dibley MJ, Homaira N, Hayes A, Thornburg J, Kelly P. Reducing household air pollution exposure to improve early child growth and development; a randomized control trial protocol for the "Poriborton-Extension: The CHANge trial". Trials 2022; 23:505. [PMID: 35710445 PMCID: PMC9205063 DOI: 10.1186/s13063-022-06342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, household air pollution (HAP) is a leading environmental cause of morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on child health outcomes, compared to usual cooking practices in Bangladesh. The primary aim is to evaluate if reduced exposure to HAP through the provision of LPG for cooking from early gestation through to age 2 improves child anthropometry, health, and neuro-cognitive developmental outcomes, compared to children exposed to emissions from usual practice. Methods Two-arm parallel cluster randomized controlled trial (cCRT). We will extend the intervention and follow-up of our existing “Poriborton” trial. In a subset of the original surviving participants, we will supply LPG cylinders and LPG stoves (intervention) compared to usual cooking practices and extend the follow-up to 24 months of age. The expected final sample size, for both (intervention and control) is 1854 children with follow-up to 2 years of age available for analysis. Discussion This trial will answer important research gaps related to HAP and child health and neuro-cognitive developmental outcomes. This evidence will help to understand the impact of a HAP intervention on child health to inform policies for the adoption of clean fuel in Bangladesh and other similar settings. Trial registration The Poriborton: Change trial: Household Air Pollution and Perinatal and early Neonatal mortality is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001214224, original trial registered on 19th July 2018, extension approved on 23rd June 2021. www.anzctr.org.au.
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Affiliation(s)
| | - Sk Masum Billah
- The University of Sydney, School of Public Health, Sydney, Australia.,Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sajia Islam
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Fahmida Tofail
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.,Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Ashraful Alam
- The University of Sydney, School of Public Health, Sydney, Australia
| | - Ryan Chartier
- RTI International, Research Triangle Park, NC, 27707, USA
| | | | | | - Michael J Dibley
- The University of Sydney, School of Public Health, Sydney, Australia
| | | | - Alison Hayes
- The University of Sydney, School of Public Health, Sydney, Australia
| | | | - Patrick Kelly
- The University of Sydney, School of Public Health, Sydney, Australia
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5
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Watanabe RAS, Cruz JS, de Souza Luna LK, Alves VRG, Conte DD, Lyra L, Nishiyama F, Camargo BS, Bellei N. Respiratory syncytial virus: viral load, viral decay, and disease progression in children with bronchiolitis. Braz J Microbiol 2022; 53:1241-1247. [PMID: 35362939 PMCID: PMC9433556 DOI: 10.1007/s42770-022-00742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Acute viral bronchiolitis is the major cause of hospital admissions in children under 2 years of age, and respiratory syncytial virus (RSV) can be responsible for up to 80% of these infections. We aimed to describe RSV dynamics among hospitalized children with bronchiolitis. Upper respiratory samples of 101 hospitalized patients were collected and submitted to RSV detection by a quantitative real-time RT-PCR to assess viral load (Log10 RNA copies/mL). Seventy-two patients were positive for RSV infection, of which 38 (52.7%) could be followed up until RSV was no longer detected. The first RSV RT-qPCR was carried out on average on the 5th day of symptom onset. Thirty-six patients (94.7%) were still shedding RSV after 7 days, and 9 (23.6%) after 14 days of symptoms onset. Only 2 patients (5.2%) were still shedding RSV after 21 days. Only 7 of the followed patients (18.9%) were submitted to intubation. There was no difference between the viral load of the first collected sample and the viral persistence of patients with comorbidities, who needed intensive care unit and who needed intubation. These data could help understand RSV dynamics and future studies and treatments to come.
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Affiliation(s)
- Raí André Silva Watanabe
- Clinical Virology Laboratory, Infectious Diseases Unit, Medicine Department, São Paulo Federal University, Rua Pedro de Toledo, 781 - Vila Clementino, 15° andar frente, São Paulo, SP 04039-032 Brazil
| | - Jessica Santiago Cruz
- Clinical Virology Laboratory, Infectious Diseases Unit, Medicine Department, São Paulo Federal University, Rua Pedro de Toledo, 781 - Vila Clementino, 15° andar frente, São Paulo, SP 04039-032 Brazil
| | - Luciano Kleber de Souza Luna
- Clinical Virology Laboratory, Infectious Diseases Unit, Medicine Department, São Paulo Federal University, Rua Pedro de Toledo, 781 - Vila Clementino, 15° andar frente, São Paulo, SP 04039-032 Brazil
| | - Vitória Rodrigues Guimarães Alves
- Clinical Virology Laboratory, Infectious Diseases Unit, Medicine Department, São Paulo Federal University, Rua Pedro de Toledo, 781 - Vila Clementino, 15° andar frente, São Paulo, SP 04039-032 Brazil
| | - Danielle Dias Conte
- Clinical Virology Laboratory, Infectious Diseases Unit, Medicine Department, São Paulo Federal University, Rua Pedro de Toledo, 781 - Vila Clementino, 15° andar frente, São Paulo, SP 04039-032 Brazil
| | | | | | | | - Nancy Bellei
- Clinical Virology Laboratory, Infectious Diseases Unit, Medicine Department, São Paulo Federal University, Rua Pedro de Toledo, 781 - Vila Clementino, 15° andar frente, São Paulo, SP 04039-032 Brazil
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6
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Shen Z, Zhang Y, Li H, Du L. Rapid typing diagnosis and clinical analysis of subtypes A and B of human respiratory syncytial virus in children. Virol J 2022; 19:15. [PMID: 35062975 PMCID: PMC8781464 DOI: 10.1186/s12985-022-01744-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background Human respiratory syncytial virus (HRSV) is the leading pathogens causing acute respiratory infections (ARI) in children under five years old. We aimed to investigate the distribution of HRSV subtypes and explore the relationship between viral subtypes and clinical symptoms and disease severity. Methods From November 2016 to April 2017, 541 children hospitalized because of ARI were included in the study. Throat swabs were collected for analysis and all samples were tested by multiplex one-step qRT-PCR for quantitative analysis and typing of HRSV. Patients’ demographics, clinical symptoms as well as laboratory and imaging results were retrieved from medical records. Results HRSV was detected in 19.6% of children hospitalized due to ARI. HRSV-positive children were younger (P < 0.001), had a higher frequency of wheezing and pulmonary rales (P < 0.001; P = 0.003), and were more likely to develop bronchopneumonia (P < 0.001). Interleukin (IL) 10、CD4/CD8 (below normal range) and C-reactive protein levels between subtypes A and B groups were significantly different (P = 0.037; P = 0.029; P = 0.007), and gender differences were evident. By age-stratified analysis between subtypes A and B, we found significant differences in fever frequency and lymphocyte ratio (P = 0.008; P = 0.03) in the 6–12 months age group, while the 12. 1–36 months age group showed significant differences in fever days and count of leukocytes, platelets, levels aspartate aminotransferase, IL-6, lactate dehydrogenase and proportion CD4 positive T cells(P = 0.013; P = 0.018; P = 0.016; P = 0.037; P = 0.049; P = 0.025; P = 0.04). We also found a positive correlation between viral load and wheezing days in subtype A (P < 0.05), and a negative correlation between age, monocyte percentage and LDH concentration in subtype B (P < 0.05). Conclusions HRSV is the main causative virus of bronchopneumonia in infants and children. The multiplex one-step qRT-PCR not only provides a rapid and effective diagnosis of HRSV infection, but also allows its typing. There were no significant differences in the severity of HRSV infection between subtypes A and B, except significant gender-specific and age-specific differences in some clinical characteristics and laboratory results. Knowing the viral load of HRSV infection can help understanding the clinical features of different subtypes of HRSV infection.
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Satav A, Crow R, Potdar V, Dani V, Satav S, Chadha M, Hessong D, Carosone-Link P, Palaskar S, Simões EAF. The Burden of Respiratory Syncytial Virus in Children Under 2 Years of Age in a Rural Community in Maharashtra, India. Clin Infect Dis 2021; 73:S238-S247. [PMID: 34472575 PMCID: PMC8411254 DOI: 10.1093/cid/ciab508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Globally, respiratory syncytial virus (RSV) is a common cause of acute lower tract infection (LRTI) in children younger than 2 years of age, but there are scant population-based studies on the burden of RSV illness in rural communities and no community studies in preterm infants. METHODS Active surveillance of LRTI was performed in the community and hospital setting for the population of 93 tribal villages in Melghat, Central India, over 4 respiratory seasons. A nasopharyngeal swab was obtained from cases presenting as a severe LRTI for molecular analysis of respiratory pathogens including RSVA and B. RESULTS High rates of RSV-associated LRTI were found in preterm and term infants beyond 6 months of age, extending into the second year of life. Community severe RSV LRTI rates for 0-11 months of age was 22.4 (18.6-27.0)/1000 child-years (CY) and the hospital-associated rate was 14.1 (11.1-17.8)/1000 CY. For preterm infants, these rates were 26.2 (17.8-38.5)/1000 CY and 12.6 (7.2-22.0)/1000 CY. Comparable rates in the first 6 months were 15.9 (11.8-21.4)/1000 CY and 12.9 (9.3-18.0)/1000 CY in term infants and 26.3 (15.4-45.0)/1000 CY and 10.1 (4.2-24.2)/1000 CY for preterms. The single RSV B season had higher incidences of RSV LRTI in every age group than the 2 RSV A seasons in both preterm and term infants. There were 11 deaths, all term infants. CONCLUSIONS Studies restricted to the healthcare settings significantly underestimate the burden of RSV LRTI and preterm and term infants have comparable burdens of disease in this rural community.
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Affiliation(s)
- Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Rowena Crow
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital, Aurora, Colorado, USA
| | - Varsha Potdar
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Vibhawari Dani
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Shilpa Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Mandeep Chadha
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Danielle Hessong
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital, Aurora, Colorado, USA
| | - Phyllis Carosone-Link
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital, Aurora, Colorado, USA
| | - Sameer Palaskar
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Eric A F Simões
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital, Aurora, Colorado, USA
- Centre for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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8
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Simões EAF, Dani V, Potdar V, Crow R, Satav S, Chadha MS, Hessong D, Carosone-Link P, Palaskar S, Satav A. Mortality From Respiratory Syncytial Virus in Children Under 2 Years of Age: A Prospective Community Cohort Study in Rural Maharashtra, India. Clin Infect Dis 2021; 73:S193-S202. [PMID: 34472578 PMCID: PMC8411248 DOI: 10.1093/cid/ciab481] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although respiratory syncytial virus (RSV) is the most important viral cause of lower respiratory tract infection deaths in infants, there are few data on infant community deaths caused by RSV. METHODS This was an active surveillance of children younger than 2 years of age in 93 villages, 5 primary health centers, and 3 hospitals serving these villages. Village health workers and counselors at the health facilities monitored all lower respiratory tract infections (LRTIs) in consented subjects. Children with severe, or very severe LRTIs and all who died, had nasopharyngeal swabs collected for detection of RSV by molecular methods. RESULTS In the 12 134 subjects, there were 2064 episodes of severe LRTIs and 1732 of very severe LRTIs, of which 271 and 195, respectively, had RSV. Fifteen of 16 (94%) children with RSV died of LRTIs, 14 in the community and 1 in the hospital. The case fatality ratios for severe RSV LRTIs in the first 6 months of life were 3/52 (7.1%) and 1/36 (2.8%) in the community and hospital, respectively. Of those with very severe LRTIs in the community, 17.6% died. There were no very severe RSV LRTI hospital deaths. The adjusted RSV LRTI mortality rates ranged from 1.0 to 3.0/1000 child-years (CY) overall, and 2.0 to 6.1/1000 CY, accounting for 20% of the LRTI deaths and 10% of the postneonatal infant mortality. CONCLUSIONS Community deaths from RSV account for the majority of RSV LRTI deaths, and efforts at prevention should be preferentially directed at populations where access to care is limited.
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Affiliation(s)
- Eric A F Simões
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
- Centre for Global Health, Department of Epidemiology,Colorado School of Public Health, Aurora, Colorado, USA
| | - Vibhawari Dani
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Varsha Potdar
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Rowena Crow
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Shilpa Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Mandeep S Chadha
- National Institute of Virology, Indian Counsel of Medical Research, Pune, India
| | - Danielle Hessong
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Phyllis Carosone-Link
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado Aurora, Colorado, USA
| | - Sameer Palaskar
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
| | - Ashish Satav
- MAHAN Trust Mahatma Gandhi Tribal Hospital, Karmgram, Utavali, Tahsil, Dharni, India
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9
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Brooks WA, Zaman K, Goswami D, Prosperi C, Endtz HP, Hossain L, Rahman M, Ahmed D, Rahman MZ, Banu S, Shikder AU, Jahan Y, Nahar K, Chisti MJ, Yunus M, Khan MA, Matin FB, Mazumder R, Shahriar Bin Elahi M, Saifullah M, Alam M, Bin Shahid ASMS, Haque F, Sultana S, Higdon MM, Haddix M, Feikin DR, Murdoch DR, Hammitt LL, O’Brien KL, Deloria Knoll M. The Etiology of Childhood Pneumonia in Bangladesh: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S79-S90. [PMID: 34448747 PMCID: PMC8448409 DOI: 10.1097/inf.0000000000002648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pneumonia remains the leading infectious cause of death among children <5 years, but its cause in most children is unknown. We estimated etiology for each child in 2 Bangladesh sites that represent rural and urban South Asian settings with moderate child mortality. METHODS As part of the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age with World Health Organization-defined severe and very severe pneumonia, plus age-frequency-matched controls, in Matlab and Dhaka, Bangladesh. We applied microbiologic methods to nasopharyngeal/oropharyngeal swabs, blood, induced sputum, gastric and lung aspirates. Etiology was estimated using Bayesian methods that integrated case and control data and accounted for imperfect sensitivity and specificity of the measurements. RESULTS We enrolled 525 cases and 772 controls over 24 months. Of the cases, 9.1% had very severe pneumonia and 42.0% (N = 219) had infiltrates on chest radiograph. Three cases (1.5%) had positive blood cultures (2 Salmonella typhi, 1 Escherichia coli and Klebsiella pneumoniae). All 4 lung aspirates were negative. The etiology among chest radiograph-positive cases was predominantly viral [77.7%, 95% credible interval (CrI): 65.3-88.6], primarily respiratory syncytial virus (31.2%, 95% CrI: 24.7-39.3). Influenza virus had very low estimated etiology (0.6%, 95% CrI: 0.0-2.3). Mycobacterium tuberculosis (3.6%, 95% CrI: 0.5-11.0), Enterobacteriaceae (3.0%, 95% CrI: 0.5-10.0) and Streptococcus pneumoniae (1.8%, 95% CrI: 0.0-5.9) were the only nonviral pathogens in the top 10 etiologies. CONCLUSIONS Childhood severe and very severe pneumonia in young children in Bangladesh is predominantly viral, notably respiratory syncytial virus.
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Affiliation(s)
- W. Abdullah Brooks
- From the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hubert P. Endtz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Department of Clinical Microbiology & Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Fondation Mérieux, Lyon, France
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mustafizur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mohammed Ziaur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Arif Uddin Shikder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Mohammed Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | | | - Razib Mazumder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Muhammad Saifullah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Muntasir Alam
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Fahim Haque
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabiha Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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10
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Azziz-Baumgartner E, Bruno A, Daugherty M, Chico ME, Lopez A, Arriola CS, de Mora D, Ropero AM, Davis WW, McMorrow M, Cooper PJ. Incidence and seasonality of respiratory viruses among medically attended children with acute respiratory infections in an Ecuador birth cohort, 2011-2014. Influenza Other Respir Viruses 2021; 16:24-33. [PMID: 34432362 PMCID: PMC8692806 DOI: 10.1111/irv.12887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023] Open
Abstract
Background Ecuador annually has handwashing and respiratory hygiene campaigns and seasonal influenza vaccination to prevent respiratory virus illnesses but has yet to quantify disease burden and determine epidemic timing. Methods To identify respiratory virus burden and assess months with epidemic activity, we followed a birth cohort in northwest Ecuador during 2011–2014. Mothers brought children to the study clinic for routine checkups at ages 1, 2, 3, 5, and 8 years or if children experienced any acute respiratory illness symptoms (e.g., cough, fever, or difficulty breathing); clinical care was provided free of charge. Those with medically attended acute respiratory infections (MAARIs) were tested for common respiratory viruses via real‐time reverse‐transcription polymerase chain reaction (rRT‐PCR). Results In 2011, 2376 children aged 1–4 years (median 35 months) were enrolled in the respiratory cohort and monitored for 7017.5 child‐years (cy). The incidence of respiratory syncytial virus (RSV) was 23.9 (95% CI 17.3–30.5), influenza 10.6 (2.4–18.8), adenoviruses 6.7 (4.6–28.0), parainfluenzas 5.0 (2.3–10.5), and rhinoviruses, bocaviruses, human metapneumoviruses, seasonal coronaviruses, and enteroviruses <3/100 cy among children aged 12–23 months and declined with age. Most (75%) influenza detections occurred April–September. Conclusion Cohort children frequently had MAARIs, and while the incidence decreased rapidly among older children, more than one in five children aged 12–23 months tested positive for RSV, and one in 10 tested positive for influenza. Our findings suggest this substantial burden of influenza occurred more commonly during the winter Southern Hemisphere influenza season.
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Affiliation(s)
- Eduardo Azziz-Baumgartner
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfredo Bruno
- Faculty of Veterinary Medicine and Zootechnics, Universidad Agraria del Ecuador, Guayaquil, Ecuador.,National Reference Laboratory for Influenza and Other Respiratory Viruses, Instituto Nacional de Investigación en Salud Pública (INSPI), Guayaquil, Ecuador
| | - Michael Daugherty
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha E Chico
- Fundación Ecuatoriana Para Investigación en Salud, Quinindé, Ecuador
| | - Andrea Lopez
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Carmen Sofia Arriola
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Domenica de Mora
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alba María Ropero
- Immunizations Program, Pan American Health Organization, Washington, DC, USA
| | - William W Davis
- International Epidemiology and Research Team, Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith McMorrow
- Enhanced Surveillance Platforms Team, Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip J Cooper
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
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11
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Wang X, Wang D, Umar S, Qin S, Ling Q, Gray GC, Liu Y. Molecular typing of human adenoviruses among hospitalized patients with respiratory tract infections in a tertiary Hospital in Guangzhou, China between 2017 and 2019. BMC Infect Dis 2021; 21:748. [PMID: 34344310 PMCID: PMC8330471 DOI: 10.1186/s12879-021-06412-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Human Adenoviruses (HAdVs) cause a wide array of illnesses in all age groups. They particularly cause frequent morbidity among children. In China, human adenovirus types 3, 4, 7, 11, 14, 21, and 55 have caused at least seven outbreaks since 2000. However, limited studies are available regarding the epidemiological patterns and diversity of HAdVs types among hospitalized patients with respiratory tract infections (RTIs). Methods To understand the epidemiology and subtype distribution of HAdV infections associated with RTIs in China, nasal swab (NS) clinical samples were collected from 4129 patients in a Guangzhou hospital between August 2017 and October 2019. PCR, sequencing, and phylogenetic analysis were performed on these specimens to identify HAdV subtypes. Results HAdV was successfully sequenced in 99 (2.4%) of the 4129 NS specimens, with the highest HAdV prevalence (6.3%) found in children between the ages of 5 and 10 years. Among HAdV-positive specimens, the most prevalent genotypes identified were HAdV-B3 (55.6%) and HAdV-B7 (25.3%). The most common symptoms in the HAdV-infected patients were fever (100%), cough (80.8%), and rhinorrhea (71.8%). HAdV infections were detected throughout the year with a relatively higher prevalence in summer. Conclusion All ages suffer adenovirus infections, but young children are at the greatest risk. This study data demonstrates that at least three species of HAdVs (species B, C, and E) are circulating in Guangzhou City, China. As antiviral therapies and type-specific vaccines become available, such epidemiological data will be useful in guiding therapy and public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06412-0.
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Affiliation(s)
- Xinye Wang
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Dawei Wang
- Emergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, China
| | - Sajid Umar
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Sheng Qin
- Laboratory Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiong Ling
- Laboratory Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gregory C Gray
- Global Health Research Center, Duke Kunshan University, Kunshan, China. .,Division of Infectious Diseases, Duke University, School of Medicine, DUMC Box 102359, Durham, NC, 27710, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA. .,Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
| | - Yuntao Liu
- Emergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, China.
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12
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Johnson EK, Sylte D, Chaves SS, Li Y, Mahe C, Nair H, Paget J, van Pomeren T, Shi T, Viboud C, James SL. Hospital utilization rates for influenza and RSV: a novel approach and critical assessment. Popul Health Metr 2021; 19:31. [PMID: 34126993 PMCID: PMC8204427 DOI: 10.1186/s12963-021-00252-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/31/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Influenza and respiratory syncytial virus (RSV) contribute significantly to the burden of acute lower respiratory infection (ALRI) inpatient care, but heterogeneous coding practices and availability of inpatient data make it difficult to estimate global hospital utilization for either disease based on coded diagnoses alone. METHODS This study estimates rates of influenza and RSV hospitalization by calculating the proportion of ALRI due to influenza and RSV and applying this proportion to inpatient admissions with ALRI coded as primary diagnosis. Proportions of ALRI attributed to influenza and RSV were extracted from a meta-analysis of 360 total sources describing inpatient hospital admissions which were input to a Bayesian mixed effects model over age with random effects over location. Results of this model were applied to inpatient admission datasets for 44 countries to produce rates of hospital utilization for influenza and RSV respectively, and rates were compared to raw coded admissions for each disease. RESULTS For most age groups, these methods estimated a higher national admission rate than the rate of directly coded influenza or RSV admissions in the same inpatient sources. In many inpatient sources, International Classification of Disease (ICD) coding detail was insufficient to estimate RSV burden directly. The influenza inpatient burden estimates in older adults appear to be substantially underestimated using this method on primary diagnoses alone. Application of the mixed effects model reduced heterogeneity between countries in influenza and RSV which was biased by coding practices and between-country variation. CONCLUSIONS This new method presents the opportunity of estimating hospital utilization rates for influenza and RSV using a wide range of clinical databases. Estimates generally seem promising for influenza and RSV associated hospitalization, but influenza estimates from primary diagnosis seem highly underestimated among older adults. Considerable heterogeneity remains between countries in ALRI coding (i.e., primary vs non-primary cause), and in the age profile of proportion positive for influenza and RSV across studies. While this analysis is interesting because of its wide data utilization and applicability in locations without laboratory-confirmed admission data, understanding the sources of variability and data quality will be essential in future applications of these methods.
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Affiliation(s)
- Emily K Johnson
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.
| | - Dillon Sylte
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Sandra S Chaves
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
- Vaccine Epidemiology and Modeling Department, Sanofi Pasteur, Lyon, France
| | - You Li
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cedric Mahe
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
- Vaccine Epidemiology and Modeling Department, Sanofi Pasteur, Lyon, France
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Tayma van Pomeren
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Ting Shi
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cecile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, USA
| | - Spencer L James
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
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13
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Howard LM, Edwards KM, Zhu Y, Grijalva CG, Self WH, Jain S, Ampofo K, Pavia AT, Arnold SR, McCullers JA, Anderson EJ, Wunderink RG, Williams DJ. Clinical Features of Human Metapneumovirus-Associated Community-acquired Pneumonia Hospitalizations. Clin Infect Dis 2021; 72:108-117. [PMID: 32010955 DOI: 10.1093/cid/ciaa088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/28/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Human metapneumovirus (HMPV) is a leading cause of respiratory tract infections. Few studies have compared the clinical characteristics and severity of HMPV-associated pneumonia with other pathogens. METHODS Active, population-based surveillance was previously conducted for radiographically confirmed, community-acquired pneumonia hospitalizations among children and adults in 8 United States hospitals. Clinical data and specimens for pathogen detection were systematically collected. We described clinical features of all HMPV-associated pneumonia and, after excluding codetections with other pathogen types, we compared features of HMPV-associated pneumonia with other viral, atypical, and bacterial pneumonia and modeled the severity (mild, moderate, and severe) and length of stay using multivariable proportional odds regression. RESULTS HMPV was detected in 298/2358 (12.6%) children and 88/2320 (3.8%) adults hospitalized with pneumonia and was commonly codetected with other pathogens (125/298 [42%] children and 21/88 [24%] adults). Fever and cough were the most common presenting symptoms of HMPV-associated pneumonia and were also common symptoms of other pathogens. After excluding codetections in children (n = 1778), compared to HMPV (reference), bacterial pneumonia exhibited increased severity (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.43-9.40), respiratory syncytial virus (RSV; OR, 0.76; 95% CI, .59-.99) and atypical (OR, 0.39; 95% CI, .19-.81) infections exhibited decreased severity, and other viral pneumonia exhibited similar severity (OR, 0.88; 95% CI, .55-1.39). In adults (n = 2145), bacterial (OR, 3.74; 95% CI, 1.87-7.47) and RSV pneumonia (OR, 1.82; 95% CI, 1.32-2.50) were more severe than HMPV (reference), but all other pathogens had similar severity. CONCLUSIONS Clinical features did not reliably distinguish HMPV-associated pneumonia from other pathogens. HMPV-associated pneumonia was less severe than bacterial and adult RSV pneumonia, but was otherwise as or more severe than other common pathogens.
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Affiliation(s)
- Leigh M Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Andrew T Pavia
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Sandra R Arnold
- University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jonathan A McCullers
- University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.,St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Derek J Williams
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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14
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Rafeek RAM, Divarathna MVM, Noordeen F. A review on disease burden and epidemiology of childhood parainfluenza virus infections in Asian countries. Rev Med Virol 2020; 31:e2164. [PMID: 32996257 DOI: 10.1002/rmv.2164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022]
Abstract
Human parainfluenza viruses (HPIVs) are an important cause of acute respiratory tract infections (ARTIs) in children less than 5 years, second only to human respiratory syncytial viruses (HRSVs). Generally, patients infected with HPIVs are treated in outpatient clinics, yet also contribute to ARTI-associated hospitalization in children. Although HPIV infections are well studied in developed countries, these infections remain under-investigated and not considered in the routine laboratory diagnosis of childhood ARTI in many developing countries in Asia. We performed an extensive literature search on the prevalence, epidemiology, and burden of HPIV infections in children less than 5 years in Asia using PubMed and PubMed Central search engines. Based on the literature, the prevalence of HPIV infection in Asia ranges from 1% to 66%. According to many studies, HPIV-3 is the major virus circulating among children; however, several studies failed to detect HPIV-4 due to unavailability of diagnostic tools. In Asian countries, HPIV contributes a substantial disease burden in children. The data in this review should assist researchers and public health authorities to plan preventive measures, including accelerating research on vaccines and antiviral drugs.
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Affiliation(s)
- Rukshan A M Rafeek
- Faculty of Medicine, Department of Microbiology, University of Peradeniya, Peradeniya, Sri Lanka
| | - Maduja V M Divarathna
- Faculty of Medicine, Department of Microbiology, University of Peradeniya, Peradeniya, Sri Lanka
| | - Faseeha Noordeen
- Faculty of Medicine, Department of Microbiology, University of Peradeniya, Peradeniya, Sri Lanka
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15
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Ballegeer M, Saelens X. Cell-Mediated Responses to Human Metapneumovirus Infection. Viruses 2020; 12:v12050542. [PMID: 32423043 PMCID: PMC7290942 DOI: 10.3390/v12050542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/29/2022] Open
Abstract
Viruses are the most common cause of acute respiratory tract infections (ARTI). Human metapneumovirus (hMPV) frequently causes viral pneumonia which can become life-threatening if the virus spreads to the lungs. Even though hMPV was only isolated in 2001, this negative-stranded RNA virus has probably been circulating in the human population for many decades. Interestingly, almost all adults have serologic evidence of hMPV infection. A well-established host immune response is evoked when hMPV infection occurs. However, the virus has evolved to circumvent and even exploit the host immune response. Further, infection with hMPV induces a weak memory response, and re-infections during life are common. In this review, we provide a comprehensive overview of the different cell types involved in the immune response in order to better understand the immunopathology induced by hMPV. Such knowledge may contribute to the development of vaccines and therapeutics directed against hMPV.
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Affiliation(s)
- Marlies Ballegeer
- VIB-UGent Center for Medical Biotechnology, VIB, B-9052 Ghent, Belgium;
- Department of Biochemistry and Microbiology, Ghent University, B-9000 Ghent, Belgium
| | - Xavier Saelens
- VIB-UGent Center for Medical Biotechnology, VIB, B-9052 Ghent, Belgium;
- Department of Biochemistry and Microbiology, Ghent University, B-9000 Ghent, Belgium
- Correspondence:
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16
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Cell-Mediated Responses to Human Metapneumovirus Infection. Viruses 2020; 12:542. [PMID: 32423043 PMCID: PMC7290942 DOI: 10.3390/v12050542&set/a 882111696+808152660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Viruses are the most common cause of acute respiratory tract infections (ARTI). Human metapneumovirus (hMPV) frequently causes viral pneumonia which can become life-threatening if the virus spreads to the lungs. Even though hMPV was only isolated in 2001, this negative-stranded RNA virus has probably been circulating in the human population for many decades. Interestingly, almost all adults have serologic evidence of hMPV infection. A well-established host immune response is evoked when hMPV infection occurs. However, the virus has evolved to circumvent and even exploit the host immune response. Further, infection with hMPV induces a weak memory response, and re-infections during life are common. In this review, we provide a comprehensive overview of the different cell types involved in the immune response in order to better understand the immunopathology induced by hMPV. Such knowledge may contribute to the development of vaccines and therapeutics directed against hMPV.
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17
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Cell-Mediated Responses to Human Metapneumovirus Infection. Viruses 2020. [DOI: 10.3390/v12050542
expr 836379838 + 819716165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Viruses are the most common cause of acute respiratory tract infections (ARTI). Human metapneumovirus (hMPV) frequently causes viral pneumonia which can become life-threatening if the virus spreads to the lungs. Even though hMPV was only isolated in 2001, this negative-stranded RNA virus has probably been circulating in the human population for many decades. Interestingly, almost all adults have serologic evidence of hMPV infection. A well-established host immune response is evoked when hMPV infection occurs. However, the virus has evolved to circumvent and even exploit the host immune response. Further, infection with hMPV induces a weak memory response, and re-infections during life are common. In this review, we provide a comprehensive overview of the different cell types involved in the immune response in order to better understand the immunopathology induced by hMPV. Such knowledge may contribute to the development of vaccines and therapeutics directed against hMPV.
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18
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Kubale J, Kuan G, Gresh L, Ojeda S, Azziz-Baumgartner E, Sanchez N, Lopez R, Harris E, Balmaseda A, Gordon A. Assessing the Incidence of Symptomatic Respiratory Syncytial Virus Illness Within a Prospective Birth Cohort in Managua, Nicaragua. Clin Infect Dis 2020; 70:2029-2035. [PMID: 31257406 PMCID: PMC7201406 DOI: 10.1093/cid/ciz585] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) causes substantial morbidity and mortality among children worldwide, commonly through acute lower respiratory tract infections (ALRI). To assess the incidence rate of symptomatic RSV illness among young children, we conducted a prospective birth cohort study following children from 0-2 years of age in Managua, Nicaragua. METHODS Children meeting the testing criteria (fever, history of fever, or severe respiratory symptoms [apnea, stridor, nasal flaring, wheezing, chest indrawing, and/or central cyanosis]) were tested for RSV infections using real-time reverse transcriptase-polymerase chain reaction. An acute lower respiratory infection was defined as a diagnosis of pneumonia, bronchiolitis, bronchitis, or bronchial hyperreactivity. The incidence rate was calculated, and 95% confidence intervals were estimated using a Poisson distribution. RESULTS A total of 833 children participated in the cohort: 289 (34.7%) had at least 1 episode of laboratory-confirmed RSV, and 156 (18.7%) of had an episode of RSV-associated ALRI (RSV-ALRI). The incidence rate of symptomatic RSV was 248.1 cases per 1000 person-years (95% confidence interval [CI] 223.2-275.7). While infants aged 6-11 months had the highest incidence of symptomatic RSV (361.3/1000 person-years, 95% CI 304.4-428.8), infants <3 months had the highest incidence of severe RSV (RSV-associated hospitalizations and/or severe ALRI). RSV was also associated with 25.0-37.5% of deaths from medical causes (n = 8). CONCLUSIONS A substantial burden of RSV exists among children aged <2 years in Nicaraguan communities. RSV was also a leading cause of infant mortality among study participants. The development and implementation of effective RSV prevention and treatment measures represent an opportunity to substantially reduce severe illness and death among children worldwide.
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Affiliation(s)
- John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Guillermina Kuan
- Sócrates Flores Vivas Health Center, Ministry of Health
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Roger Lopez
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
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19
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Li X, Willem L, Antillon M, Bilcke J, Jit M, Beutels P. Health and economic burden of respiratory syncytial virus (RSV) disease and the cost-effectiveness of potential interventions against RSV among children under 5 years in 72 Gavi-eligible countries. BMC Med 2020; 18:82. [PMID: 32248817 PMCID: PMC7132892 DOI: 10.1186/s12916-020-01537-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/18/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) frequently causes acute lower respiratory infection in children under 5, representing a high burden in Gavi-eligible countries (mostly low-income and lower-middle-income). Since multiple RSV interventions, including vaccines and monoclonal antibody (mAb) candidates, are under development, we aim to evaluate the key drivers of the cost-effectiveness of maternal vaccination and infant mAb for 72 Gavi countries. METHODS A static Multi-Country Model Application for RSV Cost-Effectiveness poLicy (MCMARCEL) was developed to follow RSV-related events monthly from birth until 5 years of age. MCMARCEL was parameterised using country- and age-specific demographic, epidemiological, and cost data. The interventions' level and duration of effectiveness were guided by the World Health Organization's preferred product characteristics and other literature. Maternal vaccination and mAb were assumed to require single-dose administration at prices assumed to align with other Gavi-subsidised technologies. The effectiveness and the prices of the interventions were simultaneously varied in extensive scenario analyses. Disability-adjusted life years (DALYs) were the primary health outcomes for cost-effectiveness, integrated with probabilistic sensitivity analyses and Expected Value of Partially Perfect Information analysis. RESULTS The RSV-associated disease burden among children in these 72 countries is estimated at an average of 20.8 million cases, 1.8 million hospital admissions, 40 thousand deaths, 1.2 million discounted DALYs, and US$611 million discounted direct costs. Strategy 'mAb' is more effective due to its assumed longer duration of protection versus maternal vaccination, but it was also assumed to be more expensive. Given all parameterised uncertainty, the optimal strategy of choice tends to change for increasing willingness to pay (WTP) values per DALY averted from the current situation to maternal vaccination (at WTP > US$1000) to mAB (at WTP > US$3500). The age-specific proportions of cases that are hospitalised and/or die cause most of the uncertainty in the choice of optimal strategy. Results are broadly similar across countries. CONCLUSIONS Both the maternal and mAb strategies need to be competitively priced to be judged as relatively cost-effective. Information on the level and duration of protection is crucial, but also more and better disease burden evidence-especially on RSV-attributable hospitalisation and death rates-is needed to support policy choices when novel RSV products become available.
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Affiliation(s)
- Xiao Li
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium.
| | - Lander Willem
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| | - Marina Antillon
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium.,Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland.,University of Basel, Petersplatz 1, Basel, Switzerland
| | - Joke Bilcke
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, UK
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, Antwerp, Belgium
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20
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Biswas D, Ahmed M, Roguski K, Ghosh PK, Parveen S, Nizame FA, Rahman MZ, Chowdhury F, Rahman M, Luby SP, Sturm-Ramirez K, Iuliano AD. Effectiveness of a Behavior Change Intervention with Hand Sanitizer Use and Respiratory Hygiene in Reducing Laboratory-Confirmed Influenza among Schoolchildren in Bangladesh: A Cluster Randomized Controlled Trial. Am J Trop Med Hyg 2020; 101:1446-1455. [PMID: 31701861 DOI: 10.4269/ajtmh.19-0376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Schoolchildren are commonly linked to influenza transmission. Handwashing with soap has been shown to decrease infections; however, improving handwashing practices using soap and water is difficult in low-resource settings. In these settings, alternative hygiene options, such as hand sanitizer, could improve handwashing promotion to reduce influenza virus infections. We conducted a cluster randomized control trial in 24 primary schools in Dhaka to assess the effectiveness of hand sanitizer and a respiratory hygiene education intervention in reducing influenza-like illness (ILI) and laboratory-confirmed influenza during June-September 2015. Twelve schools were randomly selected to receive hand sanitizer and respiratory hygiene education, and 12 schools received no intervention. Field staff actively followed children daily to monitor for new ILI episodes (cough with fever) through school visits and by phone if a child was absent. When an illness episode was identified, medical technologists collected nasal swabs to test for influenza viruses. During the 10-week follow-up period, the incidence of ILI per 1,000 student-weeks was 22 in the intervention group versus 27 in the control group (P-value = 0.4). The incidence of laboratory-confirmed influenza was 53% lower in the intervention schools (3/1,000 person-weeks) than in the control schools (6/1,000 person-weeks) (P-value = 0.01). Hand sanitizer and respiratory hygiene education can help to reduce the risk of influenza virus transmission in schools.
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Affiliation(s)
- Debashish Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Probir K Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahana Parveen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fosiul A Nizame
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
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21
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Chowdhury F, Shahid ASMSB, Ghosh PK, Rahman M, Hassan MZ, Akhtar Z, Muneer SME, Shahrin L, Ahmed T, Chisti MJ. Viral etiology of pneumonia among severely malnourished under-five children in an urban hospital, Bangladesh. PLoS One 2020; 15:e0228329. [PMID: 32017782 PMCID: PMC6999894 DOI: 10.1371/journal.pone.0228329] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 01/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In Bangladesh, pneumonia has a higher mortality among malnourished children aged <5 years. Evaluating pneumonia etiology among malnourished children may help improve empiric treatment guidelines. METHODS During April 2015-December 2017, we conducted a case-control study among severe acute malnourished (SAM) children aged <5 years admitted to the Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). We enrolled hospital admitted SAM children with clinical or radiological pneumonia as cases (during April 2015 to March 2017) and hospital admitted SAM children without any respiratory symptom in the past 10 days before admission as controls (during February 2016 to December 2017). We tested nasopharyngeal wash from both case and control for respiratory syncytial virus (RSV), human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV), rhinovirus and adenovirus by singleplex real-time reverse transcriptase polymerase chain reaction. To identify the independent association of pneumonia with viral pathogens during February 2016 to March 2017, we used multivariable logistic regression for calculating adjusted odds ratios. RESULTS We enrolled 360 cases and 334 controls. For case and control the median age was 8 months (IQR: 5-13) and 11 months (IQR: 6-18) (p = 0.001) respectively. Weight/age Z-score was -4.3 (SD ±0.7) for cases and -4.1 (SD ±1.1) for controls (p = 0.01). Among cases 68% had both clinical and radiological pneumonia, 1% had clinical pneumonia and 31% had only radiological pneumonia. Respiratory virus detection was high in cases compared to controls [69.9% (251) vs. 44.8% (148), p = 0.0001]. The most frequently detected viruses among cases were rhinoviruses (79, 22.0%) followed by RSV (32, 8.9%), adenovirus (23, 6.4%), HPIV (22, 6.1%), influenza virus (16, 4.5%), and HMPV (16, 4.5%). Among the controls, rhinoviruses (82, 24.8%) were most commonly detected one followed by adenovirus (26,7.9%), HMPV (5, 1.5%), HPIV (4, 1.2%), RSV (3, 0.9%), and influenza virus (2, 0.6%). RSV (OR 13.1; 95% CI: 1.6, 106.1), influenza virus (OR 8.7; 95% CI: 1.0, 78.9), HPIV (3.8; 95% CI: 1.0, 14.8), and HMPV (2.7; 95% CI: 1.3, 5.5) were independently associated with pneumonia while compared between 178 cases and 174 controls. CONCLUSION Viral etiology of pneumonia in SAM children were mainly attributable to RSV, influenza, HPIV and HMPV. Our study findings may help in planning further studies targeting vaccines or drugs against common respiratory viruses responsible for pneumonia among SAM children.
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Affiliation(s)
- Fahmida Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Probir Kumar Ghosh
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Zakiul Hassan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zubair Akhtar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S. Mah-E- Muneer
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Ferreira HLDS, Costa KLP, Cariolano MS, Oliveira GS, Felipe KKP, Silva ESA, Alves MS, Maramaldo CEC, de Sousa EM, Rego JS, Silva ICPA, Albuquerque RKS, Araújo NSC, Amorim AMM, Costa LD, Pinheiro CS, Guimarães VA, Santos MC, Mello WA, Falcai A, Lima-Neto LG. High incidence of rhinovirus infection in children with community-acquired pneumonia from a city in the Brazilian pre-Amazon region. J Med Virol 2019; 91:1751-1758. [PMID: 31230362 PMCID: PMC7166869 DOI: 10.1002/jmv.25524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
Community‐acquired pneumonia (CAP) is the leading cause of child death worldwide. Viruses are the most common pathogens associated with CAP in children, but their incidence varies greatly. This study investigated the presence of respiratory syncytial virus (RSV), adenovirus, human rhinovirus (HRV), human metapneumovirus (HMPV), human coronavirus (HCoV‐OC43 and HCoV‐NL63), and influenza A virus (FluA) in children with CAP and the contributing risk factors. Here, children with acute respiratory infections were screened by pediatrics; and a total of 150 radiographically‐confirmed CAP patients (aged 3 months to 10 years) from two clinical centers in Sao Luis, Brazil were recruited. Patient's clinical and epidemiological data were recorded. Nasopharyngeal swab and tracheal aspirate samples were collected to extract viral nucleic acid. RSV, adenovirus, rhinovirus, FluA, HMPV, HCoV‐OC43, and HCoV‐NL63 were detected by real‐time polymerase chain reaction. The severe CAP was associated with ages between 3 and 12 months. Viruses were detected in 43% of CAP patients. Rhinovirus infections were the most frequently identified (68%). RSV, adenovirus, FluA, and coinfections were identified in 14%, 14%, 5%, and 15% of children with viral infection, respectively. Rhinovirus was associated with nonsevere CAP (P = .014); RSV, FluA, and coinfections were associated with severe CAP (P < .05). New strategies for prevention and treatment of viral respiratory infections, mainly rhinovirus and RSV infections, are necessary. This is the first study conducted in a city in the Brazilian pre‐Amazon region to identify viruses in children with CAP. Rhinovirus infections were the most frequently identified. RSV, adenovirus, FluA, and co‐infections were associated with severe CAP.
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Affiliation(s)
| | | | | | - Gustavo S Oliveira
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Karen K P Felipe
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Elen S A Silva
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Matheus S Alves
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | | | - Eduardo M de Sousa
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Joseany S Rego
- Complexo Hospitalar Materno Infantil do Maranhão Hospital Dr. Juvêncio Mattos Maternidade Benedito Leite, São Luís, Maranhão, Brasil
| | - Ilana C P A Silva
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | | | | | - Angela M M Amorim
- Hospital da Criança Dr. Odorico de Amaral Matos, São Luís, Maranhão, Brasil
| | - Luciane D Costa
- Hospital da Criança Dr. Odorico de Amaral Matos, São Luís, Maranhão, Brasil
| | | | - Vinícius A Guimarães
- Hospital Universitário, Universidade Federal do Maranhão, São Luís, Maranhão, Brasil
| | - Mirleide C Santos
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde, Ananindeua, Pará, Brasil
| | - Wyller A Mello
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde, Ananindeua, Pará, Brasil
| | - Angela Falcai
- Mestrado em Meio Ambiente, Universidade CEUMA, São Luís, Maranhão, Brasil
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23
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Wang L, Yang S, Yan X, Liu T, Feng Z, Li G. Comparing the yield of oropharyngeal swabs and sputum for detection of 11 common pathogens in hospitalized children with lower respiratory tract infection. Virol J 2019; 16:84. [PMID: 31234918 PMCID: PMC6591818 DOI: 10.1186/s12985-019-1177-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background Advances in molecular laboratory techniques are changing the prospects for the diagnosis of viral infectious diseases. Multiplex polymerase chain reaction assay (multiplex-PCR) can detect dozens of pathogens simultaneously, greatly reducing turnaround time (TAT) and improving detection sensitivity. But as a double-edged sword, due to the high sensitivity of PCR, the type of respiratory specimens is critical to diagnosis. In this work, we performed a head-to-head comparison to evaluate the multiplex-PCR yields between two samples, sputum and flocked oropharyngeal swabs (OPS). Methods Eleven common respiratory pathogens were tested in hospitalized children< 13 years of age who met the criteria for lower respiratory tract infection by GeXP-based multiplex-PCR of paired OPS and sputum. Results From January to June 2018, 440 children with paired OPS and sputum were tested. The positive rate was 84% (369/440) for OPS and 88% (386/440) for sputum (p = .007). The frequency of detection of HRV, RSV, Influenza A virus, HMPV, parainfluenza virus, adenovirus, M. pneumoniae, coronavirus, bocavirus and C. pneumoniae in sputa was higher than that of OPSs (all p < .001). Both types of specimens had similarly very good kappa values for most of pathogens, except for Mycoplasma pneumonia (κ = 0.61) and Chlamydia pneumoniae (κ = 0.24). Additionally, 79.3% (349/440) of cases showed consistent results between the two types of samples, and they were significantly younger than patients with inconsistent results (p = .002). Conclusions Flocked oropharyngeal swabs and sputum performed similarly for the detection of common respiratory pathogens in hospitalized children by multiplex-PCR, except for Mycoplasma pneumoniae and Chlamydia pneumoniae. Young patients are likely to have consistent results between the two specimens. Electronic supplementary material The online version of this article (10.1186/s12985-019-1177-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Le Wang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, 050031, China
| | - Shuo Yang
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, 050031, China
| | - Xiaotong Yan
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, 050031, China
| | - Teng Liu
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, 050031, China
| | - Zhishan Feng
- Hebei General Hospital, Shijiazhuang, 050000, China.
| | - Guixia Li
- Institute of Pediatric Research, Children's Hospital of Hebei Province, Shijiazhuang, 050031, China.
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24
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Molecular characterization of circulating respiratory syncytial virus genotypes in Pakistani children, 2010-2013. J Infect Public Health 2019; 13:438-445. [PMID: 31229412 DOI: 10.1016/j.jiph.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Data on the viral etiology of acute lower respiratory infections are scarce in Pakistan. Human respiratory syncytial virus (RSV) is an important cause of morbidity in children but no effective vaccine or antiviral therapy is currently available. As vaccines are expected to become available in the future, it is important to understand the epidemiology of locally prevalent RSV subtypes. This study aimed to define the molecular epidemiology of RSV (A and B) genotypes in Pakistani children under 5 years. METHODS World Health Organization case definitions for influenza-like illness (ILI) and severe acute respiratory illness (SARI) were used for case selection. Children under 5 years who presented with ILI or SARI at tertiary care hospitals from all provinces/regions, including the eight influenza sentinel sites, during October-April each year between 2010 and 2013 were enrolled. Demographic and clinical data of the children were recorded and nasopharyngeal/throat swabs taken for analysis. All samples were tested for RSV A and B using real-time polymerase chain reaction for non-influenza respiratory viruses. Specific oligonucleotide primers for RSV A and B were used for subtyping and sequencing of the G protein, followed by phylogenetic analysis. RESULTS A total of 1941 samples were included. RSV was detected in 472 (24%) children, with RSV A detected in 367 (78%) and RSV B in 105 (22%). The G protein of all RSV A strains clustered in the NA1/GA2 genotype while RSV B strains carried the signature 60 nucleotide duplication and were assigned to three BA genotypes: BA-9, BA-10 and the new BA-13 genotype. CONCLUSIONS This study highlights the importance of RSV as a viral etiologic agent of acute respiratory infections in children in Pakistan, and the diversity of RSV viruses. Continued molecular surveillance for early detection of prevalent and newly emerging genotypes is needed to understand the epidemiology of RSV infections in Pakistan.
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25
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Krishnan A, Kumar R, Broor S, Gopal G, Saha S, Amarchand R, Choudekar A, Purkayastha DR, Whitaker B, Pandey B, Narayan VV, Kabra SK, Sreenivas V, Widdowson MA, Lindstrom S, Lafond KE, Jain S. Epidemiology of viral acute lower respiratory infections in a community-based cohort of rural north Indian children. J Glob Health 2019; 9:010433. [PMID: 31131104 PMCID: PMC6513504 DOI: 10.7189/jogh.09.010433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In India, community-based acute lower respiratory infections (ALRI) burden studies are limited, hampering development of prevention and control strategies. Methods We surveyed children <10 years old at home weekly from August 2012-August 2014, for cough, sore throat, rhinorrhoea, ear discharge, and shortness of breath. Symptomatic children were assessed for ALRI using World Health Organization definitions. Nasal and throat swabs were obtained from all ALRI cases and asymptomatic controls and tested using polymerase chain reaction for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza viruses (PIV), and influenza viruses (IV). We estimated adjusted odds ratios (aOR) using logistic regression to calculate etiologic fractions (EF). We multiplied agent-specific ALRI incidence rates by EF to calculate the adjusted incidence as episodes per child-year. Results ALRI incidence was 0.19 (95% confidence interval (CI) = 0.18-0.20) episode per child-year. Association between virus and ALRI was strongest for RSV (aOR = 15.9; 95% CI = 7.3-34.7; EF = 94%) and least for IV (aOR = 4.6; 95% CI = 2.0-10.6; EF = 78%). Adjusted agent-specific ALRI incidences were RSV (0.03, 95% CI = 0.02-0.03), hMPV (0.02, 95% CI = 0.01-0.02), PIV (0.02, 95% CI = 0.01-0.02), and IV (0.01, 95% CI = 0.01-0.01) episode per child-year. Conclusions ALRI among children in rural India was high; RSV was a significant contributor.
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Affiliation(s)
- Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Broor
- SGT Medical College, Hospital & Research Institute, Gurgaon, India
| | - Giridara Gopal
- All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India
| | | | | | | | - Brett Whitaker
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharti Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Marc-Alain Widdowson
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stephen Lindstrom
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Seema Jain
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India.,US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Divarathne MVM, Ahamed RR, Noordeen F. The Impact of RSV-Associated Respiratory Disease on Children in Asia. J PEDIAT INF DIS-GER 2019; 14:79-88. [PMID: 32300274 PMCID: PMC7117084 DOI: 10.1055/s-0038-1637752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
Acute respiratory tract infections (ARTIs) are leading contributors to the global infectious disease burden, which is estimated to be 112,900,000 disability adjusted life years. Viruses contribute to the etiology of ARTIs in a big way compared with other microorganisms. Since the discovery of respiratory syncytial virus (RSV) 61 years ago, the virus has been recognized as a major cause of ARTI and hospitalization in children. The morbidity and mortality attributable to RSV infection appear to be higher in infants < 3 months and in those with known risk factors such as prematurity, chronic lung, and congenital heart diseases. Crowded living conditions, exposure to tobacco smoke, and industrial or other types of air pollution also increase the risk of RSV-associated ARTI. Many epidemiological studies have been conducted in developed countries to understand the seasonal patterns and risk factors associated with RSV infections. Dearth of information on RSV-associated morbidity and mortality in Asian and developing countries indicates the need for regional reviews to evaluate RSV-associated disease burden in these countries. Epidemiological studies including surveillance is the key to track the disease burden including risk factors, seasonality, morbidity, and mortality associated with RSV infection in these countries. These data will contribute to improve the clinical diagnosis and plan preventive strategies in resource-limited developing countries.
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Affiliation(s)
| | - Rukshan Rafeek Ahamed
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Ueno F, Tamaki R, Saito M, Okamoto M, Saito-Obata M, Kamigaki T, Suzuki A, Segubre-Mercado E, Aloyon HD, Tallo V, Lupisan SP, Oshitani H. Age-specific incidence rates and risk factors for respiratory syncytial virus-associated lower respiratory tract illness in cohort children under 5 years old in the Philippines. Influenza Other Respir Viruses 2019; 13:339-353. [PMID: 30891896 PMCID: PMC6586181 DOI: 10.1111/irv.12639] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is one of the main viral causes of lower respiratory tract illness (LRTI), especially in young children. RSV vaccines, including maternal and infant vaccines, are under development; however, more epidemiological studies are needed to develop effective vaccination strategies. Objectives To estimate detailed age‐specific incidence rates and severity of RSV‐associated LRTI (RSV‐LRTI) using data from a community‐based prospective cohort study in the Philippines. Patients/Methods Cohort children who visited health facilities due to acute respiratory symptoms were identified, and nasopharyngeal swabs were collected to detect RSV. The severity of RSV‐LRTI was assessed using the severity definition proposed by the World Health Organization. Risk factors for developing RSV‐LRTI and contribution of SpO2 measurement were also evaluated. Results A total of 395 RSV episodes which occurred in children aged 2‐59 months were categorised as 183 RSV‐LRTI, 72 as severe RSV‐LRTI and 29 as very severe RSV‐LRTI. Children aged 3‐5 months had the highest incidence rate of RSV‐LRTI, at 207.4 per 1000 child‐years (95% CI: 149.0‐279.5). Younger age group, place of living and low educational level of caregivers were associated with developing RSV‐LRTI. Clinical manifestations had low levels of agreement with hypoxaemia as measured by pulse oximeter. Conclusion The highest burden of RSV was observed in young infants aged 3‐5 months, whereas the burden was also high in those aged 12‐20 months. Future vaccination strategies should consider the protection of older children, especially those aged one year, as well as young infants.
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Affiliation(s)
- Fumihiko Ueno
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Raita Tamaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Nagasaki Women's Junior College, Nagasaki, Japan
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiko Okamoto
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mariko Saito-Obata
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan.,RITM-Tohoku Collaborating Research Center on Emerging and Reemerging Infectious Diseases, Muntinlupa, Philippines
| | - Taro Kamigaki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Suzuki
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Veronica Tallo
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | | | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Rahman MZ, Sumiya M, Sahabuddin M, Pell LG, Gubbay JB, Rahman R, Momtaz F, Azmuda N, Shanta SS, Jahan I, Rahman M, Mahmud AA, Roth DE, Morris SK. Genetic characterization of human metapneumovirus identified through community and facility-based surveillance of infants in Dhaka, Bangladesh. J Med Virol 2018; 91:549-554. [PMID: 30372530 DOI: 10.1002/jmv.25351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children in low and middle-income countries. Human metapneumovirus (hMPV) is one of the most common viral etiological agents for ARIs in children. OBJECTIVES In this study, we explored the genotypic diversity and the epidemiology of hMPV among infants in Dhaka, Bangladesh. STUDY DESIGN Between December 2014 and August 2016, a total of 3810 mid-turbinate nasal swab samples were collected from infants (0 to 6 months of age) who met clinical ARI criteria, as a part of a prospective ARI cohort study. hMPV was detected using polymerase chain reaction, and genotyped by sequencing and phylogenetic analysis. RESULTS hMPV was identified in 206 (5.4%) nasal swab specimens. One-tenth of the hMPV-positive swabs (n = 19) were also positive for other respiratory viruses. hMPV activity peaked in January and September in 2015; however, no seasonal pattern of hMPV infection was detected. Phylogenetic analyses of the N and F gene-fragments revealed that the hMPV strains circulating in Dhaka, Bangladesh, belonged to three genotypes: A2b, A2c, and B1. Genotype A (57%) was the predominant hMPV genotype circulating in Bangladesh during the study period. CONCLUSION This study describes both the epidemiology of hMPV infection and its genotypic strain diversity in Dhaka, Bangladesh.
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Affiliation(s)
| | - Mariya Sumiya
- Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | | | - Lisa G Pell
- Centre for Global Child Health and Child Health Evaluative Sciences, Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan B Gubbay
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Rajibur Rahman
- Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | - Farhana Momtaz
- Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | - Nafisa Azmuda
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Shaila S Shanta
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Ishrat Jahan
- Maternal and Child Health Training Institute (MCHTI), Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | | | - Abdullah A Mahmud
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Daniel E Roth
- Centre for Global Child Health and Child Health Evaluative Sciences, Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Centre for Global Child Health and Child Health Evaluative Sciences, Sick Kids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Ram Purakayastha D, Vishnubhatla S, Rai SK, Broor S, Krishnan A. Estimation of Burden of Influenza among under-Five Children in India: A Meta-Analysis. J Trop Pediatr 2018; 64:441-453. [PMID: 29112737 DOI: 10.1093/tropej/fmx087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We estimated the burden of influenza-related acute respiratory tract infection (ARI) among under-fives in India through meta-analysis. METHODOLOGY We estimated pooled incidence and proportional positivity of laboratory-diagnosed influenza among under-fives using data from observational studies published from 1 January 1961 to 31 December 2016. Death due to influenza was estimated using a multiplier model. RESULTS Influenza-associated ARI incidence was estimated as 132 per 1000 child-years (115-149). The patients positive for influenza among ARI in outpatients and inpatients were estimated to be 11.2% (8.8-13.6) and 7.1% (5.5-8.8), respectively. We estimated total influenza cases during 2016 as 16 009 207 (13 942 916-18 082 769) in India. Influenza accounted for 10 913 476 (9 504 666-12 362 310) outpatient visits and 109 431 (83 882-134 980) hospitalizations. A total of 27 825 (21 382-34 408) influenza-associated under-five deaths were estimated in India in 2016. CONCLUSION Influenza imposes a substantial burden among under-fives in India. Public health approach for its prevention and control needs to be explored.
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Affiliation(s)
- Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sreenivas Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sanjay Kumar Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
| | - Sobha Broor
- Department of Microbiology, Faculty of Medicine and health Sciences, SGT University, Chandu-Budhera, Gurugram-Badli Road, Gurgaon, Haryana, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, AIIMS Campus, Ansari Nagar East, New Delhi, India
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Comparison of incidence and cost of influenza between healthy and high-risk children <60 months old in Thailand, 2011-2015. PLoS One 2018; 13:e0197207. [PMID: 29771945 PMCID: PMC5957403 DOI: 10.1371/journal.pone.0197207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/27/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Thailand recommends influenza vaccination for children aged 6 months to <36 months, but investment in vaccine purchase is limited. To inform policy decision with respect to influenza disease burden and associated cost in young children and to support the continued inclusion of children as the recommended group for influenza vaccination, we conducted a prospective cohort study of children in Bangkok hospital to estimate and compare influenza incidence and cost between healthy and high-risk children. Methods Caregivers of healthy children and children with medical conditions (‘high-risk’) aged <36 months were called weekly for two years to identify acute respiratory illness (ARI) episodes and collect illness-associated costs. Children with ARI were tested for influenza viruses by polymerase chain reaction. Illnesses were categorized as mild or severe depending on whether children were hospitalized. Population-averaged Poisson models were used to compare influenza incidence by risk group. Quantile regression was used to examine differences in the median illness expenses. Results During August 2011-September 2015, 659 healthy and 490 high-risk children were enrolled; median age was 10 months. Incidence of mild influenza-associated ARI was higher among healthy than high-risk children (incidence rate ratio [IRR]: 1.67; 95% confidence interval [CI]: 1.13–2.48). Incidence of severe influenza-associated ARI did not differ (IRR: 0.40; 95% CI: 0.11–1.38). The median cost per mild influenza-associated ARI episode was $22 among healthy and $25 among high-risk children (3–4% of monthly household income; difference in medians: -$1; 95% CI for difference in medians: -$9 to $6). The median cost per severe influenza-associated ARI episode was $232 among healthy and $318 among high-risk children (26–40% and 36–54% of monthly household income, respectively; difference in medians: 110; 95% CI for difference in medians: -$352 to $571). Conclusions Compared to high-risk children, healthy children had higher incidence of mild influenza-associated ARI but not severe influenza-associated ARI. Costs of severe influenza-associated ARI were substantial. These findings support the benefit of annual influenza vaccination in reducing the burden of influenza and associated cost in young children.
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Bhuiyan MU, Luby SP, Alamgir NI, Homaira N, Sturm-Ramirez K, Gurley ES, Abedin J, Zaman RU, Alamgir A, Rahman M, Ortega-Sanchez IR, Azziz-Baumgartner E. Costs of hospitalization with respiratory syncytial virus illness among children aged <5 years and the financial impact on households in Bangladesh, 2010. J Glob Health 2018; 7:010412. [PMID: 28702175 PMCID: PMC5502704 DOI: 10.7189/jogh.07.010412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is the leading cause of acute respiratory illness in young children and results in significant economic burden. There is no vaccine to prevent RSV illness but a number of vaccines are in development. We conducted this study to estimate the costs of severe RSV illness requiring hospitalization among children <5 years and associated financial impact on households in Bangladesh. Data of this study could be useful for RSV vaccine development and also the value of various preventive strategies, including use of an RSV vaccine in children if one becomes available. Methods From May through October 2010, children aged <5 years with laboratory–confirmed RSV were identified from a sentinel influenza program database at four tertiary hospitals. Research assistants visited case–patients’ homes after hospital discharge and administered a structured questionnaire to record direct medical costs (physician consultation fee, costs for hospital bed, medicines and diagnostic tests); non–medical costs (costs for food, lodging and transportation); indirect costs (caregivers’ productivity loss), and coping strategies used by families to pay for treatment. We used WHO–Choice estimates for routine health care service costs. We added direct, indirect and health care service costs to calculate cost–per–episode of severe RSV illness. We used Monte Carlo simulation to estimate annual economic burden for severe RSV illness. Findings We interviewed caregivers of 39 persons hospitalized for RSV illness. The median direct cost for hospitalization was US$ 62 (interquartile range [IQR] = 43–101), indirect cost was US$ 19 (IQR = 11–29) and total cost was US$ 94 (IQR = 67–127). The median out–of–pocket cost was 24% of monthly household income of affected families (US$ 143), and >50% families borrowed money to meet treatment cost. We estimated that the median direct cost of RSV–associated hospitalization in children aged <5 years in Bangladesh was US$ 10 million (IQR: US$ 7–16 million), the median indirect cost was US$ 3.0 million (IQR: 2–5 million) in 2010. Conclusion RSV–associated hospitalization among children aged <5 years represents a substantial economic burden in Bangladesh. Affected families frequently incurred considerable out of pocket and indirect costs for treatment that resulted in financial hardship.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Stephen P Luby
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Centres for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nadia Ishrat Alamgir
- James P Grant School of Public Health, BRAC Institute of Global Health, BRAC University, Dhaka, Bangladesh
| | - Nusrat Homaira
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Randwick, Australia
| | - Katharine Sturm-Ramirez
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Centres for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily S Gurley
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Jaynal Abedin
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Rashid Uz Zaman
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Oxford Policy Management, Oxford, UK
| | - Asm Alamgir
- Institute of Epidemiology, Disease Control and Research, Dhanka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhanka, Bangladesh
| | | | - Eduardo Azziz-Baumgartner
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Centres for Disease Control and Prevention, Atlanta, Georgia, USA
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Moreira LP, Watanabe ASA, Camargo CN, Melchior TB, Granato C, Bellei N. Respiratory syncytial virus evaluation among asymptomatic and symptomatic subjects in a university hospital in Sao Paulo, Brazil, in the period of 2009-2013. Influenza Other Respir Viruses 2018; 12:326-330. [PMID: 29078028 PMCID: PMC5907818 DOI: 10.1111/irv.12518] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/27/2022] Open
Abstract
Background The respiratory syncytial virus (RSV) is recognized as an important cause of respiratory tract infections. Immunocompromised patients, healthcare workers (HCWs) and children contacts are at increased risk of acquiring the infection. However, the impact of asymptomatic infection in transmission has not been well studied. Objectives: this study evaluated the frequency and viral load (VL) of RSV in nasal swab samples of individuals with different risk factors for acquiring infection in a university hospital in Sao Paulo, Brazil. Methods We included 196 symptomatic children and their 192 asymptomatic caregivers, 70 symptomatic and 95 asymptomatic HCWs, 43 samples from symptomatic HIV‐positive outpatients, and 100 samples of asymptomatic HIV patients in the period of 2009‐2013. Results RSV infection was detected in 10.1% (70/696) of samples, 4.4% (17/387) of asymptomatic patients, and 17.1% (53/309) from symptomatic patients. (P < .0001). The VL of symptomatic patients (4.7 log copies/mL) was significantly higher compared to asymptomatic patients (2.3 log copies/mL). RSV detection among asymptomatic caregivers (6.8%; 13/192) was significantly higher compared to other asymptomatic adults, HIV and HCWs (2.0%; 4/195; P = .0252). A close contact with an infected child at home was an important risk to RSV acquisition [OR 22.6 (95% CI 4.8‐106.7)]. Children who possibly transmitted the virus to their asymptomatic contacts had significantly higher viral load than children who probably did not transmit (P < .0001). Conclusions According to our results, it is important to know if people circulating inside the hospital have close contact with acute respiratory infected children.
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Affiliation(s)
| | | | | | | | - Celso Granato
- Medicine Department, Sao Paulo Federal University, Sao Paulo, Brazil
| | - Nancy Bellei
- Medicine Department, Sao Paulo Federal University, Sao Paulo, Brazil
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Tinoco YO, Azziz-Baumgartner E, Uyeki TM, Rázuri HR, Kasper MR, Romero C, Silva ME, Simons MP, Soto GM, Widdowson MA, Gilman RH, Bausch DG, Montgomery JM. Burden of Influenza in 4 Ecologically Distinct Regions of Peru: Household Active Surveillance of a Community Cohort, 2009-2015. Clin Infect Dis 2017; 65:1532-1541. [PMID: 29020267 PMCID: PMC5850002 DOI: 10.1093/cid/cix565] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/22/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are limited data on the burden of disease posed by influenza in low- and middle-income countries. Furthermore, most estimates of influenza disease burden worldwide rely on passive sentinel surveillance at health clinics and hospitals that lack accurate population denominators. METHODS We documented influenza incidence, seasonality, health-system utilization with influenza illness, and vaccination coverage through active community-based surveillance in 4 ecologically distinct regions of Peru over 6 years. Approximately 7200 people in 1500 randomly selected households were visited 3 times per week. Naso- and oropharyngeal swabs were collected from persons with influenza-like illness and tested for influenza virus by real-time reverse-transcription polymerase chain reaction. RESULTS We followed participants for 35353 person-years (PY). The overall incidence of influenza was 100 per 1000 PY (95% confidence interval [CI], 97-104) and was highest in children aged 2-4 years (256/1000 PY [95% CI, 236-277]). Seasonal incidence trends were similar across sites, with 61% of annual influenza cases occurring during the austral winter (May-September). Of all participants, 44 per 1000 PY (95% CI, 42-46) sought medical care, 0.7 per 1000 PY (95% CI, 0.4-1.0) were hospitalized, and 1 person died (2.8/100000 PY). Influenza vaccine coverage was 27% among children aged 6-23 months and 26% among persons aged ≥65 years. CONCLUSIONS Our results indicate that 1 in 10 persons develops influenza each year in Peru, with the highest incidence in young children. Active community-based surveillance allows for a better understanding of the true burden and seasonality of disease that is essential to plan the optimal target groups, timing, and cost of national influenza vaccination programs.
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Affiliation(s)
- Yeny O Tinoco
- US Naval Medical Research Unit No. 6, Bellavista, Peru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hugo R Rázuri
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | | | - Maria E Silva
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Mark P Simons
- US Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel G Bausch
- US Naval Medical Research Unit No. 6, Bellavista, Peru
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; and
| | - Joel M Montgomery
- US Naval Medical Research Unit No. 6, Bellavista, Peru
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Globally, as a leading agent of acute respiratory tract infections in children <5 years of age and the elderly, the human metapneumovirus (HMPV) has gained considerable attention. As inferred from studies comparing vaccinated and experimentally infected mice, the acquired immune response elicited by this pathogen fails to efficiently clear the virus from the airways, which leads to an exaggerated inflammatory response and lung damage. Furthermore, after disease resolution, there is a poor development of T and B cell immunological memory, which is believed to promote reinfections and viral spread in the community. In this article, we discuss the molecular mechanisms that shape the interactions of HMPV with host tissues that lead to pulmonary pathology and to the development of adaptive immunity that fails to protect against natural infections by this virus.
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Bacterial and viral pathogen spectra of acute respiratory infections in under-5 children in hospital settings in Dhaka city. PLoS One 2017; 12:e0174488. [PMID: 28346512 PMCID: PMC5367831 DOI: 10.1371/journal.pone.0174488] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/09/2017] [Indexed: 02/01/2023] Open
Abstract
The study aimed to examine for the first time the spectra of viral and bacterial pathogens along with the antibiotic susceptibility of the isolated bacteria in under-5 children with acute respiratory infections (ARIs) in hospital settings of Dhaka, Bangladesh. Nasal swabs were collected from 200 under-five children hospitalized with clinical signs of ARIs. Nasal swabs from 30 asymptomatic children were also collected. Screening of viral pathogens targeted ten respiratory viruses using RT-qPCR. Bacterial pathogens were identified by bacteriological culture methods and antimicrobial susceptibility of the isolates was determined following CLSI guidelines. About 82.5% (n = 165) of specimens were positive for pathogens. Of 165 infected cases, 3% (n = 6) had only single bacterial pathogens, whereas 43.5% (n = 87) cases had only single viral pathogens. The remaining 36% (n = 72) cases had coinfections. In symptomatic cases, human rhinovirus was detected as the predominant virus (31.5%), followed by RSV (31%), HMPV (13%), HBoV (11%), HPIV-3 (10.5%), and adenovirus (7%). Streptococcus pneumoniae was the most frequently isolated bacterial pathogen (9%), whereas Klebsiella pneumaniae, Streptococcus spp., Enterobacter agglomerans, and Haemophilus influenzae were 5.5%, 5%, 2%, and 1.5%, respectively. Of 15 multidrug-resistant bacteria, a Klebsiella pneumoniae isolate and an Enterobacter agglomerans isolate exhibited resistance against more than 10 different antibiotics. Both ARI incidence and predominant pathogen detection rates were higher during post-monsoon and winter, peaking in September. Pathogen detection rates and coinfection incidence in less than 1-year group were significantly higher (P = 0.0034 and 0.049, respectively) than in 1–5 years age group. Pathogen detection rate (43%) in asymptomatic cases was significantly lower compared to symptomatic group (P<0.0001). Human rhinovirus, HPIV-3, adenovirus, Streptococcus pneumonia, and Klebsiella pneumaniae had significant involvement in coinfections with P values of 0.0001, 0.009 and 0.0001, 0.0001 and 0.001 respectively. Further investigations are required to better understand the clinical roles of the isolated pathogens and their seasonality.
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Chowdhury F, Sturm-Ramirez K, Mamun AA, Iuliano AD, Bhuiyan MU, Chisti MJ, Ahmed M, Haider S, Rahman M, Azziz-Baumgartner E. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh. Patient Prefer Adherence 2017; 11:479-486. [PMID: 28293104 PMCID: PMC5345980 DOI: 10.2147/ppa.s121800] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome. METHODS A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients' relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome. RESULTS We interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment. CONCLUSION People with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of laws and regulations for drug sales.
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Affiliation(s)
- Fahmida Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Correspondence: Fahmida Chowdhury, Respiratory Viruses Working Group, Programme on Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh, Tel +88 018 1705 4481, Email
| | - Katharine Sturm-Ramirez
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Abdullah Al Mamun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mejbah Uddin Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Makhdum Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sabbir Haider
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
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Bashir U, Nisar N, Arshad Y, Alam MM, Ashraf A, Sadia H, Kazi BM, Zaidi SSZ. Respiratory syncytial virus and influenza are the key viral pathogens in children <2 years hospitalized with bronchiolitis and pneumonia in Islamabad Pakistan. Arch Virol 2016; 162:763-773. [PMID: 27885562 DOI: 10.1007/s00705-016-3146-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
Pneumonia remains a leading cause of morbidity and mortality in developing countries. Comprehensive surveillance data are needed to review the prevention and control strategies. We conducted active surveillance of acute lower respiratory infections among children aged <2 years hospitalized at two hospitals of Islamabad, Pakistan. Viral etiology was determined using real-time PCR on respiratory specimens collected during March 2011-April 2012. The overall mean age was 7.83 ± 5.25 months while no statistical difference between age or sex distribution of patients with positive and negative viral etiology (p > 0.05). The average weight of the study group was 6.1 ± 2.25 kg. ≥1 viral pathogens were detected in 75% cases. Major respiratory viruses included RSV-A: 44%, RSV-B: 23%, Influenza-A: 24.5%, Influenza-B: 7%, Adenovirus: 8.4% and HmPV: 5.2%. A single, dual or multiple viral pathogens were detected in 43%, 27% and 5.2% patients respectively. Common symptoms were cough (95%), apnoea (84%), fever (78%), wheeze (64.5%), nasal congestion (55%) and rhinorrhea (48%). Among the RSV positive cases, 2-6 months age group had highest detection rate for RSV-A (30%, n = 21/69) and RSV-B (20%, n = 14/69) while patients infected with Influenza-A were in 2.1-6 months age group (61%, 23/38). Statistically significant difference was observed between RSV-positive and negative cases for nutrition status (p = 0.001), cigarette/wood smoke exposure (p = 0.001) and concomitant clinical findings. Most patients had successful outcome on combination therapy with bronchodilators, inhaled steroids and antibiotics. Our findings underscore high burden of ALRI in Pakistan. Interventions targeting viral pathogens coupled with improved diagnostic approaches are critical for better prevention and control.
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Affiliation(s)
- Uzma Bashir
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan
| | - Nadia Nisar
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan
| | - Yasir Arshad
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan
| | - Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan
| | - Asiya Ashraf
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan
| | - Hajra Sadia
- Atta-Ur-Rahman School of Applied Sciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Birjees Mazher Kazi
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan
| | - Syed Sohail Zahoor Zaidi
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad, 44000, Pakistan.
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Morris SK, Pell LG, Rahman MZ, Dimitris MC, Mahmud A, Islam MM, Ahmed T, Pullenayegum E, Kashem T, Shanta SS, Gubbay J, Papp E, Science M, Zlotkin S, Roth DE. Maternal vitamin D supplementation during pregnancy and lactation to prevent acute respiratory infections in infancy in Dhaka, Bangladesh (MDARI trial): protocol for a prospective cohort study nested within a randomized controlled trial. BMC Pregnancy Childbirth 2016; 16:309. [PMID: 27737646 PMCID: PMC5064894 DOI: 10.1186/s12884-016-1103-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/08/2016] [Indexed: 02/08/2023] Open
Abstract
Background Early infancy is a high-risk period for severe acute respiratory infection (ARI), particularly in low-income countries with resource-limited health systems. Lower respiratory tract infection (LRTI) is commonly preceded by upper respiratory infection (URTI), and often caused by respiratory syncytial virus (RSV), influenza and other common community-acquired viral pathogens. Vitamin D status is a candidate modifiable early-life determinant of the host antiviral immune response and thus may influence the risk of ARI-associated morbidity in high-risk populations. Methods/Design In the Maternal Vitamin D for Infant Growth (MDIG) study in Dhaka, Bangladesh (NCT01924013), 1300 pregnant women are randomized to one of five groups: placebo, 4200 IU/week, 16,800 IU/week, or 28,000 IU/week from 2nd trimester to delivery plus placebo from 0–6 months postpartum; or, 28,000 IU/week prenatal and until 6-months postpartum. In the Maternal Vitamin D for ARI in Infancy (MDARI) sub-study nested within the MDIG trial, trained personnel conduct weekly postnatal home visits to inquire about ARI symptoms and conduct a standardized clinical assessment. Supplementary home visits between surveillance visits are conducted when caregivers make phone notifications of new infant symptoms. Mid-turbinate nasal swab samples are obtained from infants who meet standardized clinical ARI criteria. Specimens are tested by polymerase chain reaction (PCR) for 8 viruses (influenza A/B, parainfluenza 1/2/3, RSV, adenovirus, and human metapneumovirus), and nasal carriage density of Streptococcus pneumoniae. The primary outcome is the incidence rate of microbiologically-positive viral ARI, using incidence rate ratios to estimate between-group differences. We hypothesize that among infants 0–6 months of age, the incidence of microbiologically-confirmed viral ARI will be significantly lower in infants whose mothers received high-dose prenatal/postpartum vitamin D supplements versus placebo. Secondary outcomes include incidence of ARI associated with specific pathogens (influenza A or B, RSV), clinical ARI, and density of pneumococcal carriage. Discussion If shown to reduce the risk of viral ARI in infancy, integration of maternal prenatal/postpartum vitamin D supplementation into antenatal care programs in South Asia may be a feasible primary preventive strategy to reduce the burden of ARI-associated morbidity and mortality in young infants. Trial registration NCT02388516, registered March 9, 2015.
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Affiliation(s)
- Shaun K Morris
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada. .,Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada. .,Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Lisa G Pell
- Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada
| | - Mohammed Ziaur Rahman
- Zoonotic Diseases Research Group, Centre for Communicable Diseases, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Michelle C Dimitris
- Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada
| | - Abdullah Mahmud
- Centre for Child and Adolescent Health, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - M Munirul Islam
- Centre for Nutrition and Food Security, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada
| | - Tahmid Kashem
- Centre for Nutrition and Food Security, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shaila S Shanta
- Centre for Nutrition and Food Security, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Jonathan Gubbay
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Public Health Ontario, 661 University Ave., Toronto, ON, Canada
| | - Eszter Papp
- Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada
| | - Michelle Science
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Stanley Zlotkin
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada
| | - Daniel E Roth
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Centre for Global Child Health, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada
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Peterson I, Bar-Zeev N, Kennedy N, Ho A, Newberry L, SanJoaquin MA, Menyere M, Alaerts M, Mapurisa G, Chilombe M, Mambule I, Lalloo DG, Anderson ST, Katangwe T, Cunliffe N, Nagelkerke N, McMorrow M, Widdowson MA, French N, Everett D, Heyderman RS. Respiratory Virus-Associated Severe Acute Respiratory Illness and Viral Clustering in Malawian Children in a Setting With a High Prevalence of HIV Infection, Malaria, and Malnutrition. J Infect Dis 2016; 214:1700-1711. [PMID: 27630199 PMCID: PMC5341080 DOI: 10.1093/infdis/jiw426] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/02/2016] [Indexed: 01/10/2023] Open
Abstract
Background We used data from 4 years of pediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi, to identify factors associated with clinical severity and coviral clustering. Methods From January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to the hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza virus and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with viral codetection. Results Hospital-attended influenza virus–positive SARI incidence was 2.0 cases per 10 000 children annually; it was highest among children aged <1 year (6.3 cases per 10 000), and human immunodeficiency virus (HIV)–infected children aged 5–9 years (6.0 cases per 10 000). A total of 605 SARI cases (26.8%) had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR], 2.4; 95% confidence interval [CI], 1.4–3.9), respiratory syncytial virus infection (aRR, 1.9; 95% CI, 1.3–3.0) and rainy season (aRR, 2.4; 95% CI, 1.6–3.8). We identified 6 coviral clusters; 1 cluster was associated with SARI with warning signs. Conclusions Influenza vaccination may benefit young children and HIV-infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance.
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Affiliation(s)
| | | | - Neil Kennedy
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Antonia Ho
- Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool
| | - Laura Newberry
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | | | | | | | | | | | | | - Thembi Katangwe
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention (CDC)-South Africa, Johannesburg
| | | | | | | | - Robert S Heyderman
- Division of Infection and Immunity, University College London, United Kingdom
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Abstract
Human rhinovirus (HRV) and coronavirus (HCoV) infections are associated with both upper respiratory tract illness (“the common cold”) and lower respiratory tract illness (pneumonia). New species of HRVs and HCoVs have been diagnosed in the past decade. More sensitive diagnostic tests such as reverse transcription-polymerase chain reaction have expanded our understanding of the role these viruses play in both immunocompetent and immunosuppressed hosts. Recent identification of severe acute respiratory syndrome and Middle East respiratory syndrome viruses causing serious respiratory illnesses has led to renewed efforts for vaccine development. The role these viruses play in patients with chronic lung disease such as asthma makes the search for antiviral agents of increased importance.
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Affiliation(s)
- Stephen B Greenberg
- Department of Medicine, Ben Taub Hospital, Baylor College of Medicine, Houston, Texas
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41
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Ali A, Akhund T, Warraich GJ, Aziz F, Rahman N, Umrani FA, Qureshi S, Petri WA, Bhutta Z, Zaidi AKM, Hughes MA. Respiratory viruses associated with severe pneumonia in children under 2 years old in a rural community in Pakistan. J Med Virol 2016; 88:1882-90. [PMID: 27096404 PMCID: PMC7166621 DOI: 10.1002/jmv.24557] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 12/12/2022]
Abstract
The objective of this study was to determine the incidence of respiratory viruses associated with severe pneumonia among children less than 2 years of age in the rural district of Matiari in Sindh, Pakistan. This study was a community‐based prospective cohort active surveillance of infants enrolled at birth and followed for 2 years. Cases were identified using the World Health Organization's Integrated Management of Childhood Illnesses’ definition of severe pneumonia. Nasopharyngeal swabs were obtained for assessment by multiplex RT‐PCR for eight viruses and their subtypes, including RSV, influenza virus, human metapneumovirus, enterovirus/rhinovirus, coronavirus, parainfluenza virus, adenovirus, and human bocavirus. Blood cultures were collected from febrile participants. A total of 817 newborns were enrolled and followed with fortnightly surveillance for 2 years, accounting for a total of 1,501 child‐years of follow‐up. Of the nasopharyngeal swabs collected, 77.8% (179/230) were positive for one or more of the above mentioned respiratory viruses. The incidence of laboratory confirmed viral‐associated pneumonia was 11.9 per 100 child‐years of follow‐up. Enterovirus/rhinovirus was detected in 51.7% patients, followed by parainfluenza virus type III (8.3%), and RSV (5.7%). Of the uncontaminated blood cultures, 1.4% (5/356) were positive. Respiratory viruses are frequently detected during acute respiratory infection episodes in children under 2 years old in a rural community in Pakistan. However, causal association is yet to be established and the concomitant role of bacteria as a co‐infection or super‐infection needs further investigation. J. Med. Virol. 88:1882–1890, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tauseef Akhund
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Gohar Javed Warraich
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fatima Aziz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fayyaz Ahmed Umrani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahida Qureshi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Zulfiqar Bhutta
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Molly A Hughes
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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Oliveira JR, Bouzas ML, Cardoso MRA, Barral A, Nascimento-Carvalho C. Frequency of complications and the effects of pneumococcal vaccination in young children with acute respiratory tract infection. Vaccine 2016; 34:2556-61. [DOI: 10.1016/j.vaccine.2016.04.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/24/2022]
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Homaira N, Luby SP, Hossain K, Islam K, Ahmed M, Rahman M, Rahman Z, Paul RC, Bhuiyan MU, Brooks WA, Sohel BM, Banik KC, Widdowson MA, Willby M, Rahman M, Bresee J, Ramirez KS, Azziz-Baumgartner E. Respiratory Viruses Associated Hospitalization among Children Aged <5 Years in Bangladesh: 2010-2014. PLoS One 2016; 11:e0147982. [PMID: 26840782 PMCID: PMC4739641 DOI: 10.1371/journal.pone.0147982] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/11/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh. METHODS Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals. RESULTS We estimated that the annual incidence per 1000 children (95% CI) of all cause associated respiratory hospitalization was 11.5 (10-12). The incidences per 1000 children (95% CI) per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2-3), 0.5(0.4-0.8), 0.4 (0.3-0.6), 0.4 (0.3-0.6), and 0.4 (0.3-0.6) respectively. The incidences per 1000 children (95%CI) of rhinovirus-associated infections among hospitalized children were 5 (3-7), 2 (1-3), 1 (0.6-2), and 3 (2-4) in 2010, 2011, 2012 and 2013, respectively. CONCLUSION Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh.
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Affiliation(s)
- Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P. Luby
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Kamal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kariul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Makhdum Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Repon C. Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mejbah Uddin Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - W. Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Bloomberg School of Public, Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Badrul Munir Sohel
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kajal Chandra Banik
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marc-Alain Widdowson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Melisa Willby
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, (IEDCR), Dhaka, Bangladesh
| | - Joseph Bresee
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Katharine-Sturm Ramirez
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Burden of Influenza and Influenza-associated Pneumonia in the First Year of Life in a Prospective Cohort Study in Managua, Nicaragua. Pediatr Infect Dis J 2016; 35:152-6. [PMID: 26421805 PMCID: PMC4711382 DOI: 10.1097/inf.0000000000000944] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Influenza is a major public health problem worldwide; however, relatively little is known about influenza in tropical regions, especially for infants. Additional information is required to inform public health policy making, in particular vaccination guidelines. METHODS Between September 2011 and July 2013, we enrolled newborns into the Nicaraguan Birth Cohort Study. Infants were provided primary medical care and actively followed for reverse-transcription polymerase chain reaction-confirmed influenza virus infection when presenting with influenza-like illness or undifferentiated fever. This report presents data pertaining to the first year of life. RESULTS Of the 518 children enrolled in the study, 441 participated throughout their first year of life, 71 were withdrawn, and 6 died. Overall, 13% of the participants experienced at least 1 laboratory-confirmed influenza virus infection. The overall incidence of influenza was 15.5 cases per 100 person-years [95% confidence interval (CI): 12.2-19.5]. Infants aged 6-11 months experienced significantly higher rates of laboratory-confirmed influenza than infants aged 0-5 months (incidence rate ratio: 2.1; 95% CI: 1.3-3.4). The overall incidence of pneumonia was 52.6 cases per 100 person-years (95% CI: 46.3-59.6). Three percent of the pneumonia cases were influenza associated, and the incidence of influenza-associated pneumonia and hospitalization was 1.7 (95% CI: 0.9-3.5) and 0.22 (95% CI: 0.03-1.55) cases per 100 person-years, respectively. CONCLUSIONS We found a significant burden of influenza and influenza-associated severe respiratory outcomes in infants. Our results support the need to explore the potential value of vaccinating pregnant women and infants aged >6 months, as recommended by the World Health Organization in 2012.
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Incidence of viral respiratory infections in a prospective cohort of outpatient and hospitalized children aged ≤5 years and its associated cost in Buenos Aires, Argentina. BMC Infect Dis 2015; 15:447. [PMID: 26497393 PMCID: PMC4619328 DOI: 10.1186/s12879-015-1213-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/13/2015] [Indexed: 01/15/2023] Open
Abstract
Background Although information about the incidence of viral respiratory illnesses and their associated cost can help health officials explore the value of interventions, data are limited from middle-income countries. Methods During 2008–2010, we conducted a prospective cohort study and followed ~1,800 Argentinian children aged ≤5 years to identify those children who were hospitalized or who sought care at an emergency room with any acute respiratory infection sign or symptom (e.g., rhinorrhea, cough, wheezing, tachypnea, retractions, or cyanosis). Respiratory samples were obtained for respiratory syncytial virus, influenza, parainfluenza, adenovirus, and metapneumovirus testing by immunofluorescence and for rhinovirus by real-time reverse transcription polymerase chain reaction. Results The incidence of respiratory syncytial virus (24/1000 children-years), human metapneumovirus (8/1000 children-years), and influenza (8/1000 children-years) illnesses was highest among hospitalized children aged <6 months and decreased among older children. In contrast, the incidence of rhinovirus was highest (12/1000 children-years) among those aged 6–23 months. In the emergency room, the incidence of rhinovirus was 459; respiratory syncytial virus 352; influenza 185; parainfluenza 177; metapneumovirus 130; and adenovirus 73/1,000 children-years. The total cost of hospitalization was a median of US$529 (Interquartile range, US$362–789). Conclusions Our findings indicate that respiratory viruses, in particular rhinovirus, respiratory syncytial virus, metapneumovirus, and influenza may be associated with severe illness causing substantial economic burden.
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Liu T, Li Z, Zhang S, Song S, Julong W, Lin Y, Guo N, Xing C, Xu A, Bi Z, Wang X. Viral Etiology of acute respiratory tract infections in hospitalized children and adults in Shandong Province, China. Virol J 2015; 12:168. [PMID: 26467854 PMCID: PMC4606902 DOI: 10.1186/s12985-015-0388-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background The dominant viral etiologies responsible for acute respiratory infections (ARIs) are poorly understood, particularly among hospitalized patients. Improved etiological insight is needed to improve clinical management and prevention of ARIs. Methods Clinical and demographic information and throat swabs were collected from 607 patients from 2011 to 2013 in Shandong Province, China. Multiplex RT-PCR (SeeplexTM RV detection, Seegene) was performed to detected 12 respiratory viral pathogens. Results A total of 607 hospitalized patients were enrolled from 2011 to 2013. Viruses were identified in 35.75 % (217/607) of cases, including 78 influenza virus A and B (IVA and IVB), 47 para-influenza viruses (PIVs), 41 respiratory syncytial virus (RSV) and 38 adenovirus (ADV). For the children under 15 year old, the common detected viruses were influenza viruses, RSV, PIVS and ADV, while the principal respiratory viruses were human coronaviruses (HCoV), PIVs, influenza viruses for the old adults. Co-infections with multiple viruses were detected in 15.67 % of patients. Children under 5 years were more likely to have one or more detectable virus associated with their ARI. The peak of ARI caused by the respiratory viruses occurred in winter. Conclusion This study demonstrated respiratory viruses were the major cause of hospitalized ARI patients in Shandong Province, influenza virus was the most common detected, RSV was the highest incidence among the young children (≤5 years). These findings also gave a better understand of virus distribution among different age and seasons, which help to consider potential therapeutic approaches and develop effective prevention strategies for respiratory virus infection.
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Affiliation(s)
- Ti Liu
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Zhong Li
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Shengyang Zhang
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Shaoxia Song
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Wu Julong
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Yi Lin
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Nongjian Guo
- Jinan Central Hospital Affiliated to Shandong University, Jinan, 250014, Shandong, China.
| | - Chunyan Xing
- Jinan Central Hospital Affiliated to Shandong University, Jinan, 250014, Shandong, China.
| | - Aiqiang Xu
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Infectious Diseases Control and Prevention, Shandong University Institute for Prevention Medicine, Jinan, 250014, Shandong, China.
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Wu A, Budge PJ, Williams J, Griffin MR, Edwards KM, Johnson M, Zhu Y, Hartinger S, Verastegui H, Gil AI, Lanata CF, Grijalva CG. Incidence and Risk Factors for Respiratory Syncytial Virus and Human Metapneumovirus Infections among Children in the Remote Highlands of Peru. PLoS One 2015; 10:e0130233. [PMID: 26107630 PMCID: PMC4479592 DOI: 10.1371/journal.pone.0130233] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/17/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The disease burden and risk factors for respiratory syncytial virus (RSV) and human metapneumovirus (MPV) infections among children living in remote, rural areas remain unclear. MATERIALS AND METHODS We conducted a prospective, household-based cohort study of children aged <3 years living in remote rural highland communities in San Marcos, Cajamarca, Peru. Acute respiratory illnesses (ARI), including lower respiratory tract infection (LRTI), were monitored through weekly household visits from March 2009 through September 2011. Nasal swabs collected during ARI/LRTI were tested for RSV, MPV, and other respiratory viruses using real-time RT-PCR. Incidence rates and rate ratios were calculated using mixed effects Poisson regression. RESULTS Among 892 enrolled children, incidence rates of RSV and MPV ARI were 30 and 17 episodes per 100 child-years, respectively. The proportions of RSV and MPV ARI that presented as LRTI were 12.5% and 8.9%, respectively. Clinic visits for ARI and hospitalizations were significantly more frequent (all p values <0.05) among children with RSV (clinic 41% and hospital 5.3%) and MPV ARI (38% and 3.5%) when compared with other viral infections (23% and 0.7%) and infections without virus detected (24% and 0.6%). In multivariable analysis, risk factors for RSV detection included younger age (RR 1.02, 95% CI: 1.00-1.03), the presence of a smoker in the house (RR 1.63, 95% CI: 1.12-2.38), residing at higher altitudes (RR 1.93, 95% CI: 1.25-3.00 for 2nd compared to 1st quartile residents; RR 1.98, 95% CI: 1.26-3.13 for 3rd compared to 1st quartile residents). Having an unemployed household head was significantly associated with MPV risk (RR 2.11, 95% CI: 1.12-4.01). CONCLUSION In rural high altitude communities in Peru, childhood ARI due to RSV or MPV were common and associated with higher morbidity than ARI due to other viruses or with no viral detections. The risk factors identified in this study may be considered for interventional studies to control infections by these viruses among young children from developing countries.
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Affiliation(s)
- Andrew Wu
- School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Philip J. Budge
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - John Williams
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Marie R. Griffin
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Kathryn M. Edwards
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Monika Johnson
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Stella Hartinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Ana I. Gil
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, United States of America
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48
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Influenza and pregnancy: a review of the literature from India. Infect Dis Obstet Gynecol 2015; 2015:867587. [PMID: 25810687 PMCID: PMC4355110 DOI: 10.1155/2015/867587] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/09/2015] [Accepted: 01/14/2015] [Indexed: 11/30/2022] Open
Abstract
Maternal influenza infection is known to cause substantial morbidity and mortality among pregnant women and young children. Many professional healthcare bodies including the World Health Organization (WHO) have identified pregnant women as a priority risk group for receipt of inactivated seasonal influenza vaccination. However influenza prevention in this group is not yet a public health priority in India. This literature review was undertaken to examine the Indian studies of influenza among pregnant women. Eight Indian studies describing influenza burden and/or outcomes among pregnant women with influenza were identified. In most studies, influenza A (pH1N1) was associated with increased maternal mortality (25–75%), greater disease severity, and adverse fetal outcomes as compared to nonpregnant women. Surveillance for seasonal influenza infections along with higher quality prospective studies among pregnant women is needed to quantify disease burden, improve awareness among antenatal care providers, and formulate antenatal influenza vaccine policies.
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Amin N, Pickering AJ, Ram PK, Unicomb L, Najnin N, Homaira N, Ashraf S, Abedin J, Islam MS, Luby SP. Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. Am J Trop Med Hyg 2014; 91:415-23. [PMID: 24914003 DOI: 10.4269/ajtmh.13-0475] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among mothers to compare microbial efficacy of soapy water (30 g powdered detergent in 1.5 L water) with bar soap and water alone. Fieldworkers collected hand rinse samples before and after the following washing regimens: scrubbing with soapy water for 15 and 30 seconds; scrubbing with bar soap for 15 and 30 seconds; and scrubbing with water alone for 15 seconds. Soapy water and bar soap removed thermotolerant coliforms similarly after washing for 15 seconds (mean log10 reduction = 0.7 colony-forming units [CFU], P < 0.001 for soapy water; mean log10 reduction = 0.6 CFU, P = 0.001 for bar soap). Increasing scrubbing time to 30 seconds did not improve removal (P > 0.05). Scrubbing hands with water alone also reduced thermotolerant coliforms (mean log10 reduction = 0.3 CFU, P = 0.046) but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbiologically effective cleansing agent to improve handwashing among households with vulnerable children.
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Affiliation(s)
- Nuhu Amin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy J Pickering
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pavani K Ram
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nusrat Najnin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sania Ashraf
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jaynal Abedin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Sirajul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen P Luby
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Stanford University, Stanford, California; University at Buffalo, Buffalo, New York; Centers for Disease Control and Prevention, Atlanta, Georgia
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50
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Budge PJ, Griffin MR, Edwards KM, Williams JV, Verastegui H, Hartinger SM, Johnson M, Klemenc JM, Zhu Y, Gil AI, Lanata CF, Grijalva CG. A household-based study of acute viral respiratory illnesses in Andean children. Pediatr Infect Dis J 2014; 33:443-7. [PMID: 24378948 PMCID: PMC4223552 DOI: 10.1097/inf.0000000000000135] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Few community studies have measured the incidence, severity and etiology of acute respiratory illness (ARI) among children living at high-altitude in remote rural settings. METHODS We conducted active, household-based ARI surveillance among children aged <3 years in rural highland communities of San Marcos, Cajamarca, Peru from May 2009 through September 2011 (RESPIRA-PERU study). ARI (defined by fever or cough) were considered lower respiratory tract infections if tachypnea, wheezing, grunting, stridor or retractions were present. Nasal swabs collected during ARI episodes were tested for respiratory viruses by real-time, reverse-transcriptase polymerase chain reaction. ARI incidence was calculated using Poisson regression. RESULTS During 755.1 child-years of observation among 892 children in 58 communities, 4475 ARI were observed, yielding an adjusted incidence of 6.2 ARI/child-year (95% confidence interval: 5.9-6.5). Families sought medical care for 24% of ARI, 4% were classified as lower respiratory tract infections and 1% led to hospitalization. Of 5 deaths among cohort children, 2 were attributed to ARI. One or more respiratory viruses were detected in 67% of 3957 samples collected. Virus-specific incidence rates per 100 child-years were: rhinovirus, 236; adenovirus, 73; parainfluenza virus, 46; influenza, 37; respiratory syncytial virus, 30 and human metapneumovirus, 17. Respiratory syncytial virus, metapneumovirus and parainfluenza virus 1-3 comprised a disproportionate share of lower respiratory tract infections compared with other etiologies. CONCLUSIONS In this high-altitude rural setting with low-population density, ARI in young children were common, frequently severe and associated with a number of different respiratory viruses. Effective strategies for prevention and control of these infections are needed.
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Affiliation(s)
- Philip J. Budge
- Division of Infectious Diseases, Department of Internal Medicine, Vanderbilt University, Nashville, TN, USA
| | - Marie R. Griffin
- Department of Preventive Medicine, Vanderbilt University, Nashville, TN, USA
| | - Kathryn M. Edwards
- Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - John V. Williams
- Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA
| | | | - Stella M. Hartinger
- Instituto de Investigacion Nutricional, Lima, Peru
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Monika Johnson
- Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | | | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Ana I. Gil
- Instituto de Investigacion Nutricional, Lima, Peru
| | | | - Carlos G. Grijalva
- Department of Preventive Medicine, Vanderbilt University, Nashville, TN, USA
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