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Nisar M, Kerai S, Shahid S, Qazi M, Rehman S, Aziz F, Jehan F. Predictors of Respiratory Syncytial Virus, Influenza Virus, and Human Metapneumovirus Carriage in Children Under 5 Years With WHO-Defined Fast-Breathing Pneumonia in Pakistan. Influenza Other Respir Viruses 2024; 18:e13285. [PMID: 38616564 PMCID: PMC11016811 DOI: 10.1111/irv.13285] [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: 12/27/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality in children < 5 years. We describe nasopharyngeal carriage of respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus among children with fast-breathing pneumonia in Karachi, Pakistan. METHODS We performed a cross-sectional analysis of nasopharyngeal swabs from children aged 2-59 months with fast-breathing pneumonia, enrolled in the randomized trial of amoxicillin versus placebo for fast-breathing pneumonia (RETAPP) (NCT02372461) from 2014 to 2016. Swabs were collected using WHO standardized methods, processed at the Aga Khan University, Pakistan. Viral detection was performed using LUMINEX xTAG respiratory viral panel assay and logistic regression identified clinical and sociodemographic predictors. FINDINGS Of the 1000 children tested, 92.2% (n = 922) were positive for viral carriage. RSV, hMPV, and influenza virus were detected in 59 (6.4%), 56 (6.1%), and 58 (6.3%) children and co-infections in three samples (two RSV-hMPV and one influenza-hMPV). RSV carriage was common in infants (56%), we observed a higher occurrence of fever in children with hMPV and influenza virus (80% and 88%, respectively) and fast breathing in RSV (80%) carriage. RSV carriage was positively associated with a history of fast/difficulty breathing (aOR: 1.96, 95% CI 1.02-3.76) and low oxygen saturation (aOR: 2.52, 95% CI 1.32-4.82), hMPV carriage was positively associated with a complete vaccination status (aOR: 2.22, 95% CI 1.23-4.00) and body temperature ≥ 37.5°C (aOR: 2.34, 95% CI 1.35-4.04) whereas influenza viral carriage was associated with body temperature ≥ 37.5°C (aOR: 4.48, 95% CI 2.53-7.93). CONCLUSION We observed a high nasopharyngeal viral carriage among children with WHO-defined fast-breathing pneumonia in Pakistan. Fever, difficulty in breathing, hypoxia and vaccination status are important clinical predictors for viral nonsevere community-acquired pneumonia.
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Affiliation(s)
| | - Salima Kerai
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Shahira Shahid
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | | | - Sarah Rehman
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Fatima Aziz
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
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Hassan MZ, Islam MA, Haider S, Shirin T, Chowdhury F. Respiratory Syncytial Virus-Associated Deaths among Children under Five before and during the COVID-19 Pandemic in Bangladesh. Viruses 2024; 16:111. [PMID: 38257812 PMCID: PMC10818674 DOI: 10.3390/v16010111] [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: 11/11/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infections in young children worldwide. RSV-associated deaths in children are underreported in Bangladesh. We analyzed hospital-based surveillance data on severe acute respiratory infections (SARIs) in under-five children before (August 2009-February 2020) and during the COVID-19 pandemic (March 2020-March 2022). Using the World Health Organization definition, we identified SARI cases in 14 tertiary-level hospitals. Nasopharyngeal and oropharyngeal swabs were collected for real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) testing of six respiratory viruses, including RSV. SARI deaths during the pandemic (2.6%, 66) were higher than pre-pandemic (1.8%, 159; p < 0.001). Nearly half of pandemic deaths (47%) had underlying respiratory viruses, similar to the pre-pandemic rate (45%). RSV detection in deaths was consistent pre-pandemic (13%, 20/159) and during the pandemic (12%, 8/66). Children aged < 6 months constituted 57% (16) of RSV-related deaths. Evaluating interventions like maternal vaccination and infant monoclonal antibody prophylaxis is crucial to address RSV, a major contributor to under-five SARI deaths.
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Affiliation(s)
- Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Bangladesh (icddr,b), Dhaka 1213, Bangladesh; (M.A.I.); (S.H.); (F.C.)
| | - Md. Ariful Islam
- International Centre for Diarrhoeal Disease Bangladesh (icddr,b), Dhaka 1213, Bangladesh; (M.A.I.); (S.H.); (F.C.)
| | - Saleh Haider
- International Centre for Diarrhoeal Disease Bangladesh (icddr,b), Dhaka 1213, Bangladesh; (M.A.I.); (S.H.); (F.C.)
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh;
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Bangladesh (icddr,b), Dhaka 1213, Bangladesh; (M.A.I.); (S.H.); (F.C.)
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Yesmin MF, Chowdhury MRK, Bornee FA, Kader M, Mondal MNI, Hossain M, Rashid M. Urban-rural difference in factors associated with childhood functional difficulty in Bangladesh: a cross-sectional study. Front Public Health 2023; 11:1270853. [PMID: 38026377 PMCID: PMC10652778 DOI: 10.3389/fpubh.2023.1270853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Early childhood functional difficulty poses a substantial worldwide public health challenge, leading to adverse effects on children's quality of life and overall productivity. Moreover, it represents a significant social and economic problem in Bangladesh. Therefore, the current study aimed to identify factors contributing to childhood functional difficulty in Bangladesh within the context of urban-rural areas. Methods A nationally representative cross-sectional survey data from Multiple Indicator Cluster Survey (MICS), 2019 in Bangladesh was used in this study. Chi-square test and multivariable logistic regression analyses were carried out to identify factors associated with childhood functional difficulty. Results Functional difficulties were found in approximately 3.3% of children 2-4 years of age in urban areas and 2.5% in rural areas. Having a mother with functional difficulties and undernutrition were identified as significant factors common in both urban and rural areas. Further, mothers who had no formal education (AOR = 2.76, 95%CI = 1.18-6.45) and experienced infant death (AOR = 1.94, 95%CI = 1.01-3.70) were identified as significant factors of functional difficulty in urban areas. On the other hand, in rural areas, no access to mass media, children with acute respiratory infection (ARI) (AOR = 2.13, 95%CI = 1.39-3.28), female sex (AOR = 0.69, 95%CI = 0.53-0.91), child undernutrition (AOR = 1.73, 95%CI = 1.32-2.27) and poorer socio-economic status (AOR = 1.95, 95%CI = 1.08-3.55) were found significant factors. Conclusion Functional difficulty was found to be present in one out of every 35 children age 2 to 4 years in Bangladesh. Childhood functional difficulties were reported slightly higher in urban areas as compared to rural areas. Reducing childhood difficulties in urban areas demands comprehensive strategies: quality healthcare, inclusive education, community support, better information systems, and collaboration. To achieve urban-rural parity in child health, address disparities in economic development, healthcare, and education, especially for girls.
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Affiliation(s)
- Mst Farjana Yesmin
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Mohammad Rocky Khan Chowdhury
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Farzana Akhter Bornee
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Manzur Kader
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Md Nazrul Islam Mondal
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Mohammad Hossain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Mamunur Rashid
- Department of Public Health and Sports Science, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Pre COVID-19 molecular epidemiology of respiratory syncytial virus (RSV) among children in Bangladesh. Heliyon 2022; 8:e11043. [PMID: 36247113 PMCID: PMC9551109 DOI: 10.1016/j.heliyon.2022.e11043] [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: 11/02/2021] [Revised: 02/24/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Epidemiological data of specific respiratory pathogens from the pre-COVID-19 period are essential to determine the effects of the COVID-19 pandemic on other respiratory infections. In this study, we revealed the pre-COVID-19 molecular epidemiology of respiratory syncytial virus (RSV) among children in Bangladesh. We tested 3170 samples collected from 2008 to 2012 for a panel of respiratory viruses; RSV, human metapneumovirus (hMPV), human parainfluenza viruses (hPIV) 1, 2, 3, and adenovirus. Five hundred fifty-five samples (17.5 %) were positive for RSV, including 2.5% having co-infections with other viruses. Genotypic characterization of RSV showed that RSV-A (82%) contributed more acute respiratory infections than RSV-B (18%). Clinical features were similar with RSV-A and RSV-B infections. However, children with RSV-B were more likely to have upper respiratory infections (URI) (10% vs. 29%, p = 0.03). Among RSV-A cases, hospitalization was higher for ON1 cases (25%, ON1 vs. 8%, NA1, p = 0.04), whereas the recovery without a disability was higher among the NA1 cases (56%, ON1 vs. 88%, NA1, p = 0.02). The time to the most recent common ancestor (TMRCA) for RSV in Bangladesh was 1949 for RSV-A and 1944 for RSV-B. This study revealed the genotypic diversity and evolutionary relatedness of RSV strains in Bangladesh and provided pre-COVID molecular epidemiology data to understand better the COVID-19 impact on upcoming RSV epidemiology in Bangladesh.
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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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Noble M, Khan RA, Walker B, Bennett E, Gent N. Respiratory syncytial virus-associated hospitalisation in children aged ≤5 years: a scoping review of literature from 2009 to 2021. ERJ Open Res 2022; 8:00593-2021. [PMID: 35651366 PMCID: PMC9149382 DOI: 10.1183/23120541.00593-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Following the easing of COVID-19 restrictions in many countries, a surge in respiratory syncytial virus (RSV) hospitalisations was reported, surpassing yearly trends pre-pandemic. The changes to RSV epidemiology may have unforeseen effects on healthcare systems and populations globally, adding to the burden generated during the pandemic and placing increased demand on resources. Here we aim to identify recent global trends of RSV hospitalisation amongst children aged ≤5 years, to help inform policy makers in the planning of preventative interventions. Methods We conducted a scoping review of published literature between January 2009 and May 2021. Using keywords “Hospital admissions, Respiratory syncytial virus, RSV, Bronchiolitis, Children” we located studies using Medline, EMCARE, CINAHL and HMIC. Studies were eligible if they reported on trends/data for RSV hospitalisation amongst children aged ≤5 years. The articles were reviewed by two independent reviewers. Findings We assessed 3310 abstracts, reviewed 70 studies and included 56 studies in the final review. Findings were categorised into themes. The review highlighted that, although RSV incidence has been steadily increasing since 2009, the number of reported RSV hospitalisations decreased during lockdown. The highest numbers of hospitalisations were reported in children <1 year of age, particularly 0–2-month-old infants. Globally, RSV hospitalisations tend to peak in the winter months; however, since COVID-19 restrictions have eased, countries are reporting incidence peaks at different times, in contrast to the trends of previous years. Conclusion With greater physical interactions due to the relaxation of COVID-19 restriction measures, RSV-related hospitalisations can be seen to increase amongst children aged ≤5 years, possibly surpassing the numbers reported in previous RSV seasons. With #COVID19 restriction measures being eased globally, #RSV-related hospitalisation among children will increase, possibly surpassing pre-pandemic levelshttps://bit.ly/35lg4Iv
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Merera A, Asena T, Senbeta M. Bayesian multilevel analysis of determinants of acute respiratory infection in children under the age of five years in Ethiopia. BMC Pediatr 2022; 22:123. [PMID: 35272658 PMCID: PMC8908561 DOI: 10.1186/s12887-022-03187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute respiratory tract infection (ARI) is one of the leading causes of illness and mortality in children under the age of five worldwide. Pneumonia, which is caused by a respiratory tract infection, kills about 1.9 million children under the age of 5 years around the world. The majority of these deaths occur in underdeveloped countries. According to the 2016 Ethiopia Demographic and Health Survey (EDHS), the prevalence rate of ARI in Ethiopia was 7%. Prevalence is defined as the number of infectious diseases present at a given period in relation to the total number of children under the age of five who have been exposed to ARI. The goal of this study was to determine the risk factors for acute respiratory infection among children under the age of five in Ethiopia. METHODS To provide representative samples of the population, a community-based cross-sectional sampling scheme was designed. Bayesian multilevel approach was employed to assess factors associated with the prevalence of ARI among children under age five in Ethiopia. The data was collected from 10,641 children under the age of 5 years out of which 9918 children were considered in this study. RESULTS The ARI prevalence rate in children under the age of 5 years was assessed to be 8.4%, somewhat higher than the country's anticipated prevalence rate. Children whose mothers did not have a high level of education had the highest prevalence of ARI. The key health, environmental, and nutritional factors influencing the proportion of children with ARI differed by area. Tigray (15.3%) and Oromia (14.4%) had the highest prevalence of ARI, while Benishangul Gumuz had the lowest prevalence (2.6%). The use of vitamin A was investigated, and the results revealed that roughly 43.1% of those who received vitamin A had the lowest prevalence of ARI (7.7%) as compared to those who did not receive vitamin A. Diarrhea affected 11.1% of children under the age of five, with the highest frequency of ARI (24.6%) and the highest prevalence of ARI reported in children whose drinking water source was unprotected/unimproved (9.4%). CONCLUSIONS The prevalence of ARI among children under the age of 5 years was found to be strongly affected by the child's age, household wealth index, mother's educational level, vitamin A supplement, history of diarrhea, maternal work, stunting, and drinking water source. The study also found that the incidence of ARI varies significantly between and within Ethiopian areas. When intending to improve the health status of Ethiopian children, those predictive variables should be taken into consideration.
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Affiliation(s)
- Amanuel Merera
- Department of Statistics, Mizan-Tepi University, Mizan-Tepi, Ethiopia
| | - Tilahun Asena
- Department of Statistics, Arba Minch University, Arba Minch, Ethiopia.
| | - Mebratu Senbeta
- Department of Economics, Arba Minch University, Arba Minch, Ethiopia
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Giacomelli Cao R, Christian L, Xu Z, Jaramillo L, Smith B, Karlsson EA, Schultz-Cherry S, Mejias A, Ramilo O. Early Changes in Interferon Gene Expression and Antibody Responses Following Influenza Vaccination in Pregnant Women. J Infect Dis 2022; 225:341-351. [PMID: 34197595 PMCID: PMC8915434 DOI: 10.1093/infdis/jiab345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza immunization during pregnancy provides protection to the mother and the infant. Studies in adults and children with inactivated influenza vaccine have identified changes in immune gene expression that were correlated with antibody responses. The current study was performed to define baseline blood transcriptional profiles and changes induced by inactivated influenza vaccine in pregnant women and to identify correlates with antibody responses. METHODS Pregnant women were immunized with inactivated influenza vaccine during the 2013-2014 and 2014-2015 seasons. Blood samples were collected on day 0 (before vaccination) and on days 1 and 7 after vaccination for transcriptional profile analyses, and on days 0 and 30, along with delivery and cord blood samples, to measure antibody titers. RESULTS Transcriptional analysis demonstrated overexpression of interferon-stimulated genes (ISGs) on day 1 and of plasma cell genes on day 7. Prevaccination ISG expression and ISGs overexpressed on day 1 were significantly correlated with increased H3N2, B Yamagata, and B Victoria antibody titers. Plasma cell gene expression on day 7 was correlated with increased B Yamagata and B Victoria antibody titers. Compared with women who were vaccinated during the previous influenza season, those who were not showed more frequent significant correlations between ISGs and antibody titers. CONCLUSIONS Influenza vaccination in pregnant women resulted in enhanced expression of ISGs and plasma cell genes correlated with antibody responses. Brief summary: This study identified gene expression profiles of interferon-stimulated genes and plasma cells before vaccination and early after vaccination that were correlated with antibody responses in pregnant women vaccinated for influenza.
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Affiliation(s)
- Raquel Giacomelli Cao
- Center for Vaccines and Immunity, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Lisa Christian
- Institute for Behavioral Medical Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Zhaohui Xu
- Center for Vaccines and Immunity, Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Lisa Jaramillo
- Center for Vaccines and Immunity, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Bennett Smith
- Center for Vaccines and Immunity, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Erik A Karlsson
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Current affiliation: Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Division of Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University, Columbus, Ohio, USA
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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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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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12
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Greiff DRL, Patterson-Robert A, Blyth CC, Glass K, Moore HC. Epidemiology and seasonality of human parainfluenza serotypes 1-3 in Australian children. Influenza Other Respir Viruses 2021; 15:661-669. [PMID: 33491337 PMCID: PMC8404051 DOI: 10.1111/irv.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 01/03/2023] Open
Abstract
Background Parainfluenza viruses are significant contributors to childhood respiratory illness worldwide, although detailed epidemiological studies are lacking. Few recent Australian studies have investigated serotype‐specific PIV epidemiology, and there is a paucity of southern hemisphere PIV reports. We report age‐stratified PIV hospitalisation rates and a mathematical model of PIV seasonality and dynamics in Western Australia (WA). Methods We used linked perinatal, hospital admission and laboratory diagnostic data of 469 589 children born in WA between 1996 and 2012. Age‐specific rates of viral testing and PIV detection in hospitalised children were determined using person time‐at‐risk analysis. PIV seasonality was modelled using a compartmental SEIRS model and complex demodulation methods. Results From 2000 to 2012, 9% (n = 43 627) of hospitalised children underwent PIV testing, of which 5% (n = 2218) were positive for PIV‐1, 2 or 3. The highest incidence was in children aged 1‐5 months (PIV‐1:62.6 per 100 000 child‐years, PIV‐2:26.3/100 000, PIV‐3:256/100 000), and hospitalisation rates were three times higher for Aboriginal children compared with non‐Aboriginal children overall (IRR: 2.93). PIV‐1 peaked in the autumn of even‐numbered years, and PIV‐3 annually in the spring, whereas PIV‐2 had inconsistent peak timing. Fitting models to the higher incidence serotypes estimated reproduction numbers of 1.24 (PIV‐1) and 1.72 (PIV‐3). Conclusion PIV‐1 and 3 are significant contributors towards infant respiratory hospitalisations. Interventions should prioritise children in the first 6 months of life, with respect to the observed autumn PIV‐1 and spring PIV‐3 activity peaks. Continued surveillance of all serotypes and investigation into PIV‐1 and 3 interventions should be prioritised.
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Affiliation(s)
- Daniel R L Greiff
- Wesfarmers Centre for Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Alice Patterson-Robert
- Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Kathryn Glass
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Hannah C Moore
- Wesfarmers Centre for Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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13
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Carbonell-Estrany X, Rodgers-Gray BS, Paes B. Challenges in the prevention or treatment of RSV with emerging new agents in children from low- and middle-income countries. Expert Rev Anti Infect Ther 2020; 19:419-441. [PMID: 32972198 DOI: 10.1080/14787210.2021.1828866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes approximately 120,000 deaths annually in children <5 years, with 99% of fatalities occurring in low- and middle-income countries (LMICs). AREAS COVERED There are numerous RSV interventions in development, including long-acting monoclonal antibodies, vaccines (maternal and child) and treatments which are expected to become available soon. We reviewed the key challenges and issues that need to be addressed to maximize the impact of these interventions in LMICs. The epidemiology of RSV in LMICs was reviewed (PubMed search to 30 June 2020 inclusive) and the need for more and better-quality data, encompassing hospital admissions, community contacts, and longer-term respiratory morbidity, emphasized. The requirement for an agreed clinical definition of RSV lower respiratory tract infection was proposed. The pros and cons of the new RSV interventions are reviewed from the perspective of LMICs. EXPERT OPINION We believe that a vaccine (or combination of vaccines, if practicable) is the only viable solution to the burden of RSV in LMICs. A coordinated program, analogous to that with polio, involving governments, non-governmental organizations, the World Health Organization, the manufacturers and the healthcare community is required to realize the full potential of vaccine(s) and end the devastation of RSV in LMICs.
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Affiliation(s)
- Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
| | | | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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14
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Milucky J, Pondo T, Gregory CJ, Iuliano D, Chaves SS, McCracken J, Mansour A, Zhang Y, Aleem MA, Wolff B, Whitaker B, Whistler T, Onyango C, Lopez MR, Liu N, Rahman MZ, Shang N, Winchell J, Chittaganpitch M, Fields B, Maldonado H, Xie Z, Lindstrom S, Sturm-Ramirez K, Montgomery J, Wu KH, Van Beneden CA. The epidemiology and estimated etiology of pathogens detected from the upper respiratory tract of adults with severe acute respiratory infections in multiple countries, 2014-2015. PLoS One 2020; 15:e0240309. [PMID: 33075098 PMCID: PMC7571682 DOI: 10.1371/journal.pone.0240309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Etiology studies of severe acute respiratory infections (SARI) in adults are limited. We studied potential etiologies of SARI among adults in six countries using multi-pathogen diagnostics. METHODS We enrolled both adults with SARI (acute respiratory illness onset with fever and cough requiring hospitalization) and asymptomatic adults (adults hospitalized with non-infectious illnesses, non-household members accompanying SARI patients, adults enrolled from outpatient departments, and community members) in each country. Demographics, clinical data, and nasopharyngeal and oropharyngeal specimens were collected from both SARI patients and asymptomatic adults. Specimens were tested for presence of 29 pathogens utilizing the Taqman® Array Card platform. We applied a non-parametric Bayesian regression extension of a partially latent class model approach to estimate proportions of SARI caused by specific pathogens. RESULTS We enrolled 2,388 SARI patients and 1,135 asymptomatic adults from October 2013 through October 2015. We detected ≥1 pathogen in 76% of SARI patients and 67% of asymptomatic adults. Haemophilus influenzae and Streptococcus pneumoniae were most commonly detected (≥23% of SARI patients and asymptomatic adults). Through modeling, etiology was attributed to a pathogen in most SARI patients (range among countries: 57.3-93.2%); pathogens commonly attributed to SARI etiology included influenza A (14.4-54.4%), influenza B (1.9-19.1%), rhino/enterovirus (1.8-42.6%), and RSV (3.6-14.6%). CONCLUSIONS Use of multi-pathogen diagnostics and modeling enabled attribution of etiology in most adult SARI patients, despite frequent detection of multiple pathogens in the upper respiratory tract. Seasonal flu vaccination and development of RSV vaccine would likely reduce the burden of SARI in these populations.
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Affiliation(s)
- Jennifer Milucky
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Christopher J. Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, Thailand
| | - Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Sandra S. Chaves
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Kenya Office, Kenya
| | - John McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Adel Mansour
- Division of Global Health Protection, Centers for Disease Control and Prevention, Egypt
| | - Yuzhi Zhang
- Division of Global Health Protection, Centers for Disease Control and Prevention, China
| | | | - Bernard Wolff
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Brett Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Thailand Ministry of Public Health, Thailand
| | - Clayton Onyango
- Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health Collaboration, Kisumu, Kenya
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Na Liu
- China Centers for Disease Control and Prevention, National Institute for Viral Disease, Beijing, China
| | | | - Nong Shang
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Jonas Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | | | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kenya
| | - Herberth Maldonado
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Zhiping Xie
- China Centers for Disease Control and Prevention, National Institute for Viral Disease, Beijing, China
| | - Stephen Lindstrom
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
| | - Katherine Sturm-Ramirez
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Bangladesh Office, Bangladesh
| | - Joel Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kai-Hui Wu
- Influenza Division, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, CDC Bangladesh Office, Bangladesh
| | - Chris A. Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, United States of America
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15
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Mahumud RA, Alam K, Renzaho AMN, Sarker AR, Sultana M, Sheikh N, Rawal LB, Gow J. Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis. PLoS One 2019; 14:e0218515. [PMID: 31216352 PMCID: PMC6583970 DOI: 10.1371/journal.pone.0218515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever. MATERIALS AND METHODS A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity. RESULTS The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage. CONCLUSIONS High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, School of Commerce, Faculty of Business, Education, Law and Arts, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, School of Commerce, Faculty of Business, Education, Law and Arts, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Andre M. N. Renzaho
- School of Social Science and Psychology, Western Sydney University, Sydney Australia
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde Business School, Glasgow, United Kingdom
| | - Marufa Sultana
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- School of Health & Social Development, Deakin University, Melbourne, Australia
| | - Nurnabi Sheikh
- Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Lal B. Rawal
- School of Social Science and Psychology, Western Sydney University, Sydney Australia
| | - Jeff Gow
- Health Economics and Policy Research, School of Commerce, Faculty of Business, Education, Law and Arts, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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16
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Havers FP, Fry AM, Goswami D, Nahar K, Sharmin AT, Rahman M, Brooks WA. Population-based Incidence of Childhood Pneumonia Associated With Viral Infections in Bangladesh. Pediatr Infect Dis J 2019; 38:344-350. [PMID: 30882722 DOI: 10.1097/inf.0000000000002155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The contribution of respiratory viruses to childhood pneumonia in tropical low- and middle-income countries is poorly understood. We used population-based respiratory illness surveillance in children 5 years of age or younger in Dhaka, Bangladesh, to characterize these illnesses. METHODS We conducted weekly home visits to children who were referred to clinic for fever or respiratory symptoms. Standardized clinical data were collected. Nasopharyngeal washes were collected for one fifth of children diagnosed with a febrile or respiratory syndrome, with virus isolation testing for influenza and reverse transcription polymerase chain reaction testing for other viruses. Pneumonia was defined as age-specific tachypnea and crepitations on chest auscultation by study physicians. RESULTS From April 2004 to February 2008, 17,584 children were followed for 17,644 child-years; 6335 children had 12,499 clinic visits with eligible illnesses, including 6345 pneumonia episodes (incidence of 36 episodes/100 child-years). Annual incidence of pneumonia/100 child-years ranged from 88.3 for children 0-6 months of age to 13.1 for those 36-60 months of age. Of 1248 pneumonia visits with laboratory testing, 803 (64%) had detection of viral pathogens, including 274 respiratory syncytial virus (22% of pneumonia visits with laboratory testing; incidence 7.9/100 child-years), 244 adenovirus (19%; 7.0/100 child-years), 198 human metapneumovirus (16%; 5.7/100 child-years), 174 parainfluenza (14.0%; 5.0/100 child-years), and 81 influenza (6.5%; 2.3/100 child years). CONCLUSIONS Viral pathogens contribute to a majority of childhood pneumonia episodes in Bangladesh, a setting with high pneumonia rates, especially in children 2 years of age or younger. Developing effective prevention strategies targeting these children is a high priority. Given less sensitive laboratory method used for influenza detection, influenza rates may be underestimated.
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Affiliation(s)
- Fiona P Havers
- From the Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- From the Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Doli Goswami
- International Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Kamrun Nahar
- International Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Amina Tahia Sharmin
- International Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Center for Diarrheal Diseases Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in Bangladesh. Trop Med Infect Dis 2019; 4:tropicalmed4010036. [PMID: 30759811 PMCID: PMC6473378 DOI: 10.3390/tropicalmed4010036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/02/2019] [Accepted: 02/08/2019] [Indexed: 02/04/2023] Open
Abstract
Acute respiratory infections (ARIs), as a group of diseases and symptoms, are a leading cause of morbidity and mortality among under-five children in tropical countries like Bangladesh. Currently, no clear evidence has been published on the prevalence and socioeconomic correlates of ARIs in Bangladesh. In this regard, we carried out this study with the aim of assessing the prevalence and the socioeconomic predictors of ARIs among children aged 0⁻59 months, with a special focus on socioeconomic status and wealth-related indicators. Cross-sectional data on 32,998 mother-child (singleton) pairs were collected from six rounds of Bangladesh Demographic and Health Surveys (BDHS 1997⁻2014). The outcome variable were presence of the common symptoms of ARIs, fever and dyspnea, during the previous two weeks, which were measured based on mothers' reports about the symptoms of these conditions. Explanatory variables included maternal demographic and socioeconomic factors such as age, education, occupation, wealth quintile, and child's age and sex. The prevalence and predictors of ARIs were measured using descriptive and multivariate regression methods. The prevalence of both fever (31.00% in 1997 vs. 36.76% in 2014) and dyspnea (39.27% in 1997 vs. 43.27% in 2014) has increased gradually since 1997, and tended to be higher in households in the lower wealth quintiles. Multivariable analysis revealed that higher maternal educational status, access to improved water and sanitation facilities, and living in households in higher wealth quintiles had protective effects against both fever and dyspnea. Findings suggested a significantly negative association between lacking access to improved water and sanitation and use of biomass fuel with ARI symptoms. However, no sex difference was observed in these associations. Based on the findings, childhood ARI prevention strategies should address the risk factors stemming from parental socioeconomic marginalisation, household water and sanitation poverty, and use of unclean fuel.
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18
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Njuguna HN, Zaki SR, Roberts DJ, Fligner CL, Keating MK, Rogena E, Walong E, Gachii AK, Maleche-Obimbo E, Irimu G, Mathaiya J, Orata N, Lopokoiyit R, Maina J, Emukule GO, Onyango CO, Gikunju S, Owuor C, Kinuthia P, Bunei M, Fields B, Widdowson MA, Mott JA, Chaves SS. Determining the Cause of Death Among Children Hospitalized With Respiratory Illness in Kenya: Protocol for Pediatric Respiratory Etiology Surveillance Study (PRESS). JMIR Res Protoc 2019; 8:e10854. [PMID: 30632968 PMCID: PMC6705666 DOI: 10.2196/10854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/02/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, where the burden of respiratory disease-related deaths is the highest, information on the cause of death remains inadequate because of poor access to health care and limited availability of diagnostic tools. Postmortem examination can aid in the ascertainment of causes of death. This manuscript describes the study protocol for the Pediatric Respiratory Etiology Surveillance Study (PRESS). OBJECTIVE This study protocol aims to identify causes and etiologies associated with respiratory disease-related deaths among children (age 1-59 months) with respiratory illness admitted to the Kenyatta National Hospital (KNH), the largest public hospital in Kenya, through postmortem examination coupled with innovative approaches to laboratory investigation. METHODS We prospectively followed children hospitalized with respiratory illness until the end of clinical care or death. In case of death, parents or guardians were offered grief counseling, and postmortem examination was offered. Lung tissue specimens were collected using minimally invasive tissue sampling and conventional autopsy where other tissues were collected. Tissues were tested using histopathology, immunohistochemistry, and multipathogen molecular-based assays to identify pathogens. For each case, clinical and laboratory data were reviewed by a team of pathologists, clinicians, laboratorians, and epidemiologists to assign a cause of and etiology associated with death. RESULTS We have enrolled pediatric cases of respiratory illness hospitalized at the KNH at the time of this submission; of those, 14.8% (140/945) died while in the hospital. Both analysis and interpretation of laboratory results and writing up of findings are expected in 2019-2020. CONCLUSIONS Postmortem studies can help identify major pathogens contributing to respiratory-associated deaths in children. This information is needed to develop evidence-based prevention and treatment policies that target important causes of pediatric respiratory mortality and assist with the prioritization of local resources. Furthermore, PRESS can provide insights into the interpretation of results using multipathogen testing platforms in resource-limited settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10854.
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Affiliation(s)
- Henry N Njuguna
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sherif R Zaki
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | | | - M Kelly Keating
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | | | | | | | | | - Gideon O Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Clayton O Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stella Gikunju
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Collins Owuor
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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19
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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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20
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Ahmed M, Roguski K, Tempia S, Iuliano AD. Reply to Alonso et al. "Bangladesh and Rwanda: Cases of high burden of influenza in tropical countries?". Influenza Other Respir Viruses 2018; 12:669-671. [PMID: 29858873 PMCID: PMC6086846 DOI: 10.1111/irv.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Makhdum Ahmed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine Roguski
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela D Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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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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22
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Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA, Groome MJ, Cohen C, Moyes J, Thorburn K, Thamthitiwat S, Oshitani H, Lupisan SP, Gordon A, Sánchez JF, O'Brien KL, Gessner BD, Sutanto A, Mejias A, Ramilo O, Khuri-Bulos N, Halasa N, de-Paris F, Pires MR, Spaeder MC, Paes BA, Simões EAF, Leung TF, da Costa Oliveira MT, de Freitas Lázaro Emediato CC, Bassat Q, Butt W, Chi H, Aamir UB, Ali A, Lucero MG, Fasce RA, Lopez O, Rath BA, Polack FP, Papenburg J, Roglić S, Ito H, Goka EA, Grobbee DE, Nair H, Bont LJ. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series. LANCET GLOBAL HEALTH 2018; 5:e984-e991. [PMID: 28911764 PMCID: PMC5599304 DOI: 10.1016/s2214-109x(17)30344-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/11/2017] [Accepted: 08/16/2017] [Indexed: 01/08/2023]
Abstract
Background Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data. Methods In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms “RSV”, “respiratory syncytial virus”, or “respiratory syncytial viral” combined with “mortality”, “fatality”, “death”, “died”, “deaths”, or “CFR” for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables. Findings We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5·0 months (IQR 2·3–11·0) in low-income or lower middle-income countries, 4·0 years (2·0–10·0) in upper middle-income countries, and 7·0 years (3·6–16·8) in high-income countries. Interpretation This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nienke M Scheltema
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Angela Gentile
- Department of Epidemiology, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Florencia Lucion
- Department of Epidemiology, Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - D James Nokes
- Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; School of Life Sciences, University of Warwick, Coventry, UK
| | - Patrick K Munywoki
- Kenya Medical Research Institute, Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Nursing Sciences, Pwani University, Kilifi, Kenya
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle J Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kentigern Thorburn
- Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, UK
| | - Somsak Thamthitiwat
- Division of Global Health Protection, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Miyagi, Japan
| | - Socorro P Lupisan
- Research Institute for Tropical Medicine, Alabang Muntinlupa City, Metro Manila Philippines
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, MI, USA
| | - José F Sánchez
- Department of Medicine, Hospital Infantil Manuel de Jesus Rivera, Managua, Nicaragua
| | - Katherine L O'Brien
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Asuncion Mejias
- Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus, OH, USA; Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Octavio Ramilo
- Department of Pediatrics, Division of Infectious Diseases, Ohio State University, Columbus, OH, USA; Center for Vaccines and Immunity at Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Najwa Khuri-Bulos
- Department of Pediatrics, University of Jordan, Aljubeiha, Amman, Jordan
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fernanda de-Paris
- Molecular Biology Laboratory, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil
| | - Márcia Rosane Pires
- Infection Control Commission, Hospital de Clínicas de Porto Alegre, Bairro Santa Cecília, Porto Alegre, Brazil
| | - Michael C Spaeder
- Division of Pediatric Critical Care, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bosco A Paes
- Neonatal Division, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Eric A F Simões
- Department of Pediatrics and Center for Global Health, University of Colorado, Aurora, CO, USA
| | - Ting F Leung
- Department of Paediatrics, Faculty of Medicine and Chinese University of Hong Kong-University Medical Center Utrecht Joint Research Laboratory of Respiratory Virus and Immunobiology, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | | | | | - Quique Bassat
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Warwick Butt
- Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Hsin Chi
- Department of Pediatric Infectious Disease, MacKay Children's Hospital, Taipei, Taiwan
| | - Uzma Bashir Aamir
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Alabang Muntinlupa City, Metro Manila Philippines
| | | | - Olga Lopez
- Hospital Dr. Ernesto Torres Galdames, Iquique, Chile
| | - Barbara A Rath
- Vienna Vaccine Safety Initiative, Berlin, Germany; University of Nottingham School of Medicine, Nottingham, UK
| | | | - Jesse Papenburg
- Department of Microbiology, Division of Pediatric Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Srđan Roglić
- Department of Paediatric Infectious Diseases, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Hisato Ito
- Department of Pediatrics, Nantan General Hospital, Ueno, Yagichoyagi, Nantan-shi, Kyoto, Japan
| | - Edward A Goka
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Julius Clinical Science, Zeist, Netherlands
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Louis J Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands; ReSViNET Respiratory Syncytial Virus Network, Utrecht, Netherlands.
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23
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Chakraborty A, Rahman M, Hossain MJ, Khan SU, Haider MS, Sultana R, Ali Rimi N, Islam MS, Haider N, Islam A, Sultana Shanta I, Sultana T, Al Mamun A, Homaira N, Goswami D, Nahar K, Alamgir ASM, Rahman M, Mahbuba Jamil K, Azziz-Baumgartner E, Simpson N, Shu B, Lindstrom S, Gerloff N, Davis CT, Katz JM, Mikolon A, Uyeki TM, Luby SP, Sturm-Ramirez K. Mild Respiratory Illness Among Young Children Caused by Highly Pathogenic Avian Influenza A (H5N1) Virus Infection in Dhaka, Bangladesh, 2011. J Infect Dis 2017; 216:S520-S528. [PMID: 28934459 DOI: 10.1093/infdis/jix019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In March 2011, a multidisciplinary team investigated 2 human cases of highly pathogenic avian influenza A(H5N1) virus infection, detected through population-based active surveillance for influenza in Bangladesh, to assess transmission and contain further spread. Methods We collected clinical and exposure history of the case patients and monitored persons coming within 1 m of a case patient during their infectious period. Nasopharyngeal wash specimens from case patients and contacts were tested with real-time reverse-transcription polymerase chain reaction, and virus culture and isolates were characterized. Serum samples were tested with microneutralization and hemagglutination inhibition assays. We tested poultry, wild bird, and environmental samples from case patient households and surrounding areas for influenza viruses. Results Two previously healthy case patients, aged 13 and 31 months, had influenzalike illness and fully recovered. They had contact with poultry 7 and 10 days before illness onset, respectively. None of their 57 contacts were subsequently ill. Clade 2.2.2.1 highly pathogenic avian influenza H5N1 viruses were isolated from the case patients and from chicken fecal samples collected at the live bird markets near the patients' dwellings. Conclusion Identification of H5N1 cases through population-based surveillance suggests possible additional undetected cases throughout Bangladesh and highlights the importance of surveillance for mild respiratory illness among populations frequently exposed to infected poultry.
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Affiliation(s)
- Apurba Chakraborty
- Institute of Epidemiology, Disease Control and Research.,International Centre for Diarrhoeal Diseases Research (icddr,b)
| | | | - M Jahangir Hossain
- International Centre for Diarrhoeal Diseases Research (icddr,b).,Medical Research Council Unit, The Gambia
| | | | | | - Rebeca Sultana
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | - Nadia Ali Rimi
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | - M Saiful Islam
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | - Najmul Haider
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | - Ausraful Islam
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | | | - Tahmina Sultana
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | | | - Nusrat Homaira
- International Centre for Diarrhoeal Diseases Research (icddr,b).,UNSW, Sydney, Australia
| | - Doli Goswami
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | - Kamrun Nahar
- International Centre for Diarrhoeal Diseases Research (icddr,b)
| | - A S M Alamgir
- Institute of Epidemiology, Disease Control and Research.,World Health Organization, Dhaka, Bangladesh
| | | | | | | | - Natosha Simpson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bo Shu
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nancy Gerloff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - C Todd Davis
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Andrea Mikolon
- International Centre for Diarrhoeal Diseases Research (icddr,b).,Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen P Luby
- International Centre for Diarrhoeal Diseases Research (icddr,b).,Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine Sturm-Ramirez
- International Centre for Diarrhoeal Diseases Research (icddr,b).,Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Stein RT, Bont LJ, Zar H, Polack FP, Park C, Claxton A, Borok G, Butylkova Y, Wegzyn C. Respiratory syncytial virus hospitalization and mortality: Systematic review and meta-analysis. Pediatr Pulmonol 2017; 52:556-569. [PMID: 27740723 PMCID: PMC5396299 DOI: 10.1002/ppul.23570] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/24/2016] [Accepted: 07/18/2016] [Indexed: 10/31/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major public health burden worldwide. We aimed to review the current literature on the incidence and mortality of severe RSV in children globally. METHODS Systematic literature review and meta-analysis of published data from 2000 onwards, reporting on burden of acute respiratory infection (ARI) due to RSV in children. Main outcomes were hospitalization for severe RSV-ARI and death. RESULTS Five thousand two hundred and seventy-four references were identified. Fifty-five studies were included from 32 countries. The global RSV-ARI hospitalization estimates, reported per 1,000 children per year (95% Credible Interval (CrI), were 4.37 (2.98, 6.42) among children <5 years, 19.19 (15.04, 24.48) among children <1 year, 20.01 (9.65, 41.31) among children <6 months and 63.85 (37.52, 109.70) among premature children <1 year. The RSV-ARI global case-fatality estimates, reported per 1,000 children, (95% Crl) were 6.21 (2.64, 13.73) among children <5 years, 6.60 (1.85, 16.93) for children <1 year, and 1.04 (0.17, 12.06) among preterm children <1 year. CONCLUSIONS A substantial proportion of RSV-associated morbidity occurs in the first year of life, especially in children born prematurely. These data affirm the importance of RSV disease in the causation of hospitalization and as a significant contributor to pediatric mortality and further demonstrate gestational age as a critical determinant of disease severity. An important limitation of case-fatality ratios is the absence of individual patient characteristics of non-surviving patients. Moreover, case-fatality ratios cannot be translated to population-based mortality. Pediatr Pulmonol. 2017;52:556-569. © 2016 The Authors. Pediatric Pulmonology. Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Renato T Stein
- Department of Pediatrics, Hospital da PUCRS & Biomedical Research Institute, Porto Alegre, Brazil
| | - Louis J Bont
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heather Zar
- Department of Paediatrics and Child Health, Red Cross Childrens Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Fernando P Polack
- Fundacion INFANT, Buenos Aires, Argentina.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ami Claxton
- Doctor Evidence, LLC, Santa Monica, California
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25
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Essa S, Al-Tawalah H, AlShamali S, Al-Nakib W. The potential influence of human parainfluenza viruses detected during hospitalization among critically ill patients in Kuwait, 2013-2015. Virol J 2017; 14:19. [PMID: 28159006 PMCID: PMC5291994 DOI: 10.1186/s12985-017-0681-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The four types of human parainfluenza viruses (PIV) are important causes of community-acquired pneumonia, particularly in children; however, limited information exists about the incidence of PIV in critically ill patients. The aim of this study is to describe the spectrum, incidence and clinical features of PIV-associated infections diagnosed during the hospital stay of patients admitted to pediatric intensive care unit (PICU) and intensive care unit (ICU) of 5 medical centers across Kuwait. METHODS This was a population-based, retrospective study from 2013 to 2015. Specimens were analyzed by molecular methods. This analysis was performed using the database of Virology Unit, Mubarak Al-Kabeer Hospital. Data from 1510 admitted patients with suspected respiratory viral infections was extracted. RESULTS The database contained a total of 39 (2.6%) patients infected with PIV (53.8% male and 46.2% females) and 20 (51.3%) were under 1 year of age. The most frequently isolated type was type 3 (28, 71.8%) followed by type 1 (9, 23.1%). At admission the most common clinical diagnosis was pneumonia in 12 patients (30.8%, p < 0.05) followed by bronchiolitis in 10 patients (25.6%). CONCLUSION PIV plays an important yet unrecognized role in the outcomes of PIUC and ICU patients. Our results contribute to the limited epidemiologic data of PIV in PIUC and ICU in this region.
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Affiliation(s)
- Sahar Essa
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
| | - Haya Al-Tawalah
- Ministry of Health, Sabah Hospital, Virology Unit, Kuwait City, Kuwait
| | | | - Widad Al-Nakib
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Kumar P, Medigeshi GR, Mishra VS, Islam M, Randev S, Mukherjee A, Chaudhry R, Kapil A, Ram Jat K, Lodha R, Kabra SK. Etiology of Acute Respiratory Infections in Infants: A Prospective Birth Cohort Study. Pediatr Infect Dis J 2017; 36:25-30. [PMID: 27753796 DOI: 10.1097/inf.0000000000001359] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is paucity of studies on etiology of acute respiratory infections (ARI) in infants. The objective of this study is to document incidence and etiology of ARI in infants, their seasonal variability and association of clinical profile with etiology. METHODS A birth cohort was followed for the first year of life; for each episode of ARI, nasopharyngeal aspirates were collected to identify the causative respiratory virus(es) using multiplex real-time polymerase chain reaction assay. For lower respiratory tract infections blood culture, serum procalcitonin, serum antibodies to Mycoplasma and Chlamydia and urinary Streptococcus pneumoniae antigen were also assayed. RESULTS A total of 503 ARI episodes were documented in 310 infants for an incidence rate of 1.8 episodes per infant per year. Of these, samples were processed in 395 episodes (upper respiratory tract infection: 377; lower respiratory tract infection: 18). One or more viruses were detected in 250 (63.3%) episodes and viral coinfections in 72 (18.2%) episodes. Rhinovirus was the most common virus [105 (42%)] followed by respiratory syncytial virus [50 (20%)], parainfluenza virus [42 (16.8%)] and coronavirus [44 (17.6%)]. In lower respiratory tract infections, viral infections were detected in 12 (66.7%) episodes, bacterial infections in 17 (94.4%) episodes and mixed bacterial-viral infections in 8 (44.4%) episodes. Peak incidence of viruses was observed during February-March and September-November. There was no significant difference in symptom duration with virus types. CONCLUSION In this cohort of infants, ARI incidence was 1.8 episodes per year per infant; 95% were upper respiratory tract infections. Viruses were identified in 63.3% episodes, and the most common viruses detected were rhinovirus, respiratory syncytial virus and parainfluenza virus.
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Affiliation(s)
- Prawin Kumar
- From the *Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India; †Department of Biotechnology, Vaccine and Infectious Disease Research Center, Translational Health Science and Technology Institute (THSTI), Faridabad, India; and ‡Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
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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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Chiao C. Community vulnerability and symptoms of acute respiratory infection among preschool age children in the Democratic Republic of Congo, Malawi and Nigeria: evidence from Demographic and Health Surveys. J Epidemiol Community Health 2016; 71:81-86. [PMID: 27651176 DOI: 10.1136/jech-2015-206605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND As a consequence of the global spread of HIV infection in sub-Saharan Africa, the impact of the AIDS pandemic has contributed to more than 40 million orphaned and vulnerable children (OVC) in sub-Saharan Africa. The children's vulnerability is hypothesised to increase the risk of acute respiratory infection (ARI), which remains one of the major infectious causes of child mortality and morbidity in this region. This study examines the linkages between children's vulnerability and ARI symptoms, with a focus on the individual as well as community levels. METHODS Using population-based Demographic and Health Surveys of preschool age children (0-59 months old) from the Democratic Republic of Congo (n=7755), Malawi (n=17 559) and Nigeria (n=28 049), multilevel logistic models were conducted to establish the relationships between ARI symptoms among OVC and community-level vulnerability, adjusting for children's and household characteristics and a season variation. RESULTS The child's OVC status and community vulnerability were shown to be significantly associated with an increased likelihood of the child suffering from ARI symptoms in three countries. In contrast, the relationship between ARI symptoms and some selected variables associated with community development was not consistent across the 3 countries. CONCLUSIONS Community vulnerability demonstrates a significant influence on whether or not the child exhibits ARI symptoms. Being OVC contributes to differences in children's likelihood of ARI symptoms between communities. In addition to industrial pollution, specific components, such as community development, vary in their associations with the ARI symptoms across different countries. The large differences in childhood ARI symptoms across countries suggests that policies aimed at promoting child health need to be context specific.
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Jochem WC, Razzaque A, Root ED. Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh. Int J Health Geogr 2016; 15:32. [PMID: 27586497 PMCID: PMC5009544 DOI: 10.1186/s12942-016-0061-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory infections continue to be a public health threat, particularly to young children in developing countries. Understanding the geographic patterns of diseases and the role of potential risk factors can help improve future mitigation efforts. Toward this goal, this paper applies a spatial scan statistic combined with a zero-inflated negative-binomial regression to re-examine the impacts of a community-based treatment program on the geographic patterns of acute lower respiratory infection (ALRI) mortality in an area of rural Bangladesh. Exposure to arsenic-contaminated drinking water is also a serious threat to the health of children in this area, and the variation in exposure to arsenic must be considered when evaluating the health interventions. METHODS ALRI mortality data were obtained for children under 2 years old from 1989 to 1996 in the Matlab Health and Demographic Surveillance System. This study period covers the years immediately following the implementation of an ALRI control program. A zero-inflated negative binomial (ZINB) regression model was first used to simultaneously estimate mortality rates and the likelihood of no deaths in groups of related households while controlling for socioeconomic status, potential arsenic exposure, and access to care. Next a spatial scan statistic was used to assess the location and magnitude of clusters of ALRI mortality. The ZINB model was used to adjust the scan statistic for multiple social and environmental risk factors. RESULTS The results of the ZINB models and spatial scan statistic suggest that the ALRI control program was successful in reducing child mortality in the study area. Exposure to arsenic-contaminated drinking water was not associated with increased mortality. Higher socioeconomic status also significantly reduced mortality rates, even among households who were in the treatment program area. CONCLUSION Community-based ALRI interventions can be effective at reducing child mortality, though socioeconomic factors may continue to influence mortality patterns. The combination of spatial and non-spatial methods used in this paper has not been applied previously in the literature, and this study demonstrates the importance of such approaches for evaluating and improving public health intervention programs.
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Affiliation(s)
- Warren C Jochem
- Department of Geography and Environment, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
| | - Abdur Razzaque
- Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Elisabeth Dowling Root
- Department of Geography, Division of Epidemiology, The Ohio State University, 1036 Derby Hall, 154 North Oval Mall, Columbus, OH, 43212, USA
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Rowlinson E, Dueger E, Mansour A, Azzazy N, Mansour H, Peters L, Rosenstock S, Hamid S, Said MM, Geneidy M, Abd Allah M, Kandeel A. Incidence and etiology of hospitalized acute respiratory infections in the Egyptian Delta. Influenza Other Respir Viruses 2016; 11:23-32. [PMID: 27458989 PMCID: PMC5155652 DOI: 10.1111/irv.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute Respiratory Infections (ARI) are responsible for nearly two million childhood deaths worldwide. A limited number of studies have been published on the epidemiology of viral respiratory pathogens in Egypt. Methods A total of 6113 hospitalized patients >1 month of age with suspected ARI were enrolled between June 23, 2009 and December 31, 2013. Naso‐ and oropharyngeal specimens were collected and tested for influenza A and B, respiratory syncytial virus, human metapneumovirus, adenovirus, and parainfluenza viruses 1–3. Blood specimens from children 1–11 months were cultured and bacterial growth was identified by polymerase chain reaction. Results from a healthcare utilization survey on the proportion of persons seeking care for ARI was used to calculate adjusted ARI incidence rates in the surveillance population. Results The proportion of patients with a viral pathogen detected decreased with age from 67% in patients age 1–11 months to 19% in patients ≥65 years of age. Influenza was the dominant viral pathogen detected in patients ≥1 year of age (13.9%). The highest incidence rates for hospitalized ARI were observed in children 1–11 months (1757.9–5537.5/100 000 population) and RSV was the most commonly detected pathogen in this age group. Conclusion In this study population, influenza is the largest viral contributor to hospitalized ARIs and children 1–11 months of age experience a high rate of ARI hospitalizations. This study highlights a need for surveillance of additional viral pathogens and alternative detection methods for bacterial pathogens, which may reveal a substantial proportion of as yet unidentified etiologies in adults.
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Affiliation(s)
- Emily Rowlinson
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Erica Dueger
- US Centers for Disease Control & Prevention, Atlanta, GA, USA.,US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Adel Mansour
- US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Nahed Azzazy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hoda Mansour
- US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Lisa Peters
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Summer Rosenstock
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Sarah Hamid
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Mayar M Said
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Mohamed Geneidy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Monier Abd Allah
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
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Saha S, Pandey BG, Choudekar A, Krishnan A, Gerber SI, Rai SK, Singh P, Chadha M, Lal RB, Broor S. Evaluation of case definitions for estimation of respiratory syncytial virus associated hospitalizations among children in a rural community of northern India. J Glob Health 2016; 5:010419. [PMID: 26649172 PMCID: PMC4652925 DOI: 10.7189/jogh.05.020419] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The burden estimation studies for respiratory syncytial virus (RSV) have been based on varied case definitions, including case-definitions designed for influenza surveillance systems. We used all medical admissions among children aged 0-59 months to study the effect of case definitions on estimation of RSV-associated hospitalizations rates. METHODS The hospital-based daily surveillance enrolled children aged 0-59 months admitted with acute medical conditions from July 2009-December 2012, from a well-defined rural population in Ballabgarh in northern India. All study participants were examined and nasal and throat swabs taken for testing by real-time polymerase chain reaction (RT-PCR) for RSV and influenza virus. Clinical data were used to retrospectively evaluate World Health Organization (WHO) case definitions (2011) commonly used for surveillance of respiratory pathogens, ie, acute respiratory illness (WHO-ARI), severe ARI (SARI) and influenza-like illness (ILI), for determination of RSV-associated hospitalization. RSV-associated hospitalization rates adjusted for admissions at non-study hospitals were calculated. FINDINGS Out of 505 children enrolled, 82 (16.2%) tested positive for RSV. Annual incidence rates of RSV-associated hospitalization per 1000 children were highest among infants aged 0-5 months (15.2; 95% confidence interval (CI) 8.3-26.8), followed by ages 6-23 months (5.3, 95% CI 3.2-8.7) and lowest among children 24-59 months (0.5, 95% CI 0.1-1.5). The RSV positive children were more likely to have signs of respiratory distress like wheeze, chest in-drawing, tachypnea, and crepitation compared to RSV-negative based on bivariate comparisons. Other less commonly seen signs of respiratory distress, ie, nasal flaring, grunting, accessory muscle usage were also significantly associated with being RSV positive. Compared to the estimated RSV hospitalization rate based on all medical hospitalizations, the WHO-ARI case definition captured 86% of the total incidence, while case definitions requiring fever like ILI and SARI underestimated the incidence by 50-80%. CONCLUSIONS Our study suggests that RSV is a substantial cause of hospitalization among children aged <24months especially those aged <6 months. The WHO-ARI case definition appeared to be the most suitable screening definition for RSV surveillance because of its high sensitivity.
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Affiliation(s)
- Siddhartha Saha
- Center for Disease Control and Prevention, Influenza Programme, New Delhi, India
| | - Bharti Gaur Pandey
- Manav Rachna International University, Faridabad, India ; Equal contribution of authors
| | - Avinash Choudekar
- AIIMS-INCLEN collaborative Influenza project, New Delhi, India ; Equal contribution of authors
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Susan I Gerber
- Respiratory Pathogen Branch, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanjay K Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Renu B Lal
- Center for Disease Control and Prevention, Influenza Programme, New Delhi, India
| | - Shobha Broor
- AIIMS-INCLEN collaborative Influenza project, New Delhi, India
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Cunningham S, Nair H, Campbell H. Deciphering clinical phenotypes in acute viral lower respiratory tract infection: Bronchiolitis is not an island. Thorax 2016; 71:679-80. [DOI: 10.1136/thoraxjnl-2016-209012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rahman SR, Ahmed MF, Islam MA, Majibur Rahman M. Effect of risk factors on the prevalence of influenza infections among children of slums of Dhaka city. SPRINGERPLUS 2016; 5:602. [PMID: 27247898 PMCID: PMC4864765 DOI: 10.1186/s40064-016-2275-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/04/2016] [Indexed: 12/26/2022]
Abstract
Background Influenza viruses may cause severe acute respiratory illness among human population. People of densely populated areas, e.g., slum, are mostly affected by influenza viruses. Although potential vaccines to influenza viruses have been developed, infection rate is still high, therefore, increase the morbidity and mortality rate in slum areas. To treat these infections, slum dwellers including children and mothers do not get proper medication as well as vaccination. Hence, prevention remains to be the only mean to tackle such infections. Herein, we determined the prevalence of influenza infections among nutritionally deprived children and mothers of slum areas in Dhaka city and demonstrated the association with different risk factors like age, gender and socio-economic status. Results Nasopharyngeal swab samples and a short demography of all the participants suffering from influenza-like illness (ILI) were collected. The samples were subjected to RNA extraction and then real-time RT-PCR to detect influenza viruses. Among the ILI patients, about 87.9 % did not have knowledge about influenza infections and 80.5 % did not cover their noses during coughing as well as sneezing. Children were significantly infected by both influenza A and influenza B viruses, suggesting their vulnerability to these infections. Additionally, among the children with ILI, influenza infections were significantly associated with age below or equal to three years, very poor family incomes, practicing unhygienic habits and nutritional deficiency. Conclusions This study suggests that proper vaccination, improved sanitary conditions and nutritional diet may help reduce the risk of influenza infections in slum areas.
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Affiliation(s)
| | - Md Firoz Ahmed
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Mohammad Ariful Islam
- Department of Microbiology, University of Dhaka, Dhaka, 1000 Bangladesh ; Department of Microbiology, Jagannath University, Dhaka, 1000 Bangladesh
| | - Md Majibur Rahman
- Department of Microbiology, University of Dhaka, Dhaka, 1000 Bangladesh
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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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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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Wansaula Z, Olsen SJ, Casal MG, Golenko C, Erhart LM, Kammerer P, Whitfield N, McCotter OZ. Surveillance for severe acute respiratory infections in Southern Arizona, 2010-2014. Influenza Other Respir Viruses 2016; 10:161-9. [PMID: 26590069 PMCID: PMC4814863 DOI: 10.1111/irv.12360] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/28/2022] Open
Abstract
Background The Binational Border Infectious Disease Surveillance program began surveillance for severe acute respiratory infections (SARI) on the US–Mexico border in 2009. Here, we describe patients in Southern Arizona. Methods Patients admitted to five acute care hospitals that met the SARI case definition (temperature ≥37·8°C or reported fever or chills with history of cough, sore throat, or shortness of breath in a hospitalized person) were enrolled. Staff completed a standard form and collected a nasopharyngeal swab which was tested for selected respiratory viruses by reverse transcription polymerase chain reaction. Results From October 2010–September 2014, we enrolled 332 SARI patients. Fifty‐two percent were male and 48% were white non‐Hispanic. The median age was 63 years (47% ≥65 years and 5·2% <5 years). During hospitalization, 51 of 230 (22%) patients required intubation, 120 of 297 (40%) were admitted to intensive care unit, and 28 of 278 (10%) died. Influenza vaccination was 56%. Of 309 cases tested, 49 (16%) were positive for influenza viruses, 25 (8·1%) for human metapneumovirus, 20 (6·5%) for parainfluenza viruses, 16 (5·2%) for coronavirus, 11 (3·6%) for respiratory syncytial virus, 10 (3·2%) for rhinovirus, 4 (1·3%) for rhinovirus/enterovirus, 3 (1·0%) for enteroviruses, and 3 (1·0%) for adenovirus. Among the 49 influenza‐positive specimens, 76% were influenza A (19 H3N2, 17 H1N1pdm09, and 1 not subtyped), and 24% were influenza B. Conclusion Influenza viruses were a frequent cause of SARI in hospitalized patients in Southern Arizona. Monitoring respiratory illness in border populations will help better understand the etiologies. Improving influenza vaccination coverage may help prevent some SARI cases.
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Affiliation(s)
- Zimy Wansaula
- Arizona Department of Health Services, Office of Border Health, Tucson, AZ, USA
| | - Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mariana G Casal
- Arizona Department of Health Services, Office of Border Health, Tucson, AZ, USA
| | - Catherine Golenko
- Arizona Department of Health Services, Office of Infectious Disease Services, Phoenix, AZ, USA
| | - Laura M Erhart
- Arizona Department of Health Services, Office of Infectious Disease Services, Phoenix, AZ, USA
| | | | - Natalie Whitfield
- Clinical and Molecular Microbiology, University of Arizona, Tucson, AZ, USA
| | - Orion Z McCotter
- Arizona Department of Health Services, Office of Border Health, Tucson, AZ, USA.,Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Halasa N, Williams J, Faouri S, Shehabi A, Vermund SH, Wang L, Fonnesbeck C, Khuri-Bulos N. Natural history and epidemiology of respiratory syncytial virus infection in the Middle East: Hospital surveillance for children under age two in Jordan. Vaccine 2015; 33:6479-87. [PMID: 26314623 PMCID: PMC7115487 DOI: 10.1016/j.vaccine.2015.08.048] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and viral pneumonia in infants and young children worldwide. In the Middle East and Arab countries, the burden of RSV-associated hospitalizations is not well characterized. We sought to determine the burden and clinical/epidemiological characteristics of RSV hospitalization in young children in Amman, Jordan. We investigated risk factors for severity including vitamin D levels. METHODS We conducted viral surveillance with clinical and demographic data in children <2 years admitted with respiratory symptoms and/or fever at the Al-Bashir Government Hospital from March16, 2010 to March 31, 2013. Nasal/throat swabs were obtained and placed into lysis buffer, and frozen at -80°C until testing by real-time RT-PCR for 11 respiratory viruses. Heel stick blood or sera samples for 25-hydroxyvitamin D [25(OH)D] levels were obtained and sent to a central laboratory for mass spectrometry. RESULTS Of the 3168 children, >80% testing positive for one virus, with RSV the most common virus detected (44%). The RSV-associated hospitalization rate was highest in children <6 months with an annual range of 21.1-25.9 per 1000, compared to 6.0-8.0 in 6-11-month-olds and 1.6-2.5 in 12-23-month-olds. RSV-positive children compared with RSV-negative were more likely to be previously healthy without underlying medical conditions, less likely to be born prematurely, had a higher frequency of supplemental oxygen use, and had lower median vitamin D levels. Risk factors for oxygen use in RSV-positive children included underlying medical conditions, lack of breastfeeding, younger age, and higher viral load. CONCLUSION RSV is a major cause of illness in hospitalized Jordanian children and is associated with increased severity compared to other respiratory viruses. Children with RSV in the Middle East would benefit from future RSV vaccines and antiviral therapy.
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Affiliation(s)
- Natasha Halasa
- Departments of Pediatrics, Vanderbilt University, Nashville, TN, USA; Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - John Williams
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan.
| | - Asem Shehabi
- Department of Pathology-Microbiology at University of Jordan, Amman, Jordan.
| | - Sten H Vermund
- Departments of Pediatrics, Vanderbilt University, Nashville, TN, USA; Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Li Wang
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
| | | | - Najwa Khuri-Bulos
- Department of Pathology-Microbiology at University of Jordan, Amman, Jordan.
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Onakpoya IJ, Hayward G, Heneghan CJ. Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under. Cochrane Database Syst Rev 2015; 2015:CD011530. [PMID: 26408070 PMCID: PMC10624245 DOI: 10.1002/14651858.cd011530.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) in young children account for 1.4 million deaths annually worldwide. Antibiotics could be beneficial in preventing LRTIs in high-risk children, and may also help prevent school absenteeism and work days missed by children and/or carers. While it is well documented that the efficacy of antibiotic prophylaxis for RTIs decreases over time, there are no reviews that describe the use of antibiotic prophylaxis to prevent LRTIs in high-risk children aged 12 years and under. OBJECTIVES To assess the effectiveness and safety of antibiotic prophylaxis in the prevention of bacterial LRTIs in high-risk children aged 12 years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1) and the Database of Abstracts of Reviews of Effects (DARE), MEDLINE and MEDLINE In-Process (OvidSP) (1946 to 13 February 2015), EMBASE (OvidSP) (1974 to 12 February 2015), Science Citation Index Expanded (1945 to 13 February 2015) and Conference Proceedings Citation Index-Science (Web of Science Core Collection) (1990 to 13 February 2015). We searched for ongoing studies on ClinicalTrials.gov and the World Health Organization ICTRP. We handsearched the bibliographies of retrieved full texts of relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral or intravenous antibiotics versus placebo or no treatment to prevent infections in high-risk children aged 12 years and under. We used a combination of the Centers for Disease Control and Prevention (CDC), National Health Service (NHS), American Academy of Paediatrics (AAP) and National Institute for Health and Care Excellence (NICE) guidelines to define conditions at higher risk of complications. Our primary outcome was the incidence of bacterial lower respiratory infections. Secondary outcomes included clinical function, hospital admission, mortality, growth, use of secondary antibiotics, time off school or parental work, quality of life and adverse events. DATA COLLECTION AND ANALYSIS We extracted data using a customised data extraction sheet, assessed the risk of bias of included studies using the Cochrane 'Risk of bias' criteria, and used the GRADE criteria to rate the quality of the evidence. We used a random-effects model for meta-analysis. We presented the results narratively where we could not statistically combine data. MAIN RESULTS We included 10 RCTs of high-risk children using antibiotics (azithromycin, ciprofloxacin, co-trimoxazole, isoniazid, oral penicillin V or vancomycin) to prevent LRTIs. Three studies included HIV-infected children (n = 1345), four cystic fibrosis (n = 429) and one each sickle cell disease (n = 219), cancer (n = 160) and low birth weight neonates with underlying respiratory disorders (n = 40). The study duration ranged from seven days to three years. The quality of the evidence from studies including children with HIV infection, cystic fibrosis or cancer was moderate. Due to inadequate data, we were unable to rate the quality of the evidence for two studies: one in children with sickle cell disease (low risk of bias), and another in low birth weight neonates with underlying respiratory disorders (high risk of bias).In HIV-infected children receiving continuous isoniazid prophylaxis, there was no significant difference in the incidence of pulmonary tuberculosis (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.32 to 1.29, I(2) statistic = 47%, P value = 0.21). There was no significant effect on mortality with co-trimoxazole or isoniazid prophylaxis (RR 0.82, 0.46 to 1.46, I(2) statistic = 76%, P value = 0.58); however, analysis of one study that used co-trimoxazole showed a significant reduction in mortality (RR 0.67, 95% CI 0.53 to 0.85, P value = 0.001). There was a significant decrease in the rates of hospital admission per child-year of follow-up with co-trimoxazole prophylaxis in one study (P value = 0.01). There was no evidence of increased adverse events due to antibiotic prophylaxis (RR 1.10, 95% CI 0.75 to 1.64, I(2) statistic = 22%, P value = 0.28); however, there was scant reporting of antibiotic resistance - the one study that did assess this found no increase.In two studies of children with cystic fibrosis receiving ciprofloxacin prophylaxis, there was no significant difference in Pseudomonas infections (RR 0.76, 0.44 to 1.31, I(2) statistic = 0%, P value = 0.33). In two studies assessing the benefit of azithromycin prophylaxis, there was a significant reduction in the frequency of pulmonary exacerbations (RR 0.60, 95% CI 0.48 to 0.76, I(2) statistic = 0%, P value < 0.0001). The effect of antibiotic prophylaxis on growth in children with cystic fibrosis was inconsistent across the studies. There was an increased risk of emergence of pathogenic strains with either azithromycin or ciprofloxacin prophylaxis in two studies reporting this outcome. There was no significant difference in the quality of life (one study). In three studies, there was no significant increase in the frequency of adverse events with prophylaxis with azithromycin (two studies) or ciprofloxacin (one study). There was no evidence of increased antibiotic resistance in two studies.In the one study of children with sickle cell disease, a significantly lesser proportion of children with pneumococcal septicaemia was reported with penicillin V prophylaxis (P value = 0.0025).In the one study of children with cancer there was a significant decrease in Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole prophylaxis (RR 0.03, 95% CI 0.00 to 0.47, P value < 0.01). There was no significant increase in the frequency of adverse events with antibiotic prophylaxis.In low birth weight children with underlying respiratory disorders, there was no significant difference in the proportion of children with pulmonary infection with vancomycin prophylaxis (P value = 0.18).No included studies reported time off school or carer time off work. AUTHORS' CONCLUSIONS There is inconclusive evidence that antibiotic prophylaxis in certain groups of high-risk children can reduce pneumonia, exacerbations, hospital admission and mortality in certain conditions. However, limitations in the evidence base mean more clinical trials assessing the effectiveness of antibiotics for preventing LRTIs in children at high risk should be conducted. Specifically, clinical trials assessing the effectiveness of antibiotics for preventing LRTIs in congenital heart disease, metabolic disease, endocrine and renal disorders, neurological disease or prematurity should be a priority.
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Affiliation(s)
- Igho J Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK, Oxon
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Cohen AL, Sahr PK, Treurnicht F, Walaza S, Groome MJ, Kahn K, Dawood H, Variava E, Tempia S, Pretorius M, Moyes J, Olorunju SAS, Malope-Kgokong B, Kuonza L, Wolter N, von Gottberg A, Madhi SA, Venter M, Cohen C. Parainfluenza Virus Infection Among Human Immunodeficiency Virus (HIV)-Infected and HIV-Uninfected Children and Adults Hospitalized for Severe Acute Respiratory Illness in South Africa, 2009-2014. Open Forum Infect Dis 2015; 2:ofv139. [PMID: 26566534 PMCID: PMC4630450 DOI: 10.1093/ofid/ofv139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/16/2015] [Indexed: 11/13/2022] Open
Abstract
Parainfluenza is associated with a significant amount of severe respiratory disease in South Africa, especially among children <5 years of age and individuals that are HIV-infected. Background. Parainfluenza virus (PIV) is a common cause of acute respiratory tract infections, but little is known about PIV infection in children and adults in Africa, especially in settings where human immunodeficiency virus (HIV) prevalence is high. Methods. We conducted active, prospective sentinel surveillance for children and adults hospitalized with severe acute respiratory illness (SARI) from 2009 to 2014 in South Africa. We enrolled controls (outpatients without febrile or respiratory illness) to calculate the attributable fraction for PIV infection. Respiratory specimens were tested by multiplex real-time reverse-transcription polymerase chain reaction assay for parainfluenza types 1, 2, and 3. Results. Of 18 282 SARI cases enrolled, 1188 (6.5%) tested positive for any PIV type: 230 (19.4%) were type 1; 168 (14.1%) were type 2; 762 (64.1%) were type 3; and 28 (2.4%) had coinfection with 2 PIV types. After adjusting for age, HIV serostatus, and respiratory viral coinfection, the attributable fraction for PIV was 65.6% (95% CI [confidence interval], 47.1–77.7); PIV contributed to SARI among HIV-infected and -uninfected children <5 years of age and among individuals infected with PIV types 1 and 3. The observed overall incidence of PIV-associated SARI was 38 (95% CI, 36–39) cases per 100 000 population and was highest in children <1 year of age (925 [95% CI, 864–989] cases per 100 000 population). Compared with persons without HIV, persons with HIV had an increased relative risk of PIV hospitalization (9.4; 95% CI, 8.5–10.3). Conclusions. Parainfluenza virus causes substantial severe respiratory disease in South Africa among children <5 years of age, especially those that are infected with HIV.
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Affiliation(s)
- Adam L Cohen
- Centers for Disease Control and Prevention , Pretoria , South Africa ; Centers for Disease Control and Prevention , Atlanta, Georgia ; US Public Health Service, Rockville, Maryland
| | - Philip K Sahr
- South African Field Epidemiology Training Program, Johannesburg ; School of Health Systems and Public Health, Faculty of Health Sciences , University of Pretoria
| | - Florette Treurnicht
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg
| | - Sibongile Walaza
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Public Health
| | - Michelle J Groome
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences ; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health ; Centre for Global Health Research , Umeå University , Sweden ; INDEPTH Network, Accra , Ghana
| | - Halima Dawood
- Pietermaritzburg Metropolitan Hospital Complex ; University of KwaZulu-Natal , Durban
| | - Ebrahim Variava
- Department of Internal Medicine ; Department of Internal Medicine , Klerksdorp-Tshepong Hospital Complex
| | - Stefano Tempia
- Centers for Disease Control and Prevention , Pretoria , South Africa ; Centers for Disease Control and Prevention , Atlanta, Georgia ; Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg
| | - Marthi Pretorius
- Department of Medical Virology, Zoonoses Research Unit , University of Pretoria ; National Health Laboratory Service, Tshwane Academic Division
| | - Jocelyn Moyes
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Public Health
| | | | - Babatyi Malope-Kgokong
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg
| | - Lazarus Kuonza
- South African Field Epidemiology Training Program, Johannesburg
| | - Nicole Wolter
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Pathology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Anne von Gottberg
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Pathology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Shabir A Madhi
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences ; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases
| | - Marietjie Venter
- Centers for Disease Control and Prevention , Pretoria , South Africa ; Department of Medical Virology, Zoonoses Research Unit , University of Pretoria
| | - Cheryl Cohen
- Center for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg ; School of Public Health
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - F P Polack
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA Fundacion INFANT, Buenos Aires, Argentina
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A longitudinal study on early hospitalized airway infections and subsequent childhood asthma. PLoS One 2015; 10:e0121906. [PMID: 25919024 PMCID: PMC4412821 DOI: 10.1371/journal.pone.0121906] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/04/2015] [Indexed: 12/26/2022] Open
Abstract
Background Acute airway infections, including bronchiolitis, are common causes of early childhood hospitalization. The development of later asthma may be related to early airway infections in young children. This study is to investigate the relationship between hospitalized airway infections (HAI) in young children (< 3 years old) and later childhood asthma. Methods Hospitalized children (< 3 years old) with bronchiolitis or other acute airway infections (other HAI group) from 1997-2000 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to age- and gender-matched subjects with regards to asthma until 10 years of age; and potential comorbidities and medical care conditions. Results In total, 3,264 children (1,981 with bronchiolitis; 1,283 with other HAIs) were compared to 18,527 controls. The incidence of childhood asthma was higher in the study (16.2%) than the control (11.7%) group, and most cases were diagnosed between 3-5 years old. The hazard ratios were 1.583 (95% CI: 1.414-1.772) and 1.226 (95% CI: 1.053-1.428) for the bronchiolitis and other HAI subgroups, respectively, compared to the control group, and 1.228 (95% CI: 1.075-1.542) in the bronchiolitis subgroup compared to the other HAIs subgroup. A significantly higher odds ratio (1.973, 95% CI: 1.193-3.263) for the children with congenital heart disease (CHD) in the bronchiolitis subgroup was found at an age of 3-5 years compared to the control group. Conclusions and Clinical Relevance Young children (< 3 years old) hospitalized due to acute HAIs are at a higher risk of developing childhood asthma at age 3 to 10 years. The parents of children with HAIs at age 0 to 2 years should be informed for the higher risk of developing childhood asthma, especially in children with CHD and bronchiolitis.
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del Valle Mendoza J, Cornejo-Tapia A, Weilg P, Verne E, Nazario-Fuertes R, Ugarte C, del Valle LJ, Pumarola T. Incidence of respiratory viruses in Peruvian children with acute respiratory infections. J Med Virol 2015; 87:917-24. [PMID: 25784285 PMCID: PMC7167149 DOI: 10.1002/jmv.24159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/08/2022]
Abstract
Acute respiratory infections are responsible for high morbi-mortality in Peruvian children. However, the etiological agents are poorly identified. This study, conducted during the pandemic outbreak of H1N1 influenza in 2009, aims to determine the main etiological agents responsible for acute respiratory infections in children from Lima, Peru. Nasopharyngeal swabs collected from 717 children with acute respiratory infections between January 2009 and December 2010 were analyzed by multiplex RT-PCR for 13 respiratory viruses: influenza A, B, and C virus; parainfluenza virus (PIV) 1, 2, 3, and 4; and human respiratory syncytial virus (RSV) A and B, among others. Samples were also tested with direct fluorescent-antibodies (DFA) for six respiratory viruses. RT-PCR and DFA detected respiratory viruses in 240 (33.5%) and 85 (11.9%) cases, respectively. The most common etiological agents were RSV-A (15.3%), followed by influenza A (4.6%), PIV-1 (3.6%), and PIV-2 (1.8%). The viruses identified by DFA corresponded to RSV (5.9%) and influenza A (1.8%). Therefore, respiratory syncytial viruses (RSV) were found to be the most common etiology of acute respiratory infections. The authors suggest that active surveillance be conducted to identify the causative agents and improve clinical management, especially in the context of possible circulation of pandemic viruses.
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Affiliation(s)
- Juana del Valle Mendoza
- School of Medicine, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas-UPC, Lima, Perú; Nutrition Research Institute, Lima, Perú
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G D, S T, M L, Chranioti A, E P, U A, P K, A A. Viral Profile of COPD Exacerbations According to Patients. Open Respir Med J 2015; 9:1-8. [PMID: 25741393 PMCID: PMC4347051 DOI: 10.2174/1874306401509010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 11/22/2022] Open
Abstract
Background : To compare the differences between elderly and non-elderly patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) due to viral infections. Methods : Patients with chronic obstructive pulmonary disease (COPD) exacerbation were recruited and classified as elderly (>65 years) and non-elderly (≤ 65 years). Sputum and oropharyngeal samples were assessed, PCR for respiratory viruses and cultures for common pathogens were performed. Results : 247 patients (median age: 69.3±9.5 years) were recruited and categorized into group A: non-elderly patients [n=81 (32.8%), median age 58±5.99] and group B: elderly patients [n=166 (67.2%), median age 74.8±4.8] years. In 133 (53.8%) patients a viral infection was identified and in 34 (13.8%) a bacterial pathogen was isolated from cultures. In 18 (7.3%) patients a double infection (bacterial+viral) was identified. In group B, the presence of cardiac failure (46.6% vs 28.3%, p<0.001), renal failure (10.5% vs 4%, p=0.03), bacterial co-infection (13.8% vs 7.4%, p=0.04), influenza vaccination rates (45.5% vs 215, p<0.001), and longer hospital stay (8.4±4.4 vs 7.5±3.2 days, p=0.02) were higher than group A. The overall rate of viral infections did not differ according to age. A trend to higher rates of infection with parainfluenza 3 [19 (20%) patients in group B vs3 (7.5%) patients in group A, p=0.04] was observed in older patients. Conclusion : No differences on the rate and type of viral infections were noted for elderly vs non elderly patients. However, they tended to have more bacterial co-infections that led to AECOPD and longer hospitalization stays compared to non-elderly patients.
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Affiliation(s)
- Dimopoulos G
- Department of Critical Care, University Hospital, ATTIKON, Medical School, University of Athens, Greece
| | - Tsiodras S
- 4th Department of Internal Medicine, University Hospital, ATTIKON, Medical School, University of Athens, Greece
| | - Lerikou M
- 8th Department of Pulmonary Medicine, Athens Chest Hospital, SOTIRIA, Greece
| | - Aik Chranioti
- 2nd Department of Cytology, University Hospital, ATTIKON, Medical School, University of Athens, Athens, Greece
| | - Perros E
- Department of Pneumonology, General Hospital Nikaias, Piraeus, Athens, Greece
| | - Anagnostopoulou U
- 8th Department of Pulmonary Medicine, Athens Chest Hospital, SOTIRIA, Greece
| | - Karakitsos P
- 2nd Department of Cytology, University Hospital, ATTIKON, Medical School, University of Athens, Athens, Greece
| | - Armaganidis A
- Department of Critical Care, University Hospital, ATTIKON, Medical School, University of Athens, Greece
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Onakpoya IJ, Hayward G, Heneghan CJ. The use of antibiotics for preventing lower respiratory tract infections in at risk children less than 12 years old. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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