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Lv M, Du J, Xie MZ, Zhou Y, Yang G, Wang J, Zhang WX, Yang H, Zhang SS, Cui F, Lu QB, Wu J. Protective effect of PCV13 against all-cause hospitalized pneumonia in children in Beijing, China: real-world evidence. Vaccine 2024; 42:3091-3098. [PMID: 38594120 DOI: 10.1016/j.vaccine.2024.04.015] [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: 02/01/2024] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The study evaluated the protective effect of 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) against all-cause hospitalized pneumonia in children in Beijing. METHODS Based on the vaccination record and inpatient medical record database of Beijing, children born in 2017 in Beijing, matched by age, gender, and district of the children with the ratio of 1:4, were selected as the vaccinated and unvaccinated groups according whether if vaccinated with PCV13. The incidence rate and 95 % confidence interval (95 %CI), vaccine effectiveness (VE) and direct medical costs of all-cause hospitalized pneumonia were calculated and compared within the same period of 12 months, 18 months, 24 months and 30 months after the birth of the child. RESULTS The decreased incidence rates of all-cause hospitalized pneumonia were observed at the four points in the PCV13 vaccinated group compared to the unvaccinated group, which were significant at the points of 12 months (0.42 % vs. 0.72 %, P = 0.001), 18 months (0.90 % vs. 1.26 %, P = 0.002) and 24 months (1.37 % vs. 1.65 %, P = 0.046). The VE of PCV13 against all-cause hospitalized pneumonia within 12 months was the highest as 41.9 % (95 % CI 19.6 %, 58.0 %), followed by 29.3 % (95 % CI 11.4 %, 43.5 %) within 18 months, 17.1 % (95 % CI 0.3 %, 31.1 %) within 24 months and it almost disappeared within 30 months. The VE of 4-dose vaccination within 18 months and 24 months were 39.9 % (95 % CI 20.3 %, 54.7 %) and 27.2 % (95 % CI 8.6 %, 42.0 %), respectively. The median hospitalization cost of the children in the vaccinated group was higher at the four points but without significance. CONCLUSIONS PCV13 had a certain protective effect on all-cause hospitalized pneumonia, and the booster immunization strategy had the best protective effect with great public health significance to enter the immunization program.
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Affiliation(s)
- Min Lv
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Ming-Zhu Xie
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Yiguo Zhou
- Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Guangzhao Yang
- Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne 3052, Australia
| | - Jian Wang
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Wan-Xue Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Han Yang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Shan-Shan Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China; Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China; Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
| | - Jiang Wu
- Institute for Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing 100013, China.
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Lin Y, Shi Q, Yang J, Huang G, Yan J. Association of anthropometric z score with complications and length of hospital stay in children with severe pneumonia aged 3 months to 5 years. Nutr Clin Pract 2024; 39:459-469. [PMID: 37667519 DOI: 10.1002/ncp.11067] [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: 04/19/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Severe pneumonia in children accounts for a significant healthcare burden, involving prolonged hospitalization and increased risk of complications. The prognosis is closely related to the child's nutrition status. Anthropometric z scores are preferred to evaluate growth levels in children. This study aimed to investigate the association of anthropometric z scores with complications and length of hospital stay (LOS) in children with severe pneumonia. METHODS This study included 361 hospitalized children aged 3 months to 5 years with severe pneumonia in Tianjin, China. Anthropometry was performed, and anthropometric z scores were calculated. Blood laboratory indices were assessed, and complications and LOS were recorded. RESULTS The average anthropometric z scores were -0.10 ± 1.15 (body mass index for age z score), 0.00 ± 0.97 (upper arm circumference for age z score [ACAZ]), and -0.14 ± 1.00 (triceps skinfold thickness for age z score [TSAZ]). The prevalence of complications was 73.96% (n = 267), including 82 children with only respiratory complications, 71 with only extrapulmonary complications, and 114 with both. After adjusting for confounding factors, compared with the noncomplication group, only the extrapulmonary complication group had a lower TSAZ (odds ratio [OR] = 0.597; 95% CI = 0.405-0.880; P < 0.05), whereas the respiratory and extrapulmonary complication group had a lower ACAZ (OR = 0.674; 95% CI = 0.469-0.969; P < 0.05) and TSAZ (OR = 0.573; 95% CI = 0.389-0.843; P < 0.05). ACAZ (β = -0.368; 95% CI = -0.720 to 0.016; P < 0.05) and TSAZ (β = -1.123; 95% CI = -1.470 to -0.777; P < 0.05) were negatively correlated with LOS. CONCLUSION ACAZ and TSAZ were associated with complications and LOS of severe pneumonia in children aged 3 months to 5 years.
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Affiliation(s)
- Ying Lin
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
- Department of Nutrition, Tianjin Children's Hospital, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Qian Shi
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
- Department of Nutrition, Tianjin Children's Hospital, Tianjin, China
| | - Junhong Yang
- Department of Nutrition, Tianjin Children's Hospital, Tianjin, China
| | - Guowei Huang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jing Yan
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Department of Social Medicine and Health Administration, Tianjin Medical University, Tianjin, China
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Shi H, Wang T, Zhao Z, Norback D, Wang X, Li Y, Deng Q, Lu C, Zhang X, Zheng X, Qian H, Zhang L, Yu W, Shi Y, Chen T, Yu H, Qi H, Yang Y, Jiang L, Lin Y, Yao J, Lu J, Yan Q. Prevalence, risk factors, impact and management of pneumonia among preschool children in Chinese seven cities: a cross-sectional study with interrupted time series analysis. BMC Med 2023; 21:227. [PMID: 37365601 DOI: 10.1186/s12916-023-02951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Pneumonia is a common disease worldwide in preschool children. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of pneumonia among preschool children. We therefore investigated the prevalence of pneumonia among preschool children in Chinese seven representative cities, and explore the possible risk factors of pneumonia on children, with a view to calling the world's attention to childhood pneumonia to reduce the prevalence of childhood pneumonia. METHODS Two group samples of 63,663 and 52,812 preschool children were recruited from 2011 and 2019 surveys, respectively. Which were derived from the cross-sectional China, Children, Homes, Health (CCHH) study using a multi-stage stratified sampling method. This survey was conducted in kindergartens in seven representative cities. Exclusion criteria were younger than 2 years old or older than 8 years old, non-permanent population, basic information such as gender, date of birth and breast feeding is incomplete. Pneumonia was determined on the basis of parents reported history of clearly diagnosed by the physician. All participants were assessed with a standard questionnaire. Risk factors for pneumonia, and association between pneumonia and other respiratory diseases were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was evaluated by the parents' reported history of physician diagnosis, longitudinal comparison of risk factors in 2011 and 2019. RESULTS In 2011 and 2019, 31,277 (16,152 boys and 15,125 girls) and 32,016 (16,621 boys and 15,395 girls) preschool children aged at 2-8 of permanent population completed the questionnaire, respectively, and were thus included in the final analysis. The findings showed that the age-adjusted prevalence of pneumonia in children was 32.7% in 2011 and 26.4% in 2019. In 2011, girls (odds ratio [OR] 0.91, 95%CI [confidence interval]0.87-0.96; p = 0.0002), rural (0.85, 0.73-0.99; p = 0.0387), duration of breastfeeding ≥ 6 months(0.83, 0.79-0.88; p < 0.0001), birth weight (g) ≥ 4000 (0.88, 0.80-0.97; p = 0.0125), frequency of putting bedding to sunshine (Often) (0.82, 0.71-0.94; p = 0.0049), cooking fuel type (electricity) (0.87, 0.80-0.94; p = 0.0005), indoor use air-conditioning (0.85, 0.80-0.90; p < 0.0001) were associated with a reduced risk of childhood pneumonia. Age (4-6) (1.11, 1.03-1.20; p = 0.0052), parental smoking (one) (1.12, 1.07-1.18; p < 0.0001), used antibiotics (2.71, 2.52-2.90; p < 0.0001), history of parental allergy (one and two) (1.21, 1.12-1.32; p < 0.0001 and 1.33, 1.04-1.69; p = 0.0203), indoor dampness (1.24, 1.15-1.33; p < 0.0001), home interior decoration (1.11, 1.04-1.19; p = 0.0013), Wall painting materials (Paint) (1.16, 1.04-1.29; p = 0.0084), flooring materials (Laminate / Composite wood) (1.08, 1.02-1.16; p = 0.0126), indoor heating mode(Central heating)(1.18, 1.07-1.30, p = 0.0090), asthma (2.38, 2.17-2.61; p < 0.0001), allergic rhinitis (1.36, 1.25-1.47; p < 0.0001), wheezing (1.64, 1.55-1.74; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (2.53, 2.31-2.78; p < 0.0001), allergic rhinitis (1.41, 1.29-1.53; p < 0.0001) and wheezing (1.64, 1.55-1.74; p < 0.0001). In 2019, girls (0.92, 0.87-0.97; p = 0.0019), duration of breastfeeding ≥ 6 months (0.92, 0.87-0.97; p = 0.0031), used antibiotics (0.22, 0.21-0.24; p < 0.0001), cooking fuel type (Other) (0.40, 0.23-0.63; p = 0.0003), indoor use air-conditioning (0.89, 0.83-0.95; p = 0.0009) were associated with a reduced risk of childhood pneumonia. Urbanisation (Suburb) (1.10, 1.02-1.18; p = 0.0093), premature birth (1.29, 1.08-1.55; p = 0.0051), birth weight (g) < 2500 (1.17, 1.02-1.35; p = 0.0284), parental smoking (1.30, 1.23-1.38; p < 0.0001), history of parental asthma (One) (1.23, 1.03-1.46; p = 0.0202), history of parental allergy (one and two) (1.20, 1.13-1.27; p < 0.0001 and 1.22, 1.08-1.37; p = 0.0014), cooking fuel type (Coal) (1.58, 1.02-2.52; p = 0.0356), indoor dampness (1.16, 1.08-1.24; p < 0.0001), asthma (1.88, 1.64-2.15; p < 0.0001), allergic rhinitis (1.57, 1.45-1.69; p < 0.0001), wheezing (2.43, 2.20-2.68; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (1.96, 1.72-2.25; p < 0.0001), allergic rhinitis (1.60, 1.48-1.73; p < 0.0001) and wheezing (2.49, 2.25-2.75; p < 0.0001). CONCLUSIONS Pneumonia is prevalent among preschool children in China, and it affects other childhood respiratory diseases. Although the prevalence of pneumonia in Chinese children shows a decreasing trend in 2019 compared to 2011, a well-established management system is still needed to further reduce the prevalence of pneumonia and reduce the burden of disease in children.
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Affiliation(s)
- Haonan Shi
- School of Nursing & Health Management, Shanghai University of Medicine & Health Sciences, No.279, Zhouzhu Highway, Pudong New District, Shanghai, 201318, China
| | - Tingting Wang
- School of Nursing & Health Management, Shanghai University of Medicine & Health Sciences, No.279, Zhouzhu Highway, Pudong New District, Shanghai, 201318, China.
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200433, China
- Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, 200433, China
| | - Dan Norback
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, SE-751, Uppsala, Sweden
| | - Xiaowei Wang
- Department of Operation and Security, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
| | - Yongsheng Li
- Department of Preventive Medicine, Medical College, Shihezi University, Shihezi, 832002, China
| | - Qihong Deng
- School of Public Health, Central South University, Changsha, 410083, China
| | - Chan Lu
- School of Public Health, Central South University, Changsha, 410083, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, 237016, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, 214135, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, 214135, China
| | - Ling Zhang
- Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Wei Yu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, 400044, China
- National Centre for International Research of Low-Carbon and Green Buildings, Ministry of Science and Technology), Chongqing University, Chongqing, 400044, China
| | - Yuqing Shi
- Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Tianyi Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Huaijiang Yu
- People's Hospital of Bayingguoleng Mongolian Autonomous Prefecture, Kuerle, 841099, China
| | - Huizhen Qi
- Department of Neurology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Ye Yang
- Department of No.1 Cadres, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830063, China
| | - Lan Jiang
- Department of Laboratory Medicine, Xinjiang Uyghur Autonomous Region Maternal and Child Health Hospital, Urumqi, 830001, China
| | - Yuting Lin
- Department of Laboratory Medicine, Xinjiang Uyghur Autonomous Region Maternal and Child Health Hospital, Urumqi, 830001, China
| | - Jian Yao
- School of Public Health, Xinjiang Medical University, Urumqi, 830054, China
- Xinjiang Key Laboratory of Special Environment and Health Research, Urumqi, 830054, China
| | - Junwen Lu
- School of Public Health, Xinjiang Medical University, Urumqi, 830054, China
- Xinjiang Key Laboratory of Special Environment and Health Research, Urumqi, 830054, China
| | - Qi Yan
- School of Public Health, Xinjiang Medical University, Urumqi, 830054, China
- Xinjiang Key Laboratory of Special Environment and Health Research, Urumqi, 830054, China
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Yu X, Wang Y, He C, Kang L, Miao L, Wu Y, Yang S, Zhu J, Liang J, Li Q, Dai L, Li X, Deng K, Tao J. The trend of unintentional injury-related mortality among children aged under-five years in China, 2010-2020: a retrospective analysis from a national surveillance system. BMC Public Health 2023; 23:673. [PMID: 37041562 PMCID: PMC10088152 DOI: 10.1186/s12889-023-15546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND In this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010-2020. METHODS Data were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality. RESULTS In 2010-2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1-4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4-4.9) and 1.5% (95%CI 0.1-3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010-2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010-2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1-4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August. CONCLUSION The unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males.
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Affiliation(s)
- Xue Yu
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Wang
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua He
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Leni Kang
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Lei Miao
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wu
- Department of pediatrics, Sichuan Zhongjiang County People's Hospital, Deyang, Sichuan, China
| | - Shirong Yang
- Mianyang Youxian maternal and child health care hospital, Mianyang, Sichuan, China
| | - Jun Zhu
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Juan Liang
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Li Dai
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China
| | - Kui Deng
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China.
| | - Jing Tao
- West China Second University Hospital, National Office for Maternal and Child Health Surveillance of China, Sichuan University, Chengdu, Sichuan, China.
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Shi X, Wu M, Jia X, Bao J, Wang Y, Yang C, Yu M, Yang Y. Trends of Incidence, Mortality, and Risk Factors for Lower Respiratory Infections among Children under 5 Years in China from 2000 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3547. [PMID: 36834242 PMCID: PMC9965335 DOI: 10.3390/ijerph20043547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Understanding the temporal trends in the burden of lower respiratory tract infections (LRI) and their attributable risk factors in children under 5 years is important for effective prevention strategies. METHODS We used incidence, mortality, and attributable risk factors of LRI among children under 5 years from the Global Burden of Diseases database to analyze health patterns in 33 provincial administrative units in China from 2000 to 2019. Trends were examined using the annual average percentage change (AAPC) by the joinpoint regression method. RESULTS The rates of incidence and mortality for under-5 LRI in China were 18.1 and 4134.3 per 100,000 children in 2019, with an AAPC decrease of 4.1% and 11.0% from 2000, respectively. In recent years, the under-5 LRI incidence rate has decreased significantly in 11 provinces (Guangdong, Guangxi, Guizhou, Hainan, Heilongjiang, Jiangxi, Qinghai, Sichuan, Xinjiang, Xizang, and Zhejiang) and remained stable in the other 22 provinces. The case fatality ratio was associated with the Human Development Index and the Health Resource Density Index. The largest decline in risk factors of deaths was household air pollution from solid fuels. CONCLUSIONS The burden of under-5 LRI in China and the provinces has declined significantly, with variation across provinces. Further efforts are needed to promote child health through the development of measures to control major risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
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Clinical Characteristics and Microbial Profiles of Paediatric Patients with Methicillin-Resistant Staphylococcus aureus Pneumonia in China. Jundishapur J Microbiol 2023. [DOI: 10.5812/jjm-132894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Staphylococcus aureus can cause fatal pneumonia. The evolution of bacteria and the overuse of antibiotics have enhanced the drug resistance of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). Objectives: This study aimed to recapitulate the microbiological profile and clinical characteristics of paediatric patients with MRSA. Methods: This retrospective study was conducted to investigate 1372 paediatric patients with S. aureus pneumonia from January 2017 to December 2021. Sputum specimens were collected and processed for performing bacterial culture and drug sensitivity tests. Medical records of patients were reviewed for clinical characteristics and laboratory examination results. Results: The MRSA and MSSA pneumonia mainly occurred in infants; however, comparisons of sex, age, and sampling time between patients with MRSA and MSSA pneumonia showed no significant differences (P > 0.05). The results of drug sensitivity in sputum culture revealed that all MRSA and MSSA isolates were susceptible to vancomycin, tigecycline, linezolid, teicoplanin, and ceftaroline. Methicillin-sensitive Staphylococcus aureus was completely sensitive to rifampicin and oxacillin. Methicillin-resistant Staphylococcus aureus was completely resistant to penicillin and oxacillin, while MSSA was less sensitive to penicillin. Methicillin-resistant Staphylococcus aureus and MSSA both maintained high sensitivity rates to gentamicin, sulfamethoxazole-trimethoprim, levofloxacin, and moxifloxacin, with the exception of clindamycin and erythromycin. According to our results, moreover, the sensitivity of MRSA to gentamicin and sulfamethoxazole-trimethoprim was significantly higher than that of MSSA (P < 0.05). The common symptoms of patients with S. aureus pneumonia were fever, cough, and wheezing. patients with MRSA pneumonia had significantly higher counts of white blood cells (WBCs), C-reactive protein (CRP), and procalcitonin (PCT) than patients with MSSA pneumonia (P < 0.05). Conclusions: The results of antimicrobial sensitivity test in sputum culture of MRSA and MSSA isolates can reflect the sensitivity of antibiotics and guide the use of clinical antibiotics. Infectious biomarkers can reflect the severity of infection and guide prognosis.
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Kang L, Jing W, Liu Q, Liu J, Liu M. The trends of mortality, aetiologies and risk factors of lower respiratory infections in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019. J Infect Public Health 2022; 15:870-876. [DOI: 10.1016/j.jiph.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
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Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med 2022; 11:jcm11102824. [PMID: 35628949 PMCID: PMC9144103 DOI: 10.3390/jcm11102824] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Refractory Mycoplasma pneumoniae pneumonia (RMPP) is a severe state of M. pneumoniae infection that has attracted increasing universal attention in recent years. The pathogenesis of RMPP remains unknown, but the excessive host immune responses as well as macrolide resistance of M. pneumoniae might play important roles in the development of RMPP. To improve the prognosis of RMPP, it is mandatory to recognize RMPP in the early stages, and the detection of macrolide-resistant MP, clinical unresponsiveness to macrolides and elevated proinflammatory cytokines might be clues. Timely and effective anti-mycoplasmal therapy and immunomodulating therapy are the main strategies for RMPP.
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Association of Socio-Demographic and Climatic Factors with the Duration of Hospital Stay of Under-Five Children with Severe Pneumonia in Urban Bangladesh: An Observational Study. CHILDREN 2021; 8:children8111036. [PMID: 34828747 PMCID: PMC8617833 DOI: 10.3390/children8111036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
Severe pneumonia is one of the leading contributors to morbidity and deaths among hospitalized under-five children. We aimed to assess the association of the socio-demographic characteristics of the patients and the climatic factors with the length of hospital stay (LoS) of under-five children with severe pneumonia managed at urban hospitals in Bangladesh. We extracted relevant data from a clinical trial, as well as collecting data on daily temperature, humidity, and rainfall from the Meteorological Department of Bangladesh for the entire study period (February 2016 to February 2019). We analyzed the data of 944 children with a generalized linear model using gamma distribution. The average duration of the hospitalization of the children was 5.4 ± 2.4 days. In the multivariate analysis using adjusted estimation of duration (beta; β), extended LoS showed remarkably positive associations regarding three variables: the number of household family members (β: 1.020, 95% confidence intervals (CI): 1.005–1.036, p = 0.010), humidity variation (β: 1.040, 95% Cl: 1.029–1.052, p < 0.001), and rainfall variation (β: 1.014, 95% Cl: 1.008–1.019), p < 0.001). There was also a significant negative association with LoS for children’s age (β: 0.996, 95% Cl: 0.994–0.999, p = 0.006), well-nourishment (β: 0.936, 95% Cl: 0.881–0.994, p = 0.031), and average rainfall (β: 0.980, 95% Cl: 0.973–0.987, p < 0.001). The results suggest that the LoS of children admitted to the urban hospitals of Bangladesh with severe pneumonia is associated with certain socio-demographic characteristics of patients, and the average rainfall with variation in humidity and rainfall.
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Gong H, Lu G, Ma J, Zheng J, Hu F, Liu J, Song J, Hu S, Sun L, Chen Y, Xie L, Zhang X, Duan L, Xu H. Causes and Characteristics of Children Unintentional Injuries in Emergency Department and Its Implications for Prevention. Front Public Health 2021; 9:669125. [PMID: 34422741 PMCID: PMC8374066 DOI: 10.3389/fpubh.2021.669125] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Child unintentional injuries have become a hot topic worldwide, and substantial regional disparities existed in causes and characteristics. To date, limited data are available to investigate the causes and characteristics of child unintentional injuries from hospitals for children in China. Methods: A cross-sectional study was conducted between January 2017 and December 2018 in Shanghai, China. Patients aged <18 years with an unintentional injury presented to the emergency department were enrolled. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were retrieved from electronic health records (EHRs). Frequencies and proportions of categorical variables and means and SDs of continuous variables are presented. Chi-square test and Student's t-test were used for the comparison between groups, as appropriate. Logistic regression analysis was used to estimate potential risk factors for admission to the hospital. Results: A total of 29,597 cases with unintentional injuries were identified between January 2017 and December 2018, with boys vs. girls ratio of 1.75. Preschool children account for approximately two-thirds of unintentional injuries in the emergency department. A distinctive pattern of mechanisms of unintentional injuries between gender was documented, and sports injury was significantly higher in boys than in girls (10.2 vs. 7.8%). Compared with Canadian Emergency Department Triage and Acuity Scale (CTAS) Grade 3 patients, Grade 2 [odds ratio (OR) = 2.99, 95% CI = 1.93–4.63, P < 0.001] and Grade 1 (OR = 74.85, 95% CI = 12.93–433.14, P < 0.001) patients had higher risk of inhospital admission. For causes of injuries, compared with falling, foreign body and poison had a lower risk of inhospital admission, while transport injury (OR = 1.31, 95% CI = 1.07–1.59, P = 0.008) and high fall injury (OR = 2.58. 95% CI =1.48–4.49, P < 0.001) had a significantly higher risk of admission. Conclusions: There was a significant relationship between age-groups and unintentional injuries between gender, with decreased injuries among girls growing up older. Preventive measures should be taken to reduce transport injury and high fall injury, which had a significantly higher risk of admission.
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Affiliation(s)
- Hairong Gong
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Jian Ma
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Jicui Zheng
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, China
| | - Fei Hu
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Jing Liu
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Jun Song
- Department of Orthopedics, Children's Hospital of Fudan University, Shanghai, China
| | - Shenjie Hu
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Libo Sun
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Yang Chen
- Emergency Department, Children's Hospital of Fudan University, Shanghai, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobo Zhang
- Department of Respiratory, Children's Hospital of Fudan University, Shanghai, China
| | - Leilei Duan
- Division of Injury Prevention and Mental Health, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
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Ayeni OA, Walaza S, Tempia S, Groome M, Kahn K, Madhi SA, Cohen AL, Moyes J, Venter M, Pretorius M, Treurnicht F, Hellferscee O, von Gottberg A, Wolter N, Cohen C. Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009-2013. PLoS One 2021; 16:e0255941. [PMID: 34383824 PMCID: PMC8360538 DOI: 10.1371/journal.pone.0255941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas. OBJECTIVE To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009-2013. METHODS Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death. RESULTS From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4-24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0-9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3-7.1) and age <1 year (OR: 3.7, 95% CI: 1.9-7.2) were independently associated with death, whereas duration of hospitalization ≥5 days (OR: 0.5, 95% CI: 0.3-0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3-0.8) were negatively associated with death. CONCLUSION We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed.
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Affiliation(s)
- Oluwatosin A. Ayeni
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Stefano Tempia
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa
- Mass Genics, Duluth, Georgia, Unites States of America
| | - Michelle Groome
- Faculty of Health Sciences, Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- Faculty of Health Sciences, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Shabir A. Madhi
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- Faculty of Health Sciences, Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L. Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Programme, Centers for Disease Control and Prevention-South Africa, Pretoria, South Africa
| | - Jocelyn Moyes
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Marthi Pretorius
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Florette Treurnicht
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Orienka Hellferscee
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Division of Infectious Diseases, Hubert Department of Global Health, Rollins School of Public Health, School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Nicole Wolter
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Faculty of Health Sciences, Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases of the National Health Laboratory Service, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
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Xu X, Sheng Y, Yang L, Zhou H, Tang L, Du L. Immunological Features of Pediatric Interstitial Pneumonia Due to Mycoplasma pneumoniae. Front Pediatr 2021; 9:651487. [PMID: 33959573 PMCID: PMC8093394 DOI: 10.3389/fped.2021.651487] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/24/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Inflammatory response, oxidative stress, and immunologic mechanism are involved in the pathogenesis of Mycoplasma pneumoniae pneumonia (MPP). However, the role of immune system of pediatric interstitial pneumonia due to M. pneumoniae infections remains poorly understood. The aim of this study was to analyze the immunologic features of pediatric interstitial pneumonia due to Mycoplasma pneumoniae (M. pneumoniae). Methods: A retrospective study was conducted on a primary cohort of children with MPP. Propensity score analysis was performed to match interstitial pneumonia and pulmonary consolidation children. Results: The clinical characteristics strongly associated with the development of interstitial pneumonia were boys, age >5 years, wheezing history, hydrothorax free, lymphocytes (>3.0 × 109/L), CD19+ (>0.9 × 109/L), CD3+ (>2.5 × 109/L), CD4+ (>1.5 × 109/L), CD8+ (>0.9 × 109/L), interleukin-6 (IL-6, <30 pg/ml), IL-10 (<6 pg/ml), and interferon-γ (IFN-γ, <15 pg/ml). After propensity score analysis, children with interstitial pneumonia showed significantly higher CD19+, CD3+, and CD4+ T cell counts, and lower serum IL-6, IL-10, and IFN-γ levels. The final regression model showed that only CD4+ T cells (>1.5 × 109/L, OR = 2.473), IFN-γ (<15 pg/ml, OR = 2.250), and hydrothorax free (OR = 14.454) were correlated with the development of interstitial pneumonia among children with MPP. Conclusions: The M. pneumoniae-induced interstitial pneumonia showed increased CD4+ T cells and lower serum IFN-γ level. Specific immunologic profiles could be involved in the development of pediatric interstitial pneumonia due to M. pneumoniae infections.
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Affiliation(s)
- Xuefeng Xu
- Department of Rheumatology Immunology & Allergy, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Pulmonary Medicine, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuanjian Sheng
- Department of Pulmonary Medicine, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Yang
- Department of Radiology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haichun Zhou
- Department of Radiology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lanfang Tang
- Department of Pulmonary Medicine, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lizhong Du
- Department of Neonatology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia. Sci Rep 2020; 10:4579. [PMID: 32165709 PMCID: PMC7067858 DOI: 10.1038/s41598-020-61348-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/26/2020] [Indexed: 12/23/2022] Open
Abstract
The presence of bronchial mucus plugs (BMP) in children with Mycoplasma pneumoniae pneumonia (MPP) results in delayed clinical and radiographic resolution and long-standing pulmonary sequelae. The predictive factors associated with BMP formation remains poorly defined. Nomograms to predict BMP presence in children with MPP were proposed using a cohort of patients who underwent bronchoscopy intervention at Children’s Hospital in Eastern China. Patients with MPP in an earlier period formed the training cohort (n = 872) for nomogram development, and those thereafter formed the validation cohort (n = 399) to confirmed model’s performance. BMP in children with MPP were found in 196 (22.5%) and 91(22.8%) patients in the training and validation cohorts, respectively. The independent risk factors associated with BMP were age >5years (OR 2.06; 95% CI 1.43 to 2.98), higher IL-10 level (>10 ng/L, 2.19; 95% CI 1.46 to 3.28), higher IFN-γ level (>30 ng/L, 1.69; 95% CI 1.13 to 2.54), and presence of complication (3.43; 95% CI 1.45 to 8.09). Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.771(95% CI, 0.734–0.808) and 0.796 (95% CI, 0.744–0.848) in predicting BMP in the training and validation cohorts, respectively. The nomogram achieved an optimal prediction of BMP in children with MPP. Using this model, the risk of BMP formation would be determined, contributing to a rational therapeutic choice.
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Luo M, Zhao Z, He L, Su B, Liu W, Zhang G. Ethnic disparity in pneumonia-specific mortality among children under 5 years of age in Sichuan Province of Western China from 2010 to 2017. BMC Public Health 2019; 19:1722. [PMID: 31870346 PMCID: PMC6929342 DOI: 10.1186/s12889-019-8056-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background To reveal the ethnic disparity in the pneumonia-specific mortality rates of children under the age of 5 years (PU5MRs) and provide suggestions regarding priority interventions to reduce preventable under-five-years-of-age deaths. Methods Data were obtained from the Direct Report System of Maternal and Child Health in Sichuan. The Cochran-Armitage trend test was used to assess the time trend. The Cochran-Mantel-Haenszel test and Chi-square test were used to examine the differences in the PU5MRs among different groups. Results The PU5MRs in the minority and nonminority counties decreased by 53.7 and 42.3% from 2010 to 2017, respectively. The PU5MRs of the minority counties were 4.81 times higher than those of the nonminority counties in 2017. The proportion of pneumonia deaths to total deaths in Sichuan Province increased from 11.7% in 2010 to 15.5% in 2017. The pneumonia-specific mortality rates of children in the categories of 0–28 days, 29 days-11 months, and 12–59 months were reduced by 55.1, 38.8, and 65.5%, respectively, in the minority counties and by 35.5, 43.1, and 43.7%, respectively, in the nonminority counties. Conclusions PU5MRs declined in Sichuan, especially in the minority counties, while ethnic disparity still exists. Although the PU5MRs decreased more for the minority counties as a fraction of all mortality, the absolute number of such deaths were higher, and therefore more children in these counties continue to die from pneumonia than from the non-minority counties. Priority should be given to strategies for preventing and controlling child pneumonia, especially for postneonates, in the minority counties.
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Affiliation(s)
- Min Luo
- Sichuan Provincial Maternal and Child Health Hospital, No.290, West Shayan Second Street, Chengdu, Sichuan, 610045, People's Republic of China
| | - Ziling Zhao
- Sichuan Provincial Maternal and Child Health Hospital, No.290, West Shayan Second Street, Chengdu, Sichuan, 610045, People's Republic of China
| | - Linkun He
- Sichuan Provincial Maternal and Child Health Hospital, No.290, West Shayan Second Street, Chengdu, Sichuan, 610045, People's Republic of China
| | - Bingzhong Su
- Sichuan Provincial Maternal and Child Health Hospital, No.290, West Shayan Second Street, Chengdu, Sichuan, 610045, People's Republic of China
| | - Weixin Liu
- Sichuan Provincial Maternal and Child Health Hospital, No.290, West Shayan Second Street, Chengdu, Sichuan, 610045, People's Republic of China.
| | - Gang Zhang
- Sichuan Provincial Maternal and Child Health Hospital, No.290, West Shayan Second Street, Chengdu, Sichuan, 610045, People's Republic of China.
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15
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Zhao ZL, Yao MH, Zhang G, Wu GH, Zhang L, Zhang JY, Ma X. All-cause child mortality in minority and non-minority areas in Sichuan Province in Western China, 2008-2017. Sci Rep 2019; 9:14154. [PMID: 31578355 PMCID: PMC6775076 DOI: 10.1038/s41598-019-50616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/17/2019] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the disparity in the under-five mortality rate (U5MR) between minority and non-minority areas in Sichuan Province in Western China. Data for this study was obtained from the National Health Statistics Survey System. The Cochran-Armitage trend test was used to analyze the time trend of the U5MR. We conducted Poisson regression model to compare the differences of U5MRs between minority and non-minority areas. The U5MR in Sichuan province was reduced by 62.19% from 2008 to 2017, with the minority and non-minority areas reduced by 60.48% and 65.39%, respectively. The under-five mortality risk in minority areas was approximately 1.791 times (95% CI: 1.790–1.793; P < 0.01) that in non-minority areas. The primary cause of death of children under-five years old in minority areas was the respiratory disease, which was significantly higher than that in non-minority areas (P all < 0.01). The U5MR significantly declined both in minority and non-minority areas in Sichuan Province in Western China from 2008 to 2017. However, disparities still existed between minority and non-minority areas. Respiratory diseases were the main causes of death in minority areas and corresponding rates were higher than those in non-minority areas.
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Affiliation(s)
- Zi-Ling Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Ming-Hong Yao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Gang Zhang
- Sichuan Provincial Hospital for Women and Children, Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Gong-Hua Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Li Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ju-Ying Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Xiao Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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16
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Deng Y, Wang R, Zhou X, Ren L, Liu L. Fetal, neonatal, and infant death in central China (Hubei): A 16-year retrospective study of forensic autopsy cases. Medicine (Baltimore) 2019; 98:e15788. [PMID: 31169678 PMCID: PMC6571210 DOI: 10.1097/md.0000000000015788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Data based on forensic autopsy in neonates and infants in China are rare in the literature. The purpose of this study is to evaluate the characteristics of fetal, neonatal, and infant death and to determine the main cause of death among them.A retrospective analysis of fetal and infant forensic autopsies referred to the Tongji Forensic Medical Center (TFMC) in Hubei, central China, during a 16-year period between January 1999 and December 2014, was performed.In this period, there were 1111 males and 543 females; the total male-to-female ratio (MFR) was 2.05:1. There were 173 fetal and infant autopsies conducted, comprised of 43 fetal, 84 neonatal (<28 days) and 46 infant (4 weeks to 1 year) cases. The annual case number ranged from 5 in 2004 to 18 in 2014 (annual mean of 10.8). MFR was 1.75:1. About 94% of these deaths (163/173) resulted from natural causes, 6 cases (3.5%) were accidental deaths, and 4 (2.3%) resulted from homicide (4 abandoned babies). Among fetuses, the most common causes of death were placental and umbilical cord pathologies (28%, 12/43), followed by intrapartum asphyxia resulting from amniotic fluid aspiration (AFA) or meconium aspiration syndrome (MAS) (18.6%, 8/43), congenital malformation (14%, 6/43), and intrapartum infection (9.3%, 4/43). A majority of neonatal deaths (66.7%, 56/84) died within 24 hours of birth. The main causes of neonatal death were asphyxia resulting from AFA, MAS, or hyaline membrane disease, and congenital malformation. The main causes of infant (1-12 months) death were infectious diseases, including pneumonia, meningitis, and viral brainstem encephalitis.This study was the 1st retrospective analysis of autopsies of fetal, neonatal, and infant death in TFMC and central China. We delineate the common causes of early demise among cases referred for autopsy, and report a male preponderance in this population. Our data observed that placental and/or umbilical cord pathology, asphyxia due to AFA, and/or MAS, and pneumonia were the leading causes of fetal, neonatal, and infant death, respectively. And it can inform clinical practitioners about the underlying causes of some of the most distressing cases in their practices.
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Affiliation(s)
- Yanfei Deng
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Rongshuai Wang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Chongxin Judicial Expertise Center, Wuhan, China
| | - Xiaowei Zhou
- Chongxin Judicial Expertise Center, Wuhan, China
| | - Liang Ren
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Liang Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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17
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Yao M, Wu G, Zhao Z, Luo M, Zhang J. Unintentional injury mortality among children under age five in urban and rural areas in the Sichuan province of west China, 2009-2017. Sci Rep 2019; 9:2963. [PMID: 30814522 PMCID: PMC6393442 DOI: 10.1038/s41598-019-38936-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/15/2019] [Indexed: 11/08/2022] Open
Abstract
This study analysed trends in the unintentional injuries specific mortality rates among children under age five (UI-specific U5MRs) in urban and rural areas in the Sichuan province of western China. Data were obtained from the National Health Statistics Survey System. The Cochran-Armitage trend test was used to analyse the trends in UI-specific U5MRs and the proportion of unintentional injury deaths to total deaths. The Poisson regression model was used to compare the UI-specific U5MRs between rural and urban areas. The overall UI-specific U5MRs decreased from 3.8 to 1.7 per 1,000 live births from 2009 to 2017, with an average annual decline in the rates of 8.78% and 10.05% in urban and rural areas, respectively. The UI risk of death in rural areas was approximately 1.95 times that in urban areas (95% CI: 1.73-2.18; p < 0.01). A total of 49.9% of all the children in the study did not receive any treatment before death caused by UI. The UI-specific U5MRs significantly declined in Sichuan province from 2009 to 2017, but large disparities in UI-specific U5MRs in urban and rural areas still exist. Reducing the U5MRs due to UI should be a major public health concern in western China.
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Affiliation(s)
- Minghong Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Gonghua Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ziling Zhao
- Sichuan Provincial Maternal and Child Health Hospital, Chengdu, Sichuan, People's Republic of China
| | - Min Luo
- Sichuan Provincial Maternal and Child Health Hospital, Chengdu, Sichuan, People's Republic of China
| | - Juying Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Xiang L, Wang K, Miao L, Kang L, Li X, Zhu J, Liang J, Li Q, He C, Wang Y. Injury-related mortality among children younger than 5 years in China during 2009-2016: an analysis from national surveillance system. Inj Prev 2018; 25:60-66. [PMID: 30567707 PMCID: PMC6388909 DOI: 10.1136/injuryprev-2018-042853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/30/2018] [Accepted: 08/03/2018] [Indexed: 12/16/2022]
Abstract
Background Epidemiology in injury-related mortality among children younger than 5 years was unreported in China recently. Methods Data were obtained from China’s Under 5 Child Mortality Surveillance System (U5CMSS) in 2009-2016. Injury-related mortality rates were calculated by residence, age-group, gender and major injury type (drowning, traffic injuries, suffocation, poisoning, falls). The average annual decline rate (AADR) was calculated based on the annual mortality rates by Poisson regression and the relative risk (RR) between urban and rural residence was examined based on the rates of two years for each time point by Cochran-Mantel-Haenszel method. Results U5CMSS contained 6503 injury-related deaths of children younger than 5 years during the study period, of which 58.6% were male, 86.0% occurred in rural areas, 65.7% were children aged 12–59 months. Deaths were mainly attributed to suffocation (34.3%), drowning (29.6%), traffic injuries (17.7%), falls (7.2%) or poisoning (4.7%). The injury-related mortality rate dropped from 274.7 to 189.2 per 100 000 live births from 2009 to 2016, giving an AADR of 4.53% (95% CI 3.50% to 5.55%). During 2009–2016, the injury-related mortality rate in rural area was higher than that in urban area, the adjusted RRs (aRRs) in infants and children aged 12–59 months were 3.32–6.04 and 4.31–5.49, respectively. Conclusion The rate of injury-related deaths in children younger than 5 years has decreased in China, but it remains high and strong urban–rural disparities still exist. Public health programmes and policy interventions should focus particularly on suffocation among infants and on drowning and traffic injuries among children aged 12–59 months, especially in rural areas.
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Affiliation(s)
- Liangcheng Xiang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ke Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lei Miao
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chunhua He
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China .,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, China .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Clinical evaluation of a panel of multiplex quantitative real-time reverse transcription polymerase chain reaction assays for the detection of 16 respiratory viruses associated with community-acquired pneumonia. Arch Virol 2018; 163:2855-2860. [PMID: 29961119 PMCID: PMC7087343 DOI: 10.1007/s00705-018-3921-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
We developed a panel of multiplex quantitative real-time reverse transcription polymerase chain reaction (mqRT-PCR) assay consisting of seven internally controlled qRT-PCR assays to detect 16 different respiratory viruses. We compared the new mqRT-PCR with a previously reported two-tube mRT-PCR assay using 363 clinical sputum specimens. The mqRT-PCR assay performed comparably with the two-tube assay for most viruses, offering the advantages of quantitative analysis, easier performance, lower susceptibility to contamination, and shorter turnaround time in laboratories equipped with conventional real-time PCR instrumentation, and it could therefore be a valuable tool for routine surveillance of respiratory virus infections in China.
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20
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Chen K, Zhang X, Shan W, Zhao G, Zhang T. Serotype distribution of Streptococcus pneumoniae and potential impact of pneumococcal conjugate vaccines in China: A systematic review and meta-analysis. Hum Vaccin Immunother 2018; 14:1453-1463. [PMID: 29451838 PMCID: PMC6037451 DOI: 10.1080/21645515.2018.1435224] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Thirteen-valent pneumococcal conjugate vaccines (PCV13) was licensed for optional use in mainland China since 2017, but the uptake is low. To update the research evidence for the pneumococcal serotype distribution of pre-PCV era and to estimate the potential impact of PCVs, we performed a meta-analysis on the relevant publications concerning the Chinese population. METHODS This systematic review and meta-analysis were conducted on the pneumococcal serotype distribution publications in mainland China from 2000 to 2016. The literature was searched in PubMed, Ovid-EMBASE, Web of Science, CNKI and Wanfang. Heterogeneity and publication bias were tested by I2, meta-regression, Egger's and Begg's test. The pneumococcal serotype and vaccine serotype coverage rates were pooled using the random-effects model in Stata SE 12.0. RESULTS In total, 85 publications were included. Of all 16,945 included pneumococcal isolates, the most common serotypes/serogroups were 19F, 19A, 23F, 14, and 6B, that from children were the same as above, that from adults≥18 years were 19, 3, 6, 23, and 14. Among isolates from children <18 years, the pooled coverage for PCV10 serotypes was 52.3%, that for PCV13 was 68.4% and that for PPSV23 was 65.5%. Regarding individuals ≥18 years, the pooled coverage for PCV10 serotypes was 29.7%, that for PCV13 was 49.5% and that for PPSV23 was 50.7%. Serotype prevalence and vaccine serotype coverage varied by age group, source, and region. CONCLUSIONS The most common pneumococcal serotype in mainland China was 19F. The serotype coverage rates of PCV13 and PPSV23 were 50%-68% in mainland China.
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Affiliation(s)
- Kaile Chen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Xiyan Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Wei Shan
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Ben Ayed H, Yaïch S, Ben Jmaa M, Jedidi J, Ben Hmida M, Trigui M, Kassis M, Karray R, Mejdoub Y, Feki H, Damak J. Pediatric respiratory tract diseases: Chronological trends and perspectives. Pediatr Int 2018; 60:76-82. [PMID: 28891268 DOI: 10.1111/ped.13418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to describe the epidemiological profile of childhood respiratory tract diseases (RTD) in the region of Sfax, Tunisia, and to evaluate their trends over a 13 year period. METHODS We conducted a retrospective study of all children hospitalized with RTD aged under 14 years. We collected data from the regional morbidity register of the university hospital of Sfax from 2003 to 2015. RESULTS A total of 10 797 RTD patients were enrolled from 49 880 pediatric hospitalizations (21.7%). A male predominance was noted (60%). The median age was 8 months (IQR, 2-36 months). Acute bronchitis (AB) accounted for 53.8%, followed by asthma (15%), pneumonia (14%) and acute upper respiratory infection (AURI; 7.2%). The hospital incidence rate (HIR) of RTD was 34/10 000 inhabitants/year. It was 18.2; 5.07; 4.7 and 2.4/10 000 inhabitants for AB, asthma, pneumonia and AURI, respectively. We noted a significant increase in the HIR of RTD with an annual percentage change (APC) of 10.94% (P < 0.001); in the HIR of AB (APC, 5.27%; P < 0.001); and in asthma HIR (APC, 11.2%; P < 0.001). Otherwise, a significant decrease in AURI HIR was observed (APC, -8.8%; P < 0.001). AB lethality rate increased significantly, with an APC of 7.4% (P < 0.001). Projected trends analysis up to 2024 showed a significant rise in AB and in asthma, while AURI would significantly decrease. CONCLUSIONS RTD continues to be a serious health problem over time in terms of morbidity and mortality. Preventive and curative strategies are needed urgently.
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Affiliation(s)
- Houda Ben Ayed
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Sourour Yaïch
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Maïssa Ben Jmaa
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Jihene Jedidi
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mariem Ben Hmida
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Maroua Trigui
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mondher Kassis
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Raouf Karray
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Yosra Mejdoub
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Habib Feki
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Jamel Damak
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia
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Liu Z, Yu H, Guo Q. MicroRNA‑20a promotes inflammation via the nuclear factor‑κB signaling pathway in pediatric pneumonia. Mol Med Rep 2017; 17:612-617. [PMID: 29115456 DOI: 10.3892/mmr.2017.7899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/22/2017] [Indexed: 11/06/2022] Open
Abstract
Pneumonia is a common respiratory disease worldwide, which is preventable and treatable; however, it is recognized as a leading cause of mortality in children. The present study aimed to investigate the role and mechanism of microRNA (miR)‑20a in inflammation in pediatric pneumonia. Clinical serum samples were collected from children with pneumonia and healthy children. Initially, the serum expression levels of miR‑20a were detected by reverse transcription‑quantitative polymerase chain reaction. Subsequently, A549 cells were randomly divided into four groups: Control group; lipopolysaccharide (LPS; 1 µg/ml) group; LPS + miR‑20a group; and LPS + miR‑20a + pyrrolidine dithiocarbamate (PDTC; 100 mmol/l) group. The concentrations of interleukin‑6 (IL‑6), tumor necrosis factor (TNF)‑α and C‑reactive protein (CRP) in clinical serum samples and A549 cells were determined by ELISA. In addition, the protein expression levels of inhibitor of nuclear factor (NF)‑κB α (IκBα) and phosphorylated (p)‑NF‑κB were measured by western blotting. The results demonstrated that miR‑20a was upregulated in children with pneumonia and in lung cells with LPS‑induced inflammatory injury (P<0.01). In addition, compared with the LPS group, cells in the LPS + miR‑20a group exhibited increased expression levels of IL‑6, TNF‑α and CRP (P<0.05). Overexpression of miR‑20a also resulted in upregulation of the expression levels of IκBα and p‑NF‑κB compared with in the LPS group (P<0.05). Furthermore, treatment with the NF‑κB inhibitor PDTC inhibited the expression of inflammatory factors compared with in the LPS + miR‑20a group (P<0.05). In conclusion, the present study indicated that miR‑20a is upregulated in pediatric pneumonia, and overexpression of miR‑20a may promote inflammation through activation of the NF‑κB signaling pathway.
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Affiliation(s)
- Zhihong Liu
- Department of Emergency, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Haiying Yu
- Department of Pediatrics, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Qiuye Guo
- Department of Respiratory Medicine, Hanzhong Central Hospital, Hanzhong, Shaanxi 723000, P.R. China
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Ning G, Wang X, Wu D, Yin Z, Li Y, Wang H, Yang W. The etiology of community-acquired pneumonia among children under 5 years of age in mainland China, 2001-2015: A systematic review. Hum Vaccin Immunother 2017; 13:2742-2750. [PMID: 28922613 DOI: 10.1080/21645515.2017.1371381] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of this systematic review was to examine the etiology of community-acquired pneumonia (CAP) among Chinese children younger than 5 y and provide evidence for further cost-effectiveness analyses for vaccine development, diagnostic strategies and empirical treatments. METHODS The literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were obtained by searching PubMed, Embase, Web-of Science, and the Chinese databases Wanfang Data and China National Knowledge Infrastructure. All CAP etiological studies on children under 5 y of age from China published in Chinese and English between the years of 2001 and 2015 were included. A total of 48 studies were included in the final review, comprising 100 151 hospitalized children with CAP episodes. Heterogeneity and the percentage of variation between studies was analyzed based on Q statistic and I2 indices, respectively. Random effect models were used to calculate the weighted average rate in all analyses. RESULTS The most frequently detected bacterial agents were Klebsiella pneumoniae (5.4%), Streptococcus pneumoniae (5.2%), Escherichia coli (5.2%), Staphylococcus aureus (3.9%), Haemophilus influenza (3.6%) and Haemophilus parainfluenzae (3.3%). The most frequently detected viruses were human rhinovirus (20.3%, in just 2 studies), respiratory syncytial virus (RSV, 17.3%), human bocavirus (9.9%), parainfluenza virus (5.8%), human metapneumovirus (3.9%) and influenza (3.5%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were identified in 9.5% and 2.9%, respectively, of children under 5 y of age with CAP. CONCLUSION This article provides the most comprehensive analysis to date of the factors contributing to CAP in children under 5 y of age. S. pneumoniae, H. influenzae and influenza were the most common vaccine-preventable diseases in children. Corresponding, vaccines should be introduced into Chinese immunization programs, and further economic evaluations should be conducted. RSV is common in Chinese children and preventative measures could have a substantial impact on public health. These data also have major implications for diagnostic strategies and empirical treatments.
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Affiliation(s)
- Guijun Ning
- a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Xuxia Wang
- b Immunization Program Department , Gansu Provincial Center for Disease Control and Prevention , Lanzhou , Gansu , China
| | - Dan Wu
- a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Zundong Yin
- a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Yixing Li
- a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Huaqing Wang
- a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Weizhong Yang
- a Department of National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
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Song P, Theodoratou E, Li X, Liu L, Chu Y, Black RE, Campbell H, Rudan I, Chan KY. Causes of death in children younger than five years in China in 2015: an updated analysis. J Glob Health 2017; 6:020802. [PMID: 28028436 PMCID: PMC5140075 DOI: 10.7189/jogh.06.020802] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Substantial progress in reducing the child mortality rate has been made globally in the last two decades. However, for China, the number of children dying from preventable diseases is still very large. It is important to have regularly updated information on the distribution of causes of death (COD) in children to inform policy and research. In this study, we aim to estimate the COD spectrum in children younger than five years old from 2009 to 2015 with a focus on the year 2015 and to provide an updated COD prediction model for China. Methods Updated data of under–five mortality rates (U5MRs) and the number of live births at national and provincial levels were obtained from United Nation's Inter–agency Group for Child Mortality Estimation (UN IGME), Institute for Health Metrics and Evaluation (IHME), and United Nations Population Division (UNPD). Then, we conducted a systematic review across four Chinese and English bibliographic databases and identified high–quality community–based longitudinal studies of COD in children younger than five years in China. We developed a number of single–cause models to predict the number of child death for main COD in different age groups at both national and provincial levels. The jackknife procedure was applied to construct the 95% Uncertainty Ranges (URs). Results From 2009 to 2015, the under–five mortality rates have declined by 37.1%. The leading causes of death in 2015 were preterm birth complications (17.4%), birth asphyxia (15.2%), congenital abnormalities (14.1%), accidents (13.5%) and pneumonia (12.4%) for children under five years old. The COD spectrum varied substantially across Chinese provinces with different development levels. The leading cause in children under five years in the wealthier provinces (with lower U5MRs) was congenital abnormalities (up to 18.9%), while in the poorer provinces (with higher U5MRs), pneumonia was the dominant COD (up to 23.4%). Conclusions This study updates and validates the accuracy of the findings of our previous COD study and proposes a new modelling method to predict proportions for the most common causes of child death in China. These updated COD estimates suggest that current strategies to reduce child mortality should prioritise action on neonatal deaths and target interventions against the top COD according to the local COD spectrum. Special attention should also be given to reducing differences between Chinese provinces and regions with differing development levels.
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Affiliation(s)
- Peige Song
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Evropi Theodoratou
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Xue Li
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Li Liu
- The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yue Chu
- The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert E Black
- The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Joint last authorship
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Joint last authorship
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25
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He C, Liu L, Chu Y, Perin J, Dai L, Li X, Miao L, Kang L, Li Q, Scherpbier R, Guo S, Rudan I, Song P, Chan KY, Guo Y, Black RE, Wang Y, Zhu J. National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals. Lancet Glob Health 2017; 5:e186-e197. [PMID: 28007477 PMCID: PMC5250590 DOI: 10.1016/s2214-109x(16)30334-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/18/2016] [Accepted: 11/02/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND China has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middle-income countries. METHODS In this systematic analysis, we adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. In adjusting the data, we considered the sampling design and probability, applied smoothing techniques to produce stable trends, fitted livebirth and age-specific death estimates to natvional estimates produced by the UN for international comparison, and partitioned national estimates of infrequent causes produced by independent sources to the subnational level. FINDINGS Between 1996 and 2015, the under-5 mortality rate in China declined from 50·8 per 1000 livebirths to 10·7 per 1000 livebirths, at an average annual rate of reduction of 8·2%. However, 181 600 children still died before their fifth birthday, with 93 400 (51·5%) deaths occurring in neonates. Great inequity exists in child mortality across regions and in urban versus rural areas. The leading causes of under-5 mortality in 2015 were congenital abnormalities (35 700 deaths, 95% uncertainty range [UR] 28 400-45 200), preterm birth complications (30 900 deaths, 24 200-40 800), and injuries (26 600 deaths, 21 000-33 400). Pneumonia contributed to a higher proportion of deaths in the western region of China than in the eastern and central regions, and injury was a main cause of death in rural areas. Variations in cause-of-death composition by age were also examined. The contribution of preterm birth complications to mortality decreased after the neonatal period; congenital abnormalities remained an important cause of mortality throughout infancy, whereas the contribution of injuries to mortality increased after the first year of life. INTERPRETATION China has achieved a rapid reduction in child mortality in 1996-2015. The decline has been widespread across regions, urban and rural areas, age groups, and cause-of-death categories, but great disparities remain. The western region and rural areas and especially western rural areas should receive most attention in improving child survival through enhanced policy and programmes in the Sustainable Development Goals era. Continued investment is crucial in primary and secondary prevention of deaths due to congenital abnormalities, preterm birth complications, and injuries nationally, and of deaths due to pneumonia in western rural areas. The study also has implications for improving child survival and civil registration and vital statistics in other low-income and middle-income countries. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Chunhua He
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Liu
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Yue Chu
- The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Li Dai
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Li
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lei Miao
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Leni Kang
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | | | - Sufang Guo
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Peige Song
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Yan Guo
- Peking University Health Science Center, Beijing, China
| | - Robert E Black
- The Institute for International Programs, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yanping Wang
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Jun Zhu
- National Office of Maternal and Child Health Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
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Zhou M, Wang H. National and regional under-5 mortality in China in the past two decades. LANCET GLOBAL HEALTH 2016; 5:e121-e122. [PMID: 28007478 DOI: 10.1016/s2214-109x(16)30360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, Beijing 100050, China.
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Lu R, Li X, Guo S, Wang H, Zhu J, He C, Li Q, Kang L, Wang Y, Tang J, Mu D. Neonatal mortality in the urban and rural China between 1996 and 2013: a retrospective study. Pediatr Res 2016; 79:689-96. [PMID: 26761125 DOI: 10.1038/pr.2016.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 11/02/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND One of the proposed United Nations post-2015 sustainable development goals is to eliminate avoidable neonatal deaths by 2030. This study aims to examine changes in neonatal mortality rate (NMR) and cause-specific NMR in urban and rural areas to guide renewed efforts to further reduce NMR in China. METHODS This retrospective study used 18 y of consecutive data from the National Under-5 Child Mortality Surveillance System. RESULTS Urban NMR decreased from 11.0 to 4.0 deaths per 1,000 live births, and rural NMR was decreased births from 26.0 to 8.1 deaths per 1,000 live births between the periods of 1996-1998 and 2011-2013. Rural NMR was about two times as much as urban NMR in 2011-2013. Approximately four-fifths of neonatal deaths occurred within less than 7 d after birth. In 2011-2013, the three leading causes of early neonatal death were premature delivery, intrapartum-related conditions, and congenital abnormalities; the three causes of death in late neonates were classification premature delivery, congenital abnormalities, and pneumonia. CONCLUSION China has made substantive progress in reducing NMR; however, the disparity in NMR between urban and rural areas still exists. More effort should be made to prevent and manage premature delivery and congenital abnormalities, especially in rural areas.
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Affiliation(s)
- Ruifeng Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Huiqing Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunhua He
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Leni Kang
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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