Hospitalization Rate of Respiratory Syncytial Virus associated Acute Lower Respiratory Infection among Young Children in Suzhou, China, 2010-2014

Background: Data on disease burden of respiratory syncytial virus (RSV) associated acute lower respiratory infection (ALRI) among young children are limited in China. This study aimed to estimate the hospitalization rate of RSV-associated ALRI (RSV-ALRI) among children aged 0~59 months in Suzhou, China. Methods: We retrospectively identified all hospitalized ALRI children aged 0~59 months in Suzhou University Affiliated Children’s Hospital during January 2010 to December 2014. Detailed diagnosis and treatment data were collected by individual medical chart review. Referring to WHO influenza disease burden estimation method, we estimated the hospitalization rate of RSV-ALRI among children aged 0~59 months in Suzhou, China. Results: Among 28,209 ALRI cases, 19,317 (68.5%) were tested for RSV and the RSV positive proportion was 21.3% (4,107/19,317). The average hospitalization rate of RSV-ALRI for children aged 0~59 months was 14 (95% confidence interval [CI]:14~14)/1,000 children-years, for children aged 0~5, 6~11, 12~23, and 24~59 months were 70 (95%CI: 67~73), 31 (95%CI: 29~33), 11 (95%CI: 10~12), and 3 (95%CI: 3~3) /1,000 children-years, respectively. Conclusion: There is considerable RSV-ALRI hospitalization among children aged 0~59 months, particularly among children aged <1 years. An effective monoclonal antibody or vaccine is urgently needed to address the substantial hospitalization burden owing to RSV infection. Key words: Respiratory syncytial virus, Hospitalization rate, Acute lower respiratory infection, Children, China

Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis

Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen.Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16–0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19–0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29–0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects.Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.

Size-Specific Particulate Matter Associated With Acute Lower Respiratory Infection Outpatient Visits in Children: A Counterfactual Analysis in Guangzhou, China

The burden of lower respiratory infections is primarily evident in the developing countries. However, the association between size-specific particulate matter and acute lower respiratory infection (ALRI) outpatient visits in the developing countries has been less studied. We obtained data on ALRI outpatient visits (N = 105,639) from a tertiary hospital in Guangzhou, China between 2013 and 2019. Over-dispersed generalized additive Poisson models were employed to evaluate the excess risk (ER) associated with the size-specific particulate matter, such as inhalable particulate matter (PM10), coarse particulate matter (PMc), and fine particulate matter (PM2.5). Counterfactual analyses were used to examine the potential percent reduction of ALRI outpatient visits if the levels of air pollution recommended by the WHO were followed. There were 35,310 pneumonia, 68,218 bronchiolitis, and 2,111 asthma outpatient visits included. Each 10 μg/m3 increase of 3-day moving averages of particulate matter was associated with a significant ER (95% CI) of outpatient visits of pneumonia (PM2.5: 3.71% [2.91, 4.52%]; PMc: 9.19% [6.94, 11.49%]; PM10: 4.36% [3.21, 5.52%]), bronchiolitis (PM2.5: 3.21% [2.49, 3.93%]; PMc: 9.13% [7.09, 11.21%]; PM10: 3.12% [2.10, 4.15%]), and asthma (PM2.5: 3.45% [1.18, 5.78%]; PMc: 11.69% [4.45, 19.43%]; PM10: 3.33% [0.26, 6.49%]). The association between particulate matter and pneumonia outpatient visits was more evident in men patients and in the cold seasons. Counterfactual analyses showed that PM2.5 was associated with a larger potential decline of ALRI outpatient visits compared with PMc and PM10 (pneumonia: 11.07%, 95% CI: [7.99, 14.30%]; bronchiolitis: 6.30% [4.17, 8.53%]; asthma: 8.14% [2.65, 14.33%]) if the air pollutants were diminished to the level of the reference guidelines. In conclusion, short-term exposures to PM2.5, PMc, and PM10 are associated with ALRI outpatient visits, and PM2.5 is associated with the highest potential decline in outpatient visits if it could be reduced to the levels recommended by the WHO.

The burden of influenza and other respiratory viruses in hospitalized infants and children in a university hospital, Jordan

Background: Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide in young children and is predominately caused by viral respiratory pathogens. This study aims to identify the viral etiologies of acute ALRI in hospitalized children in Jordan University Hospital and compare the clinical characteristics of influenza virus infection with other respiratory viruses. Methods: a retrospective viral surveillance study that included 152 children below 15 years of age admitted with ALRI from December 2018 through April 2019. We recorded results of real-time reverse transcriptase-polymerase chain reaction (RT- PCR ) for common respiratory viruses. Clinical and demographic information of the study population was collected from patients’ electronic medical records. Results: 152 were identified with a median age of 1 year (mean was 2.1 years). Ninety-five patients (62.5%) were males. One or more viral respiratory pathogens were detected in 145 (95.3%) children. Respiratory syncytial virus was the most commonly detected virus in 68 patients (44.8%). Influenza virus was detected in 25 (16.4%). Children with influenza infection had more fever and less leukocyte count compared to children infected with other viruses. The severity of the ALRI correlated significantly with several factors, including age less than 6 months and the presence of neuromuscular disease (p<0.05). Conclusion: Viral detection was common among children admitted with viral ALRI. Viruses, including influenza, are recognized as major contributors to the morbidity associated with ALRI. More attention is needed on strategies for the prevention and detection of viral ALRI in developing countries.

Association of infant and young child feeding practices and acute lower respiratory infections

Background: Suboptimal maternal–child nutrition leading to malnutrition is the major cause increasing morbidity and mortality from severe acute lower respiratory infection (ALRI) among under two children. This research compares the infant and young child feeding (IYCF) practices in children with ALRI and children coming for routine immunization to find out the independent risk factors.Methods: The study was a hospital-based case control study. Infant and young children from 6 months to two years with ALRI admitted to the pediatric ward were studied as cases. Infant and young children of same age coming for routine immunization to the pediatric immunization clinic were studied as controls. Feeding patterns, socio-demographic, environmental and parenting factors were obtained from them in between May 2019 to April 2020.Results: Mixed feeding till 6 months (adjusted OR=34.191; 95% CI, 2.158–541.801; p=0.012), early initiation of complimentary feeding (AOR=30.389; 95% CI, 1.426–647.603; p=0.029), late initiation of complimentary feeding (AOR=28.696; 95% CI, 1.217–676.566; p=0.037) and inadequate amount of complimentary feeding (AOR=14.406; 95% CI, 1.898–109.371; p=0.010) were significant in multivariate analysis.Conclusions: Interventions to increase awareness of breastfeeding and complimentary feeding practices seldom reach lower sections of the society. Feeding visits, mother support groups and community projects to provide home based counselling on IYCF are needed to improve the situation.

Cohort profile: Indian Network of Population-Based Surveillance Platforms for Influenza and Other Respiratory Viruses among the Elderly (INSPIRE)

PurposeWe describe here a multicentric community-dwelling cohort of older adults (>60 years of age) established to estimate incidence, study risk factors, healthcare utilisation and economic burden associated with influenza and respiratory syncytial virus (RSV) in India.ParticipantsThe four sites of this cohort are in northern (Ballabgarh), southern (Chennai), eastern (Kolkata) and western (Pune) parts of India. We enrolled 5336 participants across 4220 households and began surveillance in July 2018 for viral respiratory infections with additional participants enrolled annually. Trained field workers collected data about individual-level and household-level risk factors at enrolment and quarterly assessed frailty and grip strength. Trained nurses surveilled weekly to identify acute respiratory infections (ARI) and clinically assessed individuals to diagnose acute lower respiratory infection (ALRI) as per protocol. Nasal and oropharyngeal swabs are collected from all ALRI cases and one-fifth of the other ARI cases for laboratory testing. Cost data of the episode are collected using the WHO approach for estimating the economic burden of seasonal influenza. Handheld tablets with Open Data Kit platform were used for data collection.Findings to dateThe attrition of 352 participants due to migration and deaths was offset by enrolling 680 new entrants in the second year. All four sites reported negligible influenza vaccination uptake (0.1%–0.4%), low health insurance coverage (0.4%–22%) and high tobacco use (19%–52%). Ballabgarh had the highest proportion (54.4%) of households in the richest wealth quintile, but reported high solid fuel use (92%). Frailty levels were highest in Kolkata (11.3%) and lowest in Pune (6.8%). The Chennai cohort had highest self-reported morbidity (90.1%).Future plansThe findings of this cohort will be used to inform prioritisation of strategies for influenza and RSV control for older adults in India. We also plan to conduct epidemiological studies of SARS-CoV-2 using this platform.

A retrospective study of demographic profile and outcome of Sever acute respiratory illness (SARI) in Iraq

Background Severe acute lower respiratory infection (SARI) is one of the major causes of morbidity and mortality, especially in developing countries. There is a large global variation in the epidemiology, clinical management and outcomes, including the mortality Aim of the study: To describe the demographic features, Province of residence, occupation and outcomes of patients SARI. Patients and Methods: A retrospective study of 1009 patients involved in the study, between the first of January 2019 and twenty eight of December 2019. From the medical records in Communicable Diseases Control Centre (CDC) office in Baghdad. Results: 1009 patients, 406 with positive for influenza A, and 603 with negative for influenza, the highest incidence was in the age group between 0-10 years for both positive (19.7%) and negative (25.0%) influenza A. Male higher (56.7%) than female in influenza A group, but female is higher (50.4%) in those with negative influenza group. The incidence in Baghdad is higher than other governments for both groups. Freelance is higher than other occupations (31.8%) for positive and housewife (32.2%) for negative influenza A. Death was 6.4% for positive and 1.5% for negative influenza A, the higher mortality rate was in male in age group 0-10 year for both positive (30.8%) and negative (18.9%)influenza A. Conclusion: influenza A is an important cause of SARI, childhood is a high risk for SARI who have high mortality rate especially in male. Freelance and housewife have high occupation risk for SARI. Baghdad has the higher rate than other governments for SARI In Iraq.