Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh

Objectives: Risk factors for acute respiratory infections (ARIs) in community settings are not fully understood, especially in low-income countries. We examined the incidence and risk factors associated with ARIs in under-two children from the Microbiota and Health study.Methods: Children from a peri-urban area of Dhaka (Bangladesh) were followed from birth to 2 years of age by both active surveillance of ARIs and regular scheduled visits. Nasopharyngeal samples were collected during scheduled visits for detection of bacterial facultative respiratory pathogens. Information on socioeconomic, environmental, and household conditions, and mother and child characteristics were collected. A hierarchical modeling approach was used to identify proximate determinants of ARIs.Results: Of 267 infants, 87.3% experienced at least one ARI episode during the first 2 years of life. The peak incidence of ARIs was 330 infections per 100 infant-years and occurred between 2 and 4 months of age. Season was the main risk factor (rainy monsoon season, incidence rate ratio [IRR] 2.43 [1.92–3.07]; cool dry winter, IRR 2.10 [1.65–2.67] compared with hot dry summer) in the first 2 years of life. In addition, during the first 6 months of life, young maternal age (<22 years; IRR 1.34 [1.01–1.77]) and low birth weight (<2,500 g; IRR 1.39 [1.03–1.89]) were associated with higher ARI incidence.Conclusions: Reminiscent of industrialized settings, cool rainy season rather than socioeconomic and hygiene conditions was a major risk factor for ARIs in peri-urban Bangladesh. Understanding the causal links between seasonally variable factors such as temperature, humidity, crowding, diet, and ARIs will inform prevention measures.

The place of combined mucoactive drugs in the treatment of acute respiratory infections in children

The problem of respiratory diseases and their therapy options still retains much of its urgency. Respiratory diseases in children are still super common. According to the data on infectious morbidity among children in the Russian Federation for the period 2018–2020, current trends have not changed, and the acute respiratory infections (ARI) are still ranked number one in terms of the frequency of registered diseases. According to the official records, the frequency of ARI in children among infectious diseases is 71,850.02 per 100,000 population, or 71%. Such well-known symptom as cough is one of the most frequent manifestations of respiratory diseases. It causes the greatest discomfort for both the little patients and their parents, the quality of life of the children and those around them worsens, many domestic and foreign authors mention this symptom in their works. And it is this problem that doctors of various specialties most often face. The cough is currently treated with drugs with different effects depending on the characteristics and manifestations of the disease. Systematic reviews and multicenter studies show that prescription of mucoactive drugs to treat cough in children with underlying ARI is substantiated and feasible. The authors substantiated the necessity of using combinations of various drugs aimed to reduce inflammation of the airways, improve mucociliary clearance, thin out and promote sputum discharge and, accordingly, reduce cough. The article briefly discusses the mechanisms of the development of cough in ARI, the action of drug substances included in the combination drugs used to treat cough in children, the possibility of using the combination of muco- and bronchoactive drugs of synthetic and plant origin.

Vaccine effectiveness against severe acute respiratory infections (SARI) COVID-19 hospitalisations estimated from real-world surveillance data, Slovenia, October 2021

We estimated vaccine effectiveness (VE) against severe COVID-19 during October 2021, using Slovenian surveillance data. For people fully vaccinated with any vaccine in age groups 18–49, 50–64, ≥ 65 years, VE was 86% (95% CI: 79–90), 89% (85–91), and 77% (74–81). Among ≥ 65 year-olds fully vaccinated with mRNA vaccines, VE decreased from 93% (95% CI: 88–96) in those vaccinated ≤ 3 months ago to 43% (95% CI: 30–54) in those vaccinated ≥ 6 months ago, suggesting the need for early boosters.

Symptom Burden and Factors Associated with Acute Respiratory Infections in the First Two Years of Life—Results from the LoewenKIDS Cohort

Acute respiratory infections (ARIs) are the most common childhood illnesses worldwide whereby the reported frequency varies widely, often depending on type of assessment. Symptom diaries are a powerful tool to counteract possible under-reporting, particularly of milder infections, and thus offer the possibility to assess the full burden of ARIs. The following analyses are based on symptom diaries from participants of the German birth cohort study LoewenKIDS. Primary analyses included frequencies of ARIs and specific symptoms. Factors, which might be associated with an increased number of ARIs, were identified using the Poisson regression. A subsample of two hundred eighty-eight participants were included. On average, 13.7 ARIs (SD: 5.2 median: 14.0 IQR: 10–17) were reported in the first two years of life with an average duration of 11 days per episode (SD: 5.8, median: 9.7, IQR: 7–14). The median age for the first ARI episode was 91 days (IQR: 57–128, mean: 107, SD: 84.5). Childcare attendance and having siblings were associated with an increased frequency of ARIs, while exclusive breastfeeding for the first three months was associated with less ARIs, compared to exclusive breastfeeding for a longer period. This study provides detailed insight into the symptom burden of ARIs in German infants.

Epidemiological features of acute respiratory infections in dentists

Aim. To study the incidence of acute respiratory infections (ARI) in medical staff of dental clinics.Materials and Methods. We performed a descriptive, retrospective epidemiological study of ARI incidence by means of conducting an anonymous survey of 1,081 dentistry practitioners (358 in specialised dental clinics and 723 employees of polyclinics) in Kemerovo (2020). ARI included COVID-19, community-acquired pneumonia, and other common respiratory viral infections. The questionnaire included 12 questions about ARI, age, gender, working experience, and position.Results. The incidence of ARI in dentistry practitioners in specialised dental clinics was 2.6-fold higher as compared with those working in polyclinics [379.52 per 1,000 (95% CI = 327.10-434.11) and 146.19 per 1,000 (95% CI = 120.56-174.93), respectively, p = 0,00001], regardless of age. Prolonged and close contact with the patients along with an intensive use of aerosol-generating technologies were associated with a 2.3-fold times higher incidence of ARI in dental therapists in comparison with dental surgeons. Female dentists suffered from ARI 1.8-fold more frequently than males [410.91 per 1,000 (95% CI = 352,18-471,58) and 228.07 per 1,000 (95% CI = 127.40-358.36), p = 0,01] but most women worked as dental therapists that could confound such association. ARI incidence was not associated with age, work experience, and position (p = 0.22).Conclusion. Dentistry practitioners working in specialised clinics more frequently experienced ARI than those working in polyclinics. Dental therapists were at higher risk of ARI in comparison with dental surgeons, potentially due to the active use of aerosol generating technologies and prolonged close contact with the patients during treatment. Other factors were not among the major determinants of ARI incidence in dentistry practitioners.

Association of Acute Respiratory Infections with Indoor Air Pollution from Biomass Fuel Exposure among Under-Five Children in Jimma Town, Southwestern Ethiopia

Background. Most of the households in developing countries burn biomass fuel in traditional stoves with incomplete combustion that leads to high indoor air pollution and acute respiratory infections. Acute respiratory infection is the most common cause of under-five morbidity and mortality accounting for 2 million deaths worldwide and responsible for 18% of deaths among under-five children in Ethiopia. Although studies were done on acute respiratory infections, the majority of studies neither clinically diagnose respiratory infections nor use instant measurement of particulate matter. Methods. The community-based cross-sectional study design was employed among under-five children in Jimma town from May 21 to June 7, 2020. A total of 265 children through systematic random sampling were included in the study. The data were collected using a pretested semistructured questionnaire and laser pm 2.5 meter for indoor particulate matter concentration. Associations among factors were assessed through correlation analysis, and binary logistic regression was done to predict childhood acute respiratory infections. Variables with p -value less than 0.25 in bivariate regression were the candidate for the final multivariate logistic regression. Two independent sample t-tests were done to compare significant mean difference between concentrations of particulate matter. Results. Among 265 under-five children who were involved in the study, 179 (67.5%) were living in households that predominantly use biomass fuel. Prevalence of acute respiratory infections in the study area was 16%. Children living in households that use biomass fuel were four times more likely to develop acute respiratory infections than their counterparts (AOR: 4.348; 95% CI: 1.632, 11.580). The size of household was significantly associated with the prevalence of acute respiratory infections. Under-five children living in households that have a family size of six and greater had odds of 1.7 increased risk of developing acute respiratory infections than their counterparts (AOR: 1.7; 95% CI: 1.299, 2.212). The other factor associated with acute respiratory infection was separate kitchen; children living in households in which there were no separate kitchen were four times at increased risk of developing acute respiratory infection than children living in households which have separate kitchen (AOR: 4.591; 95% CI: 1.849, 11.402). The concentration of indoor particulate matter was higher in households using biomass fuel than clean fuel. There was statistically higher particulate matter concentration in the kitchen than living rooms (t = 4.509, p ≤ 0.001 ). Particulate matter 2.5 concentrations (μg/m3) of the households that had parental smoking were significantly higher than their counterparts (AOR: 20.224; 95% CI: 1.72, 12.58). Conclusion. There is an association between acute respiratory infections and biomass fuel usage among under-five children. Focusing on improved energy sources is essential to reduce the burden and assure the safety of children.

The use of homeopathy to prevent symptoms of human flu and acute respiratory infections: a double-blind, randomized, placebo-controlled clinical trial with 600 children from Brazilian Public Health Service

In Brazil, homeopathy was implemented in the Public Health Service through the National Policy on Complementary and Integrative Practices of the Health Ministry, published in 2006. Homeopathy appears as a very interesting therapy to be used in the Public Health Services since its medicines are compounded at a very low cost. Considering this interesting scenario to develop research in the Public Health, the Family Health Program (FHP) in Petropolis and the Faculty of Pharmacy at UFRJ started a partnership with the Roberto Costa Institute. A homeopathy clinical trial, employing a control protocol (double-blind, randomized, placebo-controlled), was developed as a result of this partnership starting in April 2009 and ending in April 2010. This clinical trial, approved by the Ethics Committee at UFRJ, number 194/08, aimed to evaluate the efficacy of two types of biotherapics to prevent symptoms of both flu and acute respiratory infections, compared to placebo (ethanol 30%). The biotherapics tested were ARI (Acute Respiratory Infection) and InfluBio. ARI is a homeopathic complex containing three different microorganisms related to respiratory infection while InfluBio is a biotherapic compounded from infectious influenza A virus. Before the development of this clinical trial, ARI had been used routinely in FHP, in Petropolis, to prevent acute respiratory infections in patients. The qualitative results obtained from this application suggested that this medicine has a prophylactic potential in the treatment of respiratory diseases. Additionally, we evaluated the antiviral activity of InfluBio using in vitro methodology and the promising results obtained motivated our group to test it in a clinical trial. With this aim, 600 children, from 1 to 5 years of age, were selected by physicians in 21 units of FHP, following the inclusion/exclusion criteria. For 1 month (April 2009), the children received daily, in a blind manner, the test solutions (placebo, ARI, InfluBio) in the posology of 1 drop per year of age. After 30 days, the use of these solutions was interrupted, and the health agents monitored the children for the subsequent twelve months, registering, in a specific questionnaire, symptoms of flu and acute respiratory infections. The respiratory symptoms that were to be reported were: runny nose, fever, prostration, myalgia, cough and headache. In the occurrence of one or more of these symptoms, the health agents evaluated the necessity of intervention by the physician. Of the 600 children, 450 completed the planned monitoring. The main reasons why 150 quit the treatment were change of address and parents’ abandonment. Additionally, no death was recorded and all the children presented good clinical evolution. In the case of the children who received placebo, the frequency of episodes diagnosed as acute respiratory infection/flu was three times higher when compared to those that received the ARI and InfluBio samples, considering the superior limit of the interquartile interval. Moreover, children treated with these biotherapics did not present any or presented only a single episode of ARI/Flu. These results showed that both biotherapics tested were statistically higher (p

The return of the RSV

Respiratory syncytial virus (RSV) hospitalizations disappeared in 2020. Now, with southern hemisphere 2021 winter behind us, RSV has returned. Despite it is difficult to weigh the impact of pandemic mitigation measures on common respiratory virus circulation, it appears that acute respiratory infections in children are returning to their usual epidemiology.