Acute Respiratory Tract Illness Research Articles

Changes in the epidemiological patterns of respiratory syncytial virus and human metapneumovirus infection among pediatric patients and their correlation with severe cases: a long-term retrospective study

ObjectivesWe aim to investigate the prevalence of respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) among pediatric patients with acute respiratory tract illness (ARTI) in southern China both pre- and post-COVID-19 pandemic, as well as identify associated risk factors for severe infections.MethodsThe study conducted a real-time PCR analysis on hospitalized children with ARTI from 2012 to 2023, specifically targeting RSV, hMPV, and other respiratory pathogens. Additionally, demographic data was collected during this analysis.ResultsThe prevalence of RSV occurs triennially, and likewise, the temporal pattern of hMPV outbreaks mirrors that of RSV. The peak infection rates of RSV and hMPV occurred during and following the implementation of COVID-19 epidemic prevention and control measures. The incidence of RSV infection exhibited bimodal peaks in 2022, while hMPV demonstrated seasonal peaks during the spring, fall, and winter periods post-COVID-19 pandemic. After the COVID-19 outbreak, there has been an upward trend in the proportion of female patients and patients aged one year and older presenting with ARTI, RSV infections, and hMPV infections. Infant (OR = 4.767, 95%CI: [3.888–5.846], p < 0.0001), presence of co-infection (OR = 0.540, 95%CI: [0.404–0.722], p < 0.0001), and existence of comorbidities (OR = 1.582, 95%CI: [1.285–1.949], p < 0.0001) was the risk ratio for the severity of RSV infection. Children infected with hMPV under the age of 1 year (OR = 0.322, 95%CI: [0.180 – 0.575], p < 0.0001), as well as those with comorbidities (OR = 8.809, 95%CI: [4.493 – 17.272], p < 0.0001), have a higher risk of developing severe illness.ConclusionThe changing epidemiological patterns have the potential to lead to widespread severe outbreaks among children, particularly those with underlying medical conditions who may experience more severe symptoms. Conducting surveillance for pneumoviridae viruses in children is an imperative measure to establish a robust foundation for future epidemic prevention and treatment strategies.

Adjuvanted Vaccine to Prevent Respiratory Syncytial Virus in Adults Ages 60 Years and Older

Respiratory syncytial virus (RSV) is a prevalent cause of acute lower respiratory tract illness that disproportionately affects older adults, young children, and infants, which can lead to hospitalizations and death. The health impact on the elderly and infants accentuates the need for effective preventive strategies. Arexvy is the first approved vaccine to prevent lower respiratory tract illness caused by RSV in older adults ages 60 and older. It contains recombinant respiratory syncytial virus glycoprotein F stabilized in the prefusion conformation. Arexvy offers approximately 83% protection in adults and appears to maintain effectiveness for up to two RSV seasons. The vaccine was generally well tolerated in clinical trials, with the most frequently observed and reported adverse events being mild to moderate injection site pain, fatigue, myalgia, headache, and arthralgia. This article includes a description of Arexvy, the target population, contraindications, side effects, and clinical implications when considering the use of this vaccine.

The Impact of COVID-19 after one year on the orthopedic spine service at the Orthopedic Center Hospital in Indonesia

link of Video Abstract: https://youtu.be/-6sruWeh-_Q Introduction: Coronavirus-2 (SARS-COV2) is the agent that causes Coronavirus Disease (COVID-19), an acute respiratory tract illness. Early in December 2019, COVID-19 was created in Wuhan, China. On March 11th, 2020, COVID-19 was classified as a pandemic by WHO. As a result, the Indonesian government enacted extensive social restrictions on March 31, 2021. This rule prohibits unnecessary public actions. This study aimed to ascertain how COVID-19 affected This study sought to ascertain how COVID-19 affected orthopedic treatments provided in the spine area at the Orthopaedic Center Hospital in Indonesia. Methods: This research is cross-sectional and comparative. The population in Indonesia during the COVID-19 epidemic was compared to the same population one year earlier in the research. This report covers every patient who visited Prof. Dr. R. Soeharso Orthopaedic Hospital with a spine-related diagnosis from the emergency room, an outpatient clinic, or an inpatient setting. Patients with other orthopedic subspecialty diagnoses and those registered at orthopedic service support facilities like radiography, laboratories, or physiotherapy were excluded. SPSS version 26 was used to analyze the data. Results: The overall number of spine patients decreased significantly (30%) from 2440 (pre-covid) to 1695 (during covid). Additionally, there was a significant decline in outpatient visits and surgical procedures (p≤0.05). Patients with trauma reported a crucial decrease during outpatient visits and during surgery (p≤0.05). Conclusions: During the COVID-19 pandemic, the overall number of spine patients from outpatient visits and patient surgery decreased significantly. Additionally, orthopedic care provided during outpatient visits and surgeries decreased.

Risk Factors for the Development of Pneumonia Below 2 Years of Age

Acute respiratory tract illness is the leading cause of death in the developing countries. This case control study was endeavored with an aim to assess the factors that can increase the risk of pneumonia in children. Methodology: This Case-Control study was carried out at the Paediatrics Department of Jalalabad Ragib Rabeya Medical College Hospital (JRRMCH) in Sylhet from January 2018 to July 2018.This study involved 200 children of 6 to 24 months age, among them 100 children who was hospitalized in JRRMCH for pneumonia during the study period as case. The control group included 100 children who was selected purposively came for immunization at JRRMCH EPI centre and at OPD for other problem but free from pneumonia. Sample were selected according to the inclusion & exclusion criteria. A case definition for pneumonia as outlined by the WHO(2014) was used as the criteria for case inclusion. Children with history of low birth weight, congenital cardiovascular or respiratory malformation, chromosomal abnormalities, recurrent wheeze, were excluded from the study. Data were collected by interviews of the parents using a structured questionnaire. Pneumonia (a child with cough or difficult breathing and fast breathing and or chest in-drawing with recently developed radiological pulmonary shadowing)1 affected 100 children included in case group and 100 children free of pneumonia included in control group. SPSS version 22 were used to analyze the data. Independent sample‘t’ test and Chi (x2 ) square test were done. Results: Residential area, socio-economic status, maternal education, H/A score, formula feeding, types of complimentary feeding, passive smoking, birth order >2, family member, crowding index and birth spacing are significantly associated with development of pneumonia. Conclusion: Children belonged to rural area, poor maternal education, low socio-economic status, stunting height for age, formula feeding, types of complimentary feeding, exposure to passive smoking, birth order>2, birth spacing, family member and crowding index were significantly (p<0.05) associated with pneumonia.

Disease Spectrum in COVID-19 Cohort with Travel History from Iran

Background: Coronavirus disease 2019 (Covid-19), declared as a pandemic in March 2020, is an acute respiratory tract illness caused by coronavirus 2 (SARS-CoV2) with clinical manifestations ranging from mild upper respiratory tract symptoms to severe pneumonia. Objectives: To determine the disease spectrum of Covid-19 in a cohort with a travel history from Iran. Materials & Methods: This cross-sectional study with a retrospective collection of data was conducted at Agha Khan University, Karachi from 15th March to 19th April 2020. One hundred and fifty-five laboratory-confirmed cases of Covid-19 were recruited from a government quarantine facility. Data were obtained from the Punjab Emergency Services (Rescue 1122) database where a record of SARS-CoV-2 positive cases and quarantined persons is maintained. Study subjects with a travel history to Iran were contacted by telephone to obtain information about demographics, symptoms, and co-morbid conditions. SPSS version 24 was used to analyze the data. Frequencies and percentages were calculated. Results: Among the returning travelers, 213 had laboratory-confirmed Covid-19, out of which 155 were included in this study. 56.1% were males with a mean age of 40 years. Among the study participants, 91.6% remained asymptomatic throughout the stay, while 8.4 % became symptomatic. 77.5% of the participants had received BCG vaccination in childhood. Among symptomatic cases 15.4% had asthma and 7.7% had hypertension. The most common clinical manifestation was cough which was present in 38.5% of the study participants. None died among the study participants. Conclusion: A mild presentation of COVID-19 was seen in our study participants with 91.6% among them being asymptomatic, while 8.4% were symptomatic. There was a high positivity rate in males as compared to females.

Frequency and Risk of Emergency Medical Service Interhospital Transportation of Patients With Acute Lower Respiratory Tract Illness During the COVID-19 Pandemic in the US

This study compares the frequency of hospital-to-hospital transportation events and associated life-threatening deterioration during transport among patients with acute lower respiratory tract illness during vs before the COVID-19 pandemic.

Interactions between the Nucleoprotein and the Phosphoprotein of Pneumoviruses: Structural Insight for Rational Design of Antivirals.

Pneumoviruses include pathogenic human and animal viruses, the most known and studied being the human respiratory syncytial virus (hRSV) and the metapneumovirus (hMPV), which are the major cause of severe acute respiratory tract illness in young children worldwide, and main pathogens infecting elderly and immune-compromised people. The transcription and replication of these viruses take place in specific cytoplasmic inclusions called inclusion bodies (IBs). These activities depend on viral polymerase L, associated with its cofactor phosphoprotein P, for the recognition of the viral RNA genome encapsidated by the nucleoprotein N, forming the nucleocapsid (NC). The polymerase activities rely on diverse transient protein-protein interactions orchestrated by P playing the hub role. Among these interactions, P interacts with the NC to recruit L to the genome. The P protein also plays the role of chaperone to maintain the neosynthesized N monomeric and RNA-free (called N0) before specific encapsidation of the viral genome and antigenome. This review aims at giving an overview of recent structural information obtained for hRSV and hMPV P, N, and more specifically for P-NC and N0-P complexes that pave the way for the rational design of new antivirals against those viruses.

Novel HLA-B7-restricted human metapneumovirus epitopes enhance viral clearance in mice and are recognized by human CD8+ T cells

Human metapneumovirus (HMPV) is a leading cause of acute lower respiratory tract illness in children and adults. Repeated infections are common and can be severe in young, elderly, and immunocompromised persons due to short-lived protective humoral immunity. In turn, few protective T cell epitopes have been identified in humans. Thus, we infected transgenic mice expressing the common human HLA MHC-I allele B*07:02 (HLA-B7) with HMPV and screened a robust library of overlapping and computationally predicted HLA-B7 binding peptides. Six HLA-B7-restricted CD8+ T cell epitopes were identified using ELISPOT screening in the F, M, and N proteins, with M195–203 (M195) eliciting the strongest responses. MHC-tetramer flow cytometric staining confirmed HLA-B7 epitope-specific CD8+ T cells migrated to lungs and spleen of HMPV-immune mice. Immunization with pooled HLA-B7-restricted peptides reduced viral titer and protected mice from virulent infection. Finally, we confirmed that CD8+ T cells from HLA-B7 positive humans also recognize the identified epitopes. These results enable identification of HMPV-specific CD8+ T cells in humans and help to inform future HMPV vaccine design.

Community Mortality Due to Respiratory Syncytial Virus in Argentina: Population-based Surveillance Study.

BackgroundMany deaths in infants from low-middle income countries (LMICs) occur at home or upon arrival to health facilities. Although acute lower respiratory tract illness plays an important role in community mortality, the accuracy of mortality rates due to respiratory syncytial virus (RSV) remains unknown.MethodsAn active surveillance study among children aged under 5 years old (U5) was performed in Buenos Aires, Argentina, between January and December 2019, to define the burden and role of RSV in childhood community mortality.ResultsA total of 63 families of children U5 participated in the study. Based on a combined approach of tissue sampling, verbal autopsies, and expert’s analysis, RSV infection was found in the causal chain of 11 from 12 cases with positive molecular biology results in respiratory samples. The estimated mortality rate due to RSV among infants was 0.27 deaths/1000 live births. The mean age of RSV-related household deaths was 2.8 months of age (standard deviation [SD] 1.7), and 8/12 were male infants (66.7%). Dying at home from RSV was associated with Streptococcus pneumoniae and/or Moraxella catarrhalis lung coinfection (75%), living in slums and settlement (odds ratio [OR], 17.09; 95% confidence interval [CI], 1.3–219.2), and other underlying comorbidities (OR, 14.87; 95% CI, 1.3–164.6).ConclusionsInfant community mortality rates due to RSV are higher than those reported in industrialized countries and similar to those reported in hospital-based studies in the same catchment population.

Days until return-to-play differ for sub-categories of acute respiratory tract illness in Super Rugby players: A cross-sectional study over 5 seasons (102,738 player-days)

ObjectivesTo document incidence rate and severity of specific sub-categories of respiratory tract illness (RTill) in rugby players during the Super Rugby tournament. DesignCross-sectional study. MethodsTeam physicians completed daily illness logs in 537 professional male rugby players from South African teams participating in the Super Rugby Union tournaments (2013–2017) (1141 player-seasons, 102,738 player-days). The incidence rate (IR: illness episodes/1000 player-days) and severity [%RTill resulting in time-loss, illness burden (IB: days lost to illness/1000 player-days) and days until return-to-play (DRTP)/single illness (mean: 95% Confidence Intervals)] are reported for the following specific sub-categories of RTill: non-infective respiratory tract illness (RTnon-inf), respiratory tract infections (RTinf), influenza-like illness, infective sinusitis, upper respiratory tract infections (URTinf), lower respiratory tract infections (LRTinf). ResultsThe overall IR of RTill was 2.9 (2.6–3.3). IR was higher for RTinf (2.5; 2.2–2.9) vs. RTnon-inf (0.4; 0.3–0.6) (p < 0.001). For sub-categories the highest IR was in URTinf (1.9; 1.7–2.2), while the % illness causing time-loss was influenza-like illness (100%), LRTinf (91.7%), infective sinusitis (55.6%), and URTinf (49.0%). IB was highest for URTinf (2.0; 1.6–2.5), and the DRTP/single illness was highest for LRTinf (3.2; 2.3–4.4), and influenza-like illness (2.1; 1.6–2.8). ConclusionsRTinf accounted for >57% of all illness during the Super Rugby tournament, and mostly URTinf. Influenza-like illness. LRTinf caused time-loss in >90% cases. URTinf, LRTinf and influenza-like illness resulted in the highest burden of illness and LRTinf caused the highest DRTP. Prevention strategies should focus on mitigating the risk of RTinf, specifically URTinf, LRTinf and influenza-like illness.

Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms.

The aim of our study was to define the spectrum of viral infections in pilgrims with acute respiratory tract illnesses presenting to healthcare facilities around the holy places in Makkah, Saudi Arabia during the 2019 Hajj pilgrimage. During the five days of Hajj, a total of 185 pilgrims were enrolled in the study. Nasopharyngeal swabs (NPSs) of 126/185 patients (68.11%) tested positive for one or more respiratory viruses by PCR. Among the 126 pilgrims whose NPS were PCR positive: (a) there were 93/126 (74%) with a single virus infection, (b) 33/126 (26%) with coinfection with more than one virus (up to four viruses): of these, 25/33 cases had coinfection with two viruses; 6/33 were infected with three viruses, while the remaining 2/33 patients had infection with four viruses. Human rhinovirus (HRV) was the most common detected viruses with 53 cases (42.06%), followed by 27 (21.43%) cases of influenza A (H1N1), and 23 (18.25%) cases of influenza A other than H1N1. Twenty-five cases of CoV-229E (19.84%) were detected more than other coronavirus members (5 CoV-OC43 (3.97%), 4 CoV-HKU1 (3.17%), and 1 CoV-NL63 (0.79%)). PIV-3 was detected in 8 cases (6.35%). A single case (0.79%) of PIV-1 and PIV-4 were found. HMPV represented 5 (3.97%), RSV and influenza B 4 (3.17%) for each, and Parechovirus 1 (0.79%). Enterovirus, Bocavirus, and M. pneumoniae were not detected. Whether identification of viral nucleic acid represents nasopharyngeal carriage or specific causal etiology of RTI remains to be defined. Large controlled cohort studies (pre-Hajj, during Hajj, and post-Hajj) are required to define the carriage rates and the specific etiology and causal roles of specific individual viruses or combination of viruses in the pathogenesis of respiratory tract infections in pilgrims participating in the annual Hajj. Studies of the specific microbial etiology of respiratory track infections (RTIs) at mass gathering religious events remain a priority, especially in light of the novel SARS-CoV-2 pandemic.

New Look at RSV Infection: Tissue Clearing and 3D Imaging of the Entire Mouse Lung at Cellular Resolution.

Background: Respiratory Syncytial Virus (RSV) is the major cause of severe acute respiratory tract illness in young children worldwide and a main pathogen for the elderly and immune-compromised people. In the absence of vaccines or effective treatments, a better characterization of the pathogenesis of RSV infection is required. To date, the pathophysiology of the disease and its diagnosis has mostly relied on chest X-ray and genome detection in nasopharyngeal swabs. The development of new imaging approaches is instrumental to further the description of RSV spread, virus–host interactions and related acute respiratory disease, at the level of the entire lung. Methods: By combining tissue clearing, 3D microscopy and image processing, we developed a novel visualization tool of RSV infection in undissected mouse lungs. Results: Whole tissue analysis allowed the identification of infected cell subtypes, based on both morphological traits and position within the cellular network. Furthermore, 3D imaging was also valuable to detect the cytoplasmic viral factories, also called inclusion bodies, a hallmark of RSV infection. Conclusions: Whole lung clearing and 3D deep imaging represents an unprecedented visualization method of infected lungs to allow insight into RSV pathophysiology and improve the 2D histology analyses.

Integrating epidemiological and genetic data with different sampling intensities into a dynamic model of respiratory syncytial virus transmission

Respiratory syncytial virus (RSV) is responsible for a significant burden of severe acute lower respiratory tract illness in children under 5 years old; particularly infants. Prior to rolling out any vaccination program, identification of the source of infant infections could further guide vaccination strategies. We extended a dynamic model calibrated at the individual host level initially fit to social-temporal data on shedding patterns to include whole genome sequencing data available at a lower sampling intensity. The study population was 493 individuals (55 aged < 1 year) distributed across 47 households, observed through one RSV season in coastal Kenya. We found that 58/97 (60%) of RSV-A and 65/125 (52%) of RSV-B cases arose from infection probably occurring within the household. Nineteen (45%) infant infections appeared to be the result of infection by other household members, of which 13 (68%) were a result of transmission from a household co-occupant aged between 2 and 13 years. The applicability of genomic data in studies of transmission dynamics is highly context specific; influenced by the question, data collection protocols and pathogen under investigation. The results further highlight the importance of pre-school and school-aged children in RSV transmission, particularly the role they play in directly infecting the household infant. These age groups are a potential RSV vaccination target group.

A Novel Way to Educate Families About Antibiotic Use for Acute Respiratory Tract Illnesses

Parents' expectations for their child to receive unnecessary antibiotics for acute respiratory tract illnesses (ARTIs; cough, congestion, sore throat,

Patterns of Influenza Vaccination and Vaccine Effectiveness Among Young US Children Who Receive Outpatient Care for Acute Respiratory Tract Illness

The burden of influenza among young children is high, and influenza vaccination is the primary strategy to prevent the virus and its complications. Less is known about differences in clinical protection following 1 vs 2 doses of initial influenza vaccination. To describe patterns of influenza vaccination among young children who receive outpatient care for acute respiratory tract illness in the US and compare vaccine effectiveness (VE) against medically attended laboratory-confirmed influenza by number of influenza vaccine doses received. This test-negative case-control study was conducted in outpatient clinics, including emergency departments, at 5 sites of the US Influenza Vaccine Effectiveness Network during the 2014-2015 through 2017-2018 influenza seasons. The present study was performed from November 5, 2014, to April 12, 2018, during periods of local influenza circulation. Children aged 6 months to 8 years with an acute respiratory tract illness with cough who presented for outpatient care within 7 days of illness onset were included. All children were tested using real-time, reverse-transcriptase polymerase chain reaction for influenza for research purposes. Vaccination in the enrollment season with either 1 or 2 doses of inactivated influenza vaccine as documented from electronic medical records, including state immunization information systems. Medically attended acute respiratory tract infection with real-time, reverse-transcriptase polymerase chain reaction testing for influenza. Of 7533 children, 3480 children (46%) were girls, 4687 children (62%) were non-Hispanic white, and 4871 children (65%) were younger than 5 years. A total of 3912 children (52%) were unvaccinated in the enrollment season, 2924 children (39%) were fully vaccinated, and 697 children (9%) were partially vaccinated. Adjusted VE against any influenza was 51% (95% CI, 44%-57%) among fully vaccinated children and 41% (95% CI, 25%-54%) among partially vaccinated children. Among 1519 vaccine-naive children aged 6 months to 2 years, the VE of 2 doses in the enrollment season was 53% (95% CI, 28%-70%), and the VE of 1 dose was 23% (95% CI, -11% to 47%); those who received 2 doses were less likely to test positive for influenza compared with children who received only 1 dose (adjusted odds ratio, 0.57; 95% CI, 0.35-0.93). Consistent with US influenza vaccine policy, receipt of the recommended number of doses resulted in higher VE than partial vaccination in 4 influenza seasons. Efforts to improve 2-dose coverage for previously unvaccinated children may reduce the burden of influenza in this population.

Vaccination Status and Adherence to Quality Measures for Acute Respiratory Tract Illnesses.

To assess the relationship between vaccination status and clinician adherence to quality measures for children with acute respiratory tract illnesses. We conducted a multicenter prospective cohort study of children aged 0 to 16 years who presented with 1 of 4 acute respiratory tract illness diagnoses (community-acquired pneumonia, croup, asthma, and bronchiolitis) between July 2014 and June 2016. The predictor variable was provider-documented up-to-date (UTD) vaccination status. Our primary outcome was clinician adherence to quality measures by using the validated Pediatric Respiratory Illness Measurement System (PRIMES). Across all conditions, we examined overall PRIMES composite scores and overuse (including indicators for care that should not be provided, eg, C-reactive protein testing in community-acquired pneumonia) and underuse (including indicators for care that should be provided, eg, dexamethasone in croup) composite subscores. We examined differences in length of stay, costs, and readmissions by vaccination status using adjusted linear and logistic regression models. Of the 2302 participants included in the analysis, 92% were documented as UTD. The adjusted mean difference in overall PRIMES scores by UTD status was not significant (adjusted mean difference -0.3; 95% confidence interval: -1.9 to 1.3), whereas the adjusted mean difference was significant for both overuse (-4.6; 95% confidence interval: -7.5 to -1.6) and underuse (2.8; 95% confidence interval: 0.9 to 4.8) composite subscores. There were no significant adjusted differences in mean length of stay, cost, and readmissions by vaccination status. We identified lower adherence to overuse quality indicators and higher adherence to underuse quality indicators for children not UTD, which suggests that clinicians "do more" for hospitalized children who are not UTD.

Vaccination Status and Resource Use During Hospital Visits for Respiratory Illnesses.

To evaluate variation in resource use for children with acute respiratory tract illness (ARTI) by vaccination status. We conducted a retrospective cohort study of children 0 to 16 years of age at 5 children's hospitals with 1 of 4 ARTI diagnoses (pneumonia, croup, asthma, and bronchiolitis) between July 2014 and June 2016. The predictor variable was provider-documented up-to-date (UTD) vaccination status (yes or no). Outcomes were receipt of each of the following tests or treatments (yes or no): complete blood cell count, blood cultures, C-reactive protein (CRP) level testing, viral testing, influenza testing, pertussis testing, chest radiographs, neck radiographs, antibiotics, and corticosteroids. We generated multivariable logistic regression models to examine the associations between our predictor and outcomes. Of the 2302 participants included in analysis, 568 (25%) were diagnosed with pneumonia, 343 (15%) were diagnosed with croup, 653 (28%) were diagnosed with asthma, and 738 (32%) were diagnosed with bronchiolitis. Most (92%) vaccination statuses were documented as UTD. Across conditions, children whose vaccination status was documented as not UTD had higher adjusted odds of receiving a complete blood cell count, blood culture, CRP level testing, and influenza testing (P < .001). Children with pneumonia whose vaccination status was documented as not UTD had higher adjusted odds of receiving CRP level testing and influenza testing (P < .001). Children with croup whose vaccination status was documented as not UTD had higher adjusted odds of receiving blood cultures (P < .001). Children with ARTI whose vaccination status was documented as not UTD had higher odds of undergoing laboratory testing compared with children whose vaccination status was documented as UTD.

1621. Acute Cardiovascular Events Among Adults Hospitalized with Influenza, FluSurv-NET, 2010–2018

BackgroundInfluenza virus infection most commonly causes acute respiratory tract illness, however may also lead to non-respiratory complications including acute cardiovascular (CV) events. We describe the frequency of and risk factors for acute CV events in adults hospitalized with influenza in the United States.MethodsWe included adults aged > 18 years hospitalized during influenza seasons 2010–2011 through 2017–2018 in FluSurv-NET, a multi-state population-based surveillance system that includes detailed medical chart review of patients hospitalized with laboratory-confirmed influenza. We defined acute CV events by International Classification of Diseases (ICD) primary and secondary discharge diagnosis codes for acute heart failure (aHF), acute ischemic heart disease (aIHD), hypertensive crisis, cardiogenic shock, acute myocarditis, acute pericarditis and cardiac tamponade. We calculated the frequency of acute CV events and used multivariable logistic regression among the 87% treated with influenza antivirals to identify independent factors associated with aHF and aIHD, the two most common diagnoses.ResultsOf 80,374 adults hospitalized with laboratory-confirmed influenza, 12% had > 1 acute CV event. We found that aHF (46%) and aIHD (42%) were the most common, followed by hypertensive crisis (8%), cardiogenic shock (3%), acute myocarditis (0.7%), acute pericarditis (0.4%) and cardiac tamponade (0.2%). Compared with treated patients without an acute cardiovascular event, treated patients with aHF (Figure A) and aIHD (Figure B) were more likely to be older, currently/formerly use tobacco and have underlying conditions including cardiovascular disease, diabetes mellitus, and kidney disease.ConclusionAmong adults hospitalized with laboratory-confirmed influenza, acute CV events are common, particularly among those with prior cardiovascular disease. During the influenza season, clinicians should consider influenza virus infection in hospitalized adults who present with acute CV events. Non-respiratory complications, specifically aHF and aIHD, may be an under-recognized contributor to the burden of influenza. Disclosures All authors: No reported disclosures.

Safety and Immunogenicity of the Respiratory Syncytial Virus Vaccine RSV/ΔNS2/Δ1313/I1314L in RSV-Seronegative Children.

BackgroundRespiratory syncytial virus (RSV) is the leading global cause of severe pediatric acute respiratory tract illness, and a vaccine is needed. RSV/ΔNS2/Δ1313/I1314L contains 2 attenuating elements: (1) deletion of the interferon antagonist NS2 gene and (2) deletion of codon 1313 of the RSV polymerase gene and the stabilizing missense mutation I1314L. This live vaccine candidate was temperature-sensitive, genetically stable, replication restricted, and immunogenic in nonhuman primates.MethodsA single intranasal dose of RSV/ΔNS2/Δ1313/I1314L was evaluated in a double-blind, placebo-controlled trial (vaccine-placebo ratio, 2:1) at 106 plaque-forming units (PFU) in 15 RSV-seropositive children and at 105 and 106 PFU in 21 and 30 RSV-seronegative children, respectively.ResultsIn RSV-seronegative children, the 105 PFU dose was overattenuated, but the 106 PFU dose was well tolerated, infectious (RSV/ΔNS2/Δ1313/I1314L replication detected in 90% of vaccinees), and immunogenic (geometric mean serum RSV plaque-reduction neutralizing antibody titer, 1:64). After the RSV season, 9 of 20 vaccinees had increases in the RSV titer that were significantly greater than those in 8 of 10 placebo recipients (1:955 vs 1:69, respectively), indicating that the vaccine primed for anamnestic responses after natural RSV exposure.ConclusionRational design yielded a genetically stable candidate RSV vaccine that is attenuated yet immunogenic in RSV-seronegative children, warranting further evaluation.Clinical Trials RegistrationNCT01893554.

Study of prevalence and risk factors associated with respiratory illness in children admitted in a teaching hospital in rural Telangana

Introduction: Acute respiratory tract illness is common in children especially under 5 years of age. Poor hygiene, poor sanitation, over-crowding are the major risk factors for respiratory infections in paediatric age group. Aim of the Study: To study the prevalence and risk factors associated with respiratory illness in children admitted in a teaching hospital in rural Telangana. Materials and Methods: This was a hospital based cross sectional descriptive study done for duration of 2 years from August 2016 to July 2018 in the department of paediatrics at Government Medical College, Nizamabad, Telangana. About 3678 children with respiratory illness aged 2 months to 12 years were included in the study. Results: The prevalence of respiratory illnesses is about 30.65%. Of the 3678 children admitted with respiratory illness majority were among 2 months to 12 months, 38.8% (1428/3678) followed by 35.6% (1312/3678) among 1 year to 5 years. Boys comprised 68.7% (2527/3678) and girls were 31.2% (1151/3678). Based on clinical symptoms, 86.7% of children with respiratory illness had cough. In the present study most common respiratory illness was acute bronchiolitis (38.4%) followed by bronchopneumonia (28.2%), and bronchial asthma in 13.9% cases. Others were 1.7% of foreign body aspirations, 2.7% of bronchiectasis, 7.9% of pleural effusions, 1.1% of aspiration pneumonitis, and 5.7% of pulmonary tuberculosis. Over-crowding and poor sanitation were present in 88.8% of cases. Conclusion: In the present study the prevalence of respiratory illness among children aged 2 months to12 years was about 30.6% and risk factors associated with respiratory illnesses were poor sanitation, overcrowding, and low socioeconomic status. Keywords: Respiratory illnesses, Prevalence in children, Risk factors for respiratory illness.