Acute Respiratory Infection Cases Research Articles

Epidemiology of respiratory pathogens in patients with acute respiratory tract infection in Xiamen, China: A retrospective survey from 2020 to 2022

Acute respiratory tract infections (ARTI) are caused by respiratory pathogens and range from asymptomatic infections to severe respiratory diseases. These diseases can be life threatening with high morbidity and mortality worldwide. Under the pandemic of coronavirus disease 2019 (COVID-19), little has been reported about the pathogen etiologies and epidemiology of patients suffering from ARTI of all age in Xiamen. Region-specific surveillance in individuals with ARTI of all ages was performed in Xiamen from January 2020 to October 2022. Here, we observed the epidemiological characteristics of thirteen pathogens within ARTI patients and further revealed the difference of that between upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI). In total 56.36 % (2358/4184) of the ARTI patients were positive for at least one respiratory pathogen. Rhinovirus (RVs, 29.22 %), influenza A (FluA, 19.59 %), respiratory syncytial virus (RSV, 18.36 %), metapneumovirus (MPV, 13.91 %), and adenovirus (ADV, 10.31 %) were the five leading respiratory pathogens. Respiratory pathogens displayed age- and season-specific patterns, even between URTI and LRTI. Compared with other groups, a higher proportion of FluA (52.17 % and 68.75 %, respectively) infection was found in the adult group and the elder group, while the lower proportion of RVs (14.11 % and 11.11 %) infection was also observed in them. Although ARTI cases circulated throughout the year, RVs, FluB, and BoV peaked in autumn, and FluA circulated more in summer. Besides, the co-infectious rate was 8.7 % with the most common for RVs. Logistic regression analyses revealed the correlations between respiratory pathogens and disease types. These results are essential for replenishing epidemiological characteristics of common respiratory pathogens that caused ARTI in Xiamen during the epidemic of COVID-19, and a better understanding of it might optimize the local prevention and clinical control.

Pan-India influenza-like illness (ILI) and Severe acute respiratory infection (SARI) surveillance: epidemiological, clinical and genomic analysis.

Over time, COVID-19 testing has significantly declined across the world. However, it is critical to monitor the virus through surveillance. In late 2020, WHO released interim guidance advising the use of the existing Global Influenza Surveillance and Response System (GISRS) for the integrated surveillance of influenza and SARS-CoV-2. In July 2021, we initiated a pan-India integrated surveillance for influenza and SARS-CoV-2 through the geographically representative network of Virus Research and Diagnostic Laboratories (VRDLs) across 26 hospital and laboratory sites and 70 community sites. A total of 34,260 cases of influenza-like illness (ILI) and Severe acute respiratory infection (SARI) were enrolled from 4 July 2021 to 31 October 2022. Influenza A(H3) and B/Victoria dominated during 2021 monsoon season while A(H1N1)pdm09 dominated during 2022 monsoon season. The SARS-CoV-2 "variants of concern" (VoC) Delta and Omicron predominated in 2021 and 2022, respectively. Increased proportion of SARI was seen in extremes of age: 90% cases in < 1 year; 68% in 1 to 5 years and 61% in ≥ 8 years age group. Approximately 40.7% of enrolled cases only partially fulfilled WHO ILI and SARI case definitions. Influenza- and SARS-CoV-2-infected comorbid patients had higher risks of hospitalization, ICU admission, and oxygen requirement. The results depicted the varying strains and transmission dynamics of influenza and SARS-CoV-2 viruses over time, thus emphasizing the need to continue and expand surveillance across countries for improved decision making. The study also describes important information related to clinical outcomes of ILI and SARI patients and highlights the need to review existing WHO ILI and SARI case definitions.

Database derived from an electronic medical record-based surveillance network of US emergency department patients with acute respiratory illness

BackgroundFor surveillance of episodic illness, the emergency department (ED) represents one of the largest interfaces for generalizable data about segments of the US public experiencing a need for unscheduled care. This protocol manuscript describes the development and operation of a national network linking symptom, clinical, laboratory and disposition data that provides a public database dedicated to the surveillance of acute respiratory infections (ARIs) in EDs.MethodsThe Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) network includes 26 academic investigators, from 24 sites, with 91 hospitals, and the Centers for Disease Control and Prevention (CDC) to survey viral infections. All data originate from electronic medical records (EMRs) accessed by structured query language (SQL) coding. Each Tuesday, data are imported into the standard data form for ARI visits that occurred the prior week (termed the index file); outcomes at 30 days and ED volume are also recorded. Up to 325 data fields can be populated for each case. Data are transferred from sites into an encrypted Google Cloud Platform, then programmatically checked for compliance, parsed, and aggregated into a central database housed on a second cloud platform prior to transfer to CDC.ResultsAs of August, 2023, the network has reported data on over 870,000 ARI cases selected from approximately 5.2 million ED encounters. Post-contracting challenges to network execution have included local shifts in testing policies and platforms, delays in ICD-10 coding to detect ARI cases, and site-level personnel turnover. The network is addressing these challenges and is poised to begin streaming weekly data for dissemination.ConclusionsThe RESP-LENS network provides a weekly updated database that is a public health resource to survey the epidemiology, viral causes, and outcomes of ED patients with acute respiratory infections.

Clinical trial of tolerability, safety, and immunogenicity of the Russian influenza inactivated split vaccine Flu-m in children from 6 months to 9 years of age

Purpose: To study the reactogenicity, safety and immunogenicity of the Russian vaccine Flu-M in comparison with Vaxigrip vaccine for influenza prevention in children aged from 6 months to 9 years (phase III).Materials and Methods. In 2021, a clinical study was conducted in which children aged 6 months to 9 years were immunized with Flu-M vaccine (produced by SPbSRIVS, Russia) and Vaxigrip vaccine (produced by Sanofi Pasteur S.A., France). After randomization one group of children was vaccinated with Flu-M, the other with Vaxigrip, and monitored for 180±3 days after vaccination. Children vaccinated between 3 and 9 years of age were studied in phase I, and between 6 months and 3 years of age in phase II. Tolerability and safety were assessed by the frequency and extent of adverse events, as well as by the assessment of vital signs and physical examination. Immunological efficacy assessment criteria were geometric mean antibody titer, seroconversion level, seroconversion factor, seroprotection level.Results. Both vaccines (Flu-M and Vaxigrip) were shown to be well tolerated by children of both age groups. No serious adverse events or severe adverse events were reported in the study. Immunological efficacy criteria were achieved for both vaccines for all strains of influenza virus in children of both age groups at 28 and 56 days after vaccination. No cases of influenza or acute respiratory infections were seen at 180±3 days postvaccination.Conclusion. The results of the clinical study show that the Flu-M and Vaxigrip vaccines are comparable in both age groups of children.The trial is registered at ClinicalTrials.gov (NCT 05470582).

Analysis of parainfluenza virus infection in acute respiratory tract infection adult cases in Shanghai, 2015-2021

Objective: To study the infection status and epidemiological characteristics of parainfluenza virus (PIV) in acute respiratory tract infection adult cases in Shanghai from 2015 to 2021, and to provide a scientific basis for preventing and controlling PIV. Methods: Acute respiratory tract infections were collected from 13 hospitals in Shanghai from 2015 to 2021. Relevant information was registered, and respiratory specimens were sampled to detect respiratory pathogens by multiplex PCR. Results: A total of 5 104 adult acute respiratory tract infection cases were included; the overall positive rate of the respiratory pathogens was 29.37% (1 499/5 104). The positive rate of PIV was 2.61% (133/5 104), compared with 2.32% (55/2 369) and 2.85% (78/2 735) in influenza-like cases (ILI) and severe acute respiratory infection (SARI) cases, respectively. Among them, PIV3 accounted for the highest proportion (62.41%, 83/133), followed by PIV1 (18.80%, 25/133), PIV2 (9.77%, 13/133), and PIV4 (9.02%, 12/133). The incidence of PIV-positive cases was mainly distributed in the first and second quarters, accounting for 62.41% (83/133). The difference in the incidence in each quarter was significant (χ2=24.78, P<0.001). Mixed infection accounted for 18.80% (25/133) of 133 PIV-positive cases, the mixed infection rates of ILI and SARI were 18.18% (10/55) and 19.23% (15/78), respectively, and the main mixed pathogen of PIV was coronavirus 229E. Conclusions: There are a certain proportion of PIV-positive acute respiratory tract infection cases in Shanghai. It is necessary to strengthen the etiological surveillance in acute respiratory tract infection cases, especially the mixed infection of PIV and other pathogens.

Epidemiological effectiveness of domestic influenza vaccines in cases with vaccination against a new coronavirus infection in 2022–2023

The study presents the results of an epidemiological prospective field cohort study on a comparative assessment of the epidemiological effectiveness of domestic inactivated influenza vaccines and vaccines against new coronavirus infection during immunization of adults aged 18 years. Statistically significant differences were found in the incidence of influenza, acute upper respiratory infections, and new coronavirus infection between the vaccinated and unvaccinated groups. The etiologies of cases of acute upper respiratory infections registered in the study participants during the epidemic season of influenza in 2022–2023 were verified. The clinical symptoms of influenza in the vaccinated group were significantly less severe than those in the unvaccinated group. No significant differences were found in the clinical picture of acute upper respiratory infections between the compared groups. Influenza immunoprophylaxis is an urgent problem, which consists of the ability of viruses to change their antigenic structure and avoid immunity, remaining in constant circulation. Thus, the antigenic composition of influenza vaccines must be systematically updated to ensure the formation of effective population immunity. More studies on the etiological spectrum of respiratory pathogens and assessment of the epidemiological effectiveness of vaccination against vaccine-controlled infections in the analyzed groups are needed. Therefore, to assess immunological protection, including the assessment of the epidemiological effectiveness of seasonal vaccines used against influenza and new coronavirus infection, the priority age group includes individuals aged 18–25 years (especially those belonging to organized collectives) and adults with an unfavorable premorbid background. The use of domestic vaccines against influenza and the new coronavirus infection for specific immunoprophylaxis is generally recognized as the most effective sanitary and anti-epidemic (preventive) measure in the morbidity management of several infectious diseases.

HUBUNGAN KONDISI FISIK RUMAH DENGAN PENYAKIT ISPA PADA BALITA DI DESA PAYA MABAR KECAMATAN TEBING TINGGI KABUPATEN SERDANG BEDAGAI TAHUN 2022

Acute respiratory infection (ARI) is one of the main causes of death by killing ± 4 million children under five each year. There were 108 cases of acute respiratory infection in Paya Mabar Village. This study aims to determine the relationship between the physical condition of the house and respiratory disease in toddlers in Paya Mabar Village, Tebing Tinggi District, Serdang Bedagai Regency in 2022. This type of research is an analytical survey with a cross sectional approach. The sampling technique used was purposive sampling, where the number of samples was 52 respondents. The data analysis technique used the chi-square statistical test. The results showed that there was a relationship between occupancy density (p=0.042), OR(0.618), CI(0.202-1.887), wall type (p=0.012), OR(1.000), CI( 0.275-3.643), Floor type (p=0.000), OR(0.071), CI(0.019-0.272), Roof (p=0.041), OR(1.406), CI(0.446-4.432), (p=0.026) , OR(0.230), CI(0.071-0.744), and Humidity (p=0.001), OR(9.048), CI(2.571-31.842) on ISPA Disease in toddlers. The most dominant variable was humidity with OR(9.048). Therefore, it is suggested to people who have toddlers to improve the condition of the physical environment of the house, open ventilation so that there is a change of air to avoid high humidity, always clean the home environment to prevent ARI in toddlers.

Implementation of a Surveillance System for Severe Acute Respiratory Infections at a Tertiary Care Hospital in Austria: Protocol for a Retrospective Longitudinal Feasibility Study.

The risk of a large number of severe acute respiratory infection (SARI) cases emerging is a global concern. SARI can overwhelm the health care capacity and cause several deaths. Therefore, the Austrian Agency for Health and Food Safety will explore the feasibility of implementing an automatic electronically based SARI surveillance system at a tertiary care hospital in Austria as part of the hospital network, initiated by the European Centre for Disease Prevention and Control. We aim to investigate the availability of routinely collected health record data pertaining to respiratory infections and the optimal approach to use such available data for systematic surveillance of SARI in a real-world setting, describe the characteristics of patients with SARI before and after the beginning of the COVID-19 pandemic, and investigate the feasibility of identifying the risk factors for a severe outcome (intensive care unit admission or death) in patients with SARI. We will test the feasibility of a surveillance system, as part of a large European network, at a tertiary care hospital in the province of Lower Austria (called Regional Hospital Wiener Neustadt). It will be a cross-sectional study for the inventory of the electronic data records and implementation of automatic data retrieval for the period of January 2019 through the end of December 2022. The analysis will include an exploration of the database structure, descriptive analysis of the general characteristics of the patients with SARI, estimation of the SARI incidence rate, and assessment of the risk factors and different levels of severity of patients with SARI using logistic regression analysis. This will be the first study to assess the feasibility of SARI surveillance at a large 800-bed tertiary care hospital in Austria. It will provide a general overview of the potential for establishing a hospital-based surveillance system for SARI. In addition, if successful, the electronic surveillance will be able to improve the response to early warning signs of new SARI, which will better inform policy makers in strengthening the surveillance system. The findings will support the expansion of the SARI hospital-based surveillance system to other hospitals in Austria. This network will be of use to Austria in preparing for future pandemics. PRR1-10.2196/47547.

Molecular Epidemiology of Streptococcus pneumoniae Detected in Hospitalized Pediatric Acute Respiratory Infection Cases in Central Vietnam.

Streptococcus pneumoniae is the major bacterial pathogen causing high pneumonia morbidity and mortality in children <5 years of age. This study aimed to determine the molecular epidemiology of S. pneumoniae detected among hospitalized pediatric ARI cases at Khanh Hoa General Hospital, Nha Trang, Vietnam, from October 2015 to September 2016 (pre-PCV). We performed semi-quantitative culture to isolate S. pneumoniae. Serotyping, antimicrobial susceptibility testing, resistance gene detection and multi-locus sequence typing were also performed. During the study period, 1300 cases were enrolled and 413 (31.8%) S. pneumoniae were isolated. School attendance, age <3 years old and prior antibiotic use before admission were positively associated with S. pneumoniae isolation. Major serotypes were 6A/B (35.9%), 19F (23.7%) and 23F (12.7%), which accounted for 80.3% of vaccine-type pneumococci. High resistance to Clarithromycin, Erythromycin and Clindamycin (86.7%, 85%, 78.2%) and the mutant drug-resistant genes pbp1A (98.1%), pbp2b (98.8%), pbp2x (99.6%) ermB (96.6%) and mefA (30.3%) were detected. MLST data showed high genetic diversity among the isolates with dominant ST 320 (21.2%) and ST 13223 (19.3%), which were mainly found in Vietnam. Non-typeables accounted for most of the new STs found in the study. Vaccine-type pneumococcus and macrolide resistance were commonly detected among hospitalized pediatric ARI cases.

Influence of COVID-19 pandemic on the virus spectrum in children with respiratory infection in Xuzhou, China: a long-term active surveillance study from 2015 to 2021

BackgroundTo investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the prevalence of respiratory viruses among pediatric patients with acute respiratory infections in Xuzhou from 2015–2021.MethodsSevere acute respiratory infection (SARI) cases in hospitalized children were collected from 2015–2021 in Xuzhou, China. Influenza virus(IFV), respiratory syncytial virus (RSV), human parainfluenza virus type 3(hPIV-3), human rhinovirus (hRV), human adenovirus(hAdV), human coronavirus(hCoV) were detected by real-time fluorescence polymerase chain reaction(RT-qPCR), and the results were statistically analyzed by SPSS 23.0 software.ResultsA total of 1663 samples with SARI were collected from 2015–2021, with a male-to-female ratio of 1.67:1 and a total virus detection rate of 38.5% (641/1663). The total detection rate of respiratory viruses decreased from 46.2% (2015–2019) to 36% (2020–2021) under the control measures for COVID-19 (P < 0.01). The three viruses with the highest detection rates changed from hRV, RSV, and hPIV-3 to hRV, RSV, and hCoV. The epidemic trend of hPIV-3 and hAdV was upside down before and after control measures(P < 0.01); however, the epidemic trend of RV and RSV had not changed from 2015 to 2021(P > 0.05). After the control measures, the detection rate of hPIV-3 decreased in all age groups, and the detection rate of hCoV increased in all except the 1 ~ 3 years old group.ConclusionsImplementing control measures for COVID-19 outbreak curbed the spread of respiratory viruses among children as a whole. However, the epidemic of RV and RSV was not affected by the COVID-19 control policy.

Hubungan Pengetahuan Orang Tua tentang Pencegahan ISPA dengan Kondisi Sanitasi Rumah di Wilayah Kerja Puskesmas Ambulu

Acute Respiratory Infection (ARI) is a disease that often affects children younger than 5 years caused by viruses or bacteria. ARI can be caused by many factors, such as intrinsic and extrinsic factors. Extrinsic factors include the sanitation conditions of the house, such as occupancy density, ventilation, type of floor, humidity, lighting, and maternal factors, such as level of education, age and knowledge. This study aims to identify whether there is a relationship between parents' knowledge about ISPA prevention and the sanitation conditions of homes in the working area of ​​the Ambulu Health Center. This type of research were descriptive correlational with a cross-sectional approach with a sample of 92 respondents, with a sampling technique using simple random sampling. The results of the chi-square statistical test show the valueρ value = 0.000 (α &lt; 0.05).Data collection was carried out using questionnaires and observation. The results showed that 19 mothers (20.7%) had moderate knowledge and 72 mothers (78.3%) had good knowledge. The sanitary condition of the respondent's house was in the moderate category of 24 (26.1) and the sanitary condition of the house was good as much as 68 (73.9%). It is hoped that health services can provide additional knowledge regarding the prevention of ARI for parents, especially those with children under five. So this can help health services to reduce the number of ARI cases, especially in rural areas that are not exposed to information.

Effect of Overcrowding on Childhood Hospital Admissions for Acute Respiratory Infection: A Matched Case–Control Study

Objective: To determine the association between in-house overcrowding and acute respiratory infections (ARIs) in children. Methods: This case-control hospital-based study wad conducted in Saidu Teaching hospital from March-2022 to December-2022. For cases we included 80 patients of age 6 to 59 months, who presented with newly diagnosed or relapsed cases of ARI. Controls were age and gender matched individuals who presented to outdoor hospital department for non-ARI evaluation and had no history of ARI since past 2 months. The in-house crowding was defined as &gt;3 persons living in one bedroom in a home. Results: Mean age in this study was 18.3±8.9 months in ARI group and 19.7±7.8 months in control group (p-value 0.41). There were higher number of patients belonging to poor class in ARI group; 36 (45%) versus 21 (26.2%) in controls, 26 (32.5%) patients in ARI and 31 (38.7%) patients in controls were belonging to middle class, 18 (22.5%) patients in ARI and 28 (35.0%) patients in control group were belonging to upper class (p-value 0.03). Majority of patients in ARI group were from rural areas; 53 (66.3%) in ARI and 37 (46.3%) in control group (p-value 0.01). In-house overcrowding was found in 19 (20%) patients in ARI group and in only 9 (11.3%) patients in control group (p-value 0.03). Conclusion: In-house crowding is significantly associated with increased risk of ARI. The issue of overcrowding in rural regions is more serious than in cities. For Pakistani populations, the problem of overcrowded housing needs to be addressed. Keywords: In-house overcrowding, Acute respiratory infections, Rural living, socio-economic status.

Study of acute respiratory infections in breastfeeding babies up to 2 years

Acute Respiratory Infection (ARI) is a major cause of morbidity and mortality in less than two years of age. The frequent episodes of ARI need hospitalization of babies which becomes more equivocal to paediatrician /clinician. 94 babies upto 2 years with ARI were studied and compared with the same number of healthy babies (controlled group). Routine blood examination included CBC, ESR, PS, AEC, chest x-ray, and PFT was done only if necessary. The comparison of social-demographic students in both groups included gestational weeks, premature birth, birth weight, cesarean birth, employment of mother, siblings, habits of parents were found to be significant (p&amp;#60;0.001). In breastfeeding comparison 60 (± 3.8) ARI cases, 74 (± 5.3) controlled group and p&amp;#60;0.00. In the comparison of never, breastfed cases 26 (± 32) in RI cases, 14 (± 2.8) in a controlled group, and p&amp;#60;0.00 This pragmatic study has confirmed that malnourished babies are more prone to ARI and needs to be correlated with breastfed babies and nutrition supplementation must be recommended along with treatment.

Bacterial and viral etiology of acute respiratory infection among the Forcibly Displaced Myanmar Nationals (FDMNs) in fragile settings in Cox's Bazar- a prospective case-control study.

The leading infectious cause of death in children worldwide is lower acute respiratory infection (LARI), particularly pneumonia. We enrolled a total of 538 acute respiratory infection (ARI) cases according to WHO criteria and age-sex matched 514 controls in the Forcibly Displaced Myanmar National (FDMN) refugee camps in Cox's Bazar, Bangladesh, between June 2018 and March 2020 to investigate the role of bacteria, viruses, and their co-infection patterns and observe Streptococcus pneumoniae (S. pneumoniae) serotype distribution. According to the etiological findings, children ≤5 years of age have a higher bacterial positivity (90%) and viral positivity (34%) in nasopharyngeal samples (NPS) compared to those >5 years of age, in both ARI cases as well as for the control group. Among the bacteria, S. pneumoniae was predominant in both cases and controls (85% and 88%). Adenovirus (ADV)(34), influenza virus A and B (IFV-A, B)(32,23), and respiratory syncytial virus (RSV)(26) were detected as the highest number among the viruses tested for the ARI cases. The total number of viruses was also found higher in ≤5 years of age group. Within this group, positive correlation was observed between bacteria and viruses but negative correlation was observed between bacteria. Both single and co-infection for viruses were found higher in the case group than the control group. However, co-infection was significantly high for Streptococcus aureus (S. aureus) and Haemophilus influenzae b (H. influenza b) (p<0.05). Additionally, semi-quantitative bacterial and viral load was found higher for the ARI cases over control considering Cycle threshold (Ct)≤30. Pathogen identification from blood specimens was higher by qRT-PCR than blood culture (16% vs 5%, p<0.05). In the S. pneumoniae serotype distribution, the predominant serotypes in ARI cases were 23F, 19A, 16F, 35B, 15A, 20 and 10F, while 11A, 10A, 34, 35A and 13 serotypes were predominant in the control group. Pathogen correlation analysis showed RSV positively correlated with human metapneumovirus (HMPV), S. aureus and H. influenza b while S. pneumoniae was negatively correlated with other pathogens in ≤5 years age group of ARI cases. However, in >5 years age group, S. aureus and H. influenza b were positively correlated with IFVs, and S. pneumoniae was positively correlated with HMPV and ADV. Logistic regression data for viruses suggested among the respondents in cases were about 4 times more likely to be RSV positive than the control. Serotype distribution showed 30% for PCV10 serotypes, 41% for PCV13 and 59% for other serotypes. Also, among the 40 serotypes of S. pneumoniae tested, the serotypes 22F, Sg24, 9V, 38, 8, and 1 showed strong positive correlation with viruses in the case group whereas in the control group, it was predominant for serotypes 14, 38, 17F and 39 ARI cases were prevalent mostly in monsoon, post-monsoon, and winter periods, and peaked in September and October. Overall these region-specific etiological data and findings, particularly for crisis settings representing the FDMNs in Cox's Bazar, Bangladesh, is crucial for disease management and disease prevention control as well as immunization strategies more generally in humanitarian crisis settings.

Rapid assessment of case recruitment tools to inform integrated surveillance of influenza and other respiratory viruses in Eastern Mediterranean countries.

Influenza-like illness (ILI) and severe acute respiratory infection (SARI) case recruitment tools from 10 countries were reviewed. The contents of the existing tools were compared against World Health Organization's current guidelines, and we also assessed the content validity (accuracy, completeness and consistency). Five of the ILI tools and two of the SARI tools were rated as having high accuracy against WHO case definitions. ILI completeness ranged from 25% to 86% and SARI from 52% to 96%. Average internal consistency scores were 86% for ILI and 94% for SARI. Limitations in the content validity of influenza case recruitment tools may compromise recruitment of eligible cases and result in varying detection rates across countries.

Modeling Respiratory Syncytial Virus Adult Vaccination in the United States with a Dynamic Transmission Model.

Respiratory syncytial virus (RSV) is shown to cause substantial morbidity, hospitalization, and mortality in infants and older adults. Population-level modelling of RSV would allow for estimation of the full burden of disease and the potential epidemiological impact of novel prophylactics. We model the epidemiology of RSV in the US across all ages using a deterministic compartmental transmission model. Population-level symptomatic RSV acute respiratory tract infection (ARI) cases were projected across different natural history scenarios, both with and without vaccination of older adults aged ≥ 60. Impact of vaccine efficacy against ARIs and infectiousness and vaccine coverage on ARI incidence were assessed. Impact on medical attendance, hospitalization, complications, death and other outcomes were also derived. In the absence of a vaccine, we project 17.5-22.6 million symptomatic RSV ARI cases per year in ≥18-year-olds in the US, with 3.6-4.8 million/year occurring in ≥60-year-olds. Modelling indicates that up to 2.0 million symptomatic RSV ARI cases per year could be prevented in ≥60-year-olds with a hypothetical vaccine (70% vaccine efficacy against symptomatic ARI, and 60% vaccine coverage), and up to 0.69 million cases per year can be prevented in the non-vaccinated population, assuming 50% vaccine impact on infectiousness. The model provides estimated burden of RSV in the US across all age groups, with substantial burden projected specifically in older adults. Vaccination of ≥ 60 years-old population could significantly reduce the burden of disease in this population, with additional indirect effect in the < 60 years-old population due to reduced transmissibility.

Risk Factors for Influenza Disease in Shai-Osudoku and Ningo-Prampram Districts in the Greater Accra Region of Ghana

Aims: This study sought to determine the risk factors of Influenza by investigating the characteristics of patients with Acute Respiratory Infections (ARIs). Study Design: An unmatched case-control study. Place and Duration of Study: This was conducted among residents of Shai-Osudoku (SO) and Ningo-Prampram (NP) Districts from April to November 2016. Methods: Prospective cases of ARIs from a facility-based sentinel surveillance on respiratory illnesses were screened for Influenza-Like-Illnesses (ILIs). Respiratory samples were obtained from those meeting the case definition for ILI and investigated. A total of 147 samples were influenza virus-positive and selected as case-patients. Another 294 patients were selected as control-patients from the pool of influenza negative tests. These two groups were used to assess the risk factors of influenza. Crude and adjusted odds ratios were calculated. A purposive selection logistic regression was used for the adjusted modelling. Results: The study identified Influenza A(H3N2) and Influenza B as the predominant circulating influenza viruses. Study participants had poor knowledge on the causes and prevention of acute respiratory illness. After the multivariate analysis, ILI patients presenting with Chills had 4 times odds (aOR:4.57; 95%CI: 1.51 – 13.76) of having influenza as compared with the controls. In addition, ILI patients with recent travel history in past 2 weeks had 3 times odds (aOR:3.05; 95%CI: 1.07 – 8.73) of being infected with the influenza virus compared with controls with no history of travel. Conclusion: The study provided clues for increasing the index of suspicion of clinicians in identifying patients with respiratory signs who could be at risk of influenza infection. Communication of the significant risk factors identified in the study to all health workers should be prioritized as an action. This important knowledge about factors associated with influenza among ILIs will inform early detection and appropriate health interventions to reduce the burden influenza disease.

Analysis of enterovirus infection type among acute respiratory tract infection cases in Luohe City, Henan Province from 2017 to 2021

Objective: To understand the infection status of Enterovirus (EV) in cases of acute respiratory infections (ARIs) in Luohe City, Henan Province from 2017 to 2021, and analyze the prevalence and type composition of EV in ARIs. Methods: From October 2017 to May 2021, pharyngeal swab samples were collected from 1 828 patients with ARIs in Luohe Central Hospital and the clinical epidemiological data of these cases were also collected. EV-positive samples were identified by Quantitative Real-time Polymerase Chain Reaction (qPCR). The 5'-untranslated region (5'UTR) was amplified by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). The results of 5'UTR region were initially typed by Enterovirus Genotyping Tool Version 1.0. Based on the typing results, the full-length of VP1 region was amplified by RT-PCR. The EV typing was identified again by VP1 region. Results: Among 1 828 cases of ARIs, 56.7% (1 036) were males. The median (Q1, Q3) age was about 3 (1, 5) years. Patients under 5 years old accounted for 71.6% (1 309 cases). Among all cases, a total of 71 EV-positive samples were identified by qPCR, with a detection rate of 3.88% (71/1 828). The EV detection rates for men and women were 3.28% (34/1 036) and 4.67% (37/792), without statistically significant differences (χ2=2.32, P=0.14). The EV detection rates for 2 to <6 years, 6 months to <2 years, 6 to <10 years, and <6 months were 6.29% (48/763), 3.00% (18/600), 2.52% (4/159), and 1.67% (1/60) (χ2=27.91, P<0.001). The EV detection rate was 0.92% (3/326) in autumn and winter of 2017. The EV detection rates were 1.18% (6/508), 2.47% (12/485) and 8.31% (34/409) in each year from 2018 to 2020, with an increasing trend year by year(χ2trend=29.76, P<0.001). The main prevalent seasons were summer and autumn. The detection rate in spring of 2021 was 4.00% (4/100). A total of 12 types were identified and classified as CVA2, CVA4, CVA5, CVA6, CVA10, CVB3, CVB5, E5, E11, E30, PV-1, and EV-D68. The types of CVA2, CVA10, CVA6, and CVB3 were the dominant phenotypes. In 59 sample of EV typing, the main clinical manifestation was upper respiratory tract infection (36/59, 61.01%). The dominant types detected in upper respiratory tract infections were CVA10 (10/36, 27.78%), CVA6 (9/36, 25.00%) and CVB3 (8/36, 22.22%). The dominant type detected in lower respiratory tract infections was CVA2 (7/19, 36.84%). Conclusion: In Luohe City, Henan Province from 2017 to 2021, EV infection in ARIs cases has clear seasonal and age-specific patterns, and the dominant types of upper and lower respiratory tract infections are different.

Antibiotic prescription patterns for acute upper respiratory tract infections in an outpatient population with health insurance in Syria — a retrospective cross-sectional study

BackgroundAntibacterial resistance is an ongoing global issue, threatening the lives of millions and affecting the quality of health systems, resulting in high costs to the worldwide economy. Syria is one of many countries with a high rate of antibiotic prescription or consumption, even before the war. MethodsA retrospective cross-sectional study was conducted to assess the pattern of antibiotic prescribing with regard to acute upper respiratory tract infection (AURTI) cases throughout the year 2019; data were collected from GlobeMed Syria (now Modern Healthcare Claims Management Company) following ethical approval. ResultsThe study comprised 14 913 cases, of which 13 382 (90%) had received an antibiotic prescription. All age groups showed high prescribing rates, with the 46–55 years age group having the highest (95.0%). Acute tonsillitis had the most significant percentage of antibiotics prescribed (98.7%). Cephalosporins were the most commonly prescribed antibiotic class. Family physicians were more inclined to prescribe antibiotics than those in other specialism groups. ConclusionSyria has a high rate of prescribing antibiotics for AURTIs, which may contribute to the evolution of resistant bacteria. The rate is higher than those reported in other Arab countries. Physicians need to commit to following the official guidelines, taking the appropriate prescribing of antibiotics more seriously, and should take more care in distinguishing viral origins of AURTIs.

Surveillance, isolation and genomic characterization of Pteropine orthoreovirus of probable bat origin among patients with acute respiratory infection in Malaysia.

Pteropine orthoreovirus (PRV), an emerging bat-borne virus, has been linked to cases of acute respiratory infections (ARI) in humans. The prevalence, epidemiology and genomic diversity of PRV among ARI of unknown origin were studied. Among 632 urban outpatients tested negative for all known respiratory viruses, 2.2% were PRV-positive. Patients mainly presented with moderate to severe forms of cough, sore throat and muscle ache, but rarely with fever. Phylogenetic analysis revealed that over 90% of patients infected with the Melaka virus (MelV)-like PRV, while one patient infected with the Pulau virus previously found only in fruit bats. Human oral keratinocytes and nasopharyngeal epithelial cells were susceptible to clinical isolates of PRV, including the newly isolated MelV-like 12MYKLU1034. Whole genome sequence of 12MYKLU1034 using Nanopore technique revealed a novel reassortant strain. Evolutionary analysis of the global PRV strains suggests the continuous evolution of PRV through genetic reassortment among PRV strains circulating in human, bats and non-human primate hosts, creating a spectrum of reassortant lineages with complex evolutionary characteristics. In summary, the role of PRV as a common etiologic agent of ARI is evident. Continuous monitoring of PRV prevalence, pathogenicity and diversity among human and animal hosts is important to trace the emergence of novel reassortants.