Respiratory Illness In Children Research Articles

Regulatory T cells exert differential functions during the early and late stages of the immune response to respiratory virus infection

Abstract Human metapneumovirus (HMPV) is the second leading cause of viral lower respiratory illness in children, and can be severe in premature infants, immunocompromised persons, and the elderly. Clearance of HMPV is predominantly mediated by cytotoxic CD8+ T lymphocytes (CTLs). HMPV and other respiratory viruses induce CTL impairment, where virus-specific CTLs are unable to function for an optimal antiviral immune response. We recently demonstrated that the inhibitory receptor Programmed Cell Death-1 (PD-1) mediates early functional impairment of the CTL response to HMPV, influenza, and other respiratory viruses early in infection. However, CTLs became impaired by day 10 post-infection in PD-1-deficient mice, indicating that other immunoregulatory cells or molecules may be acting during HMPV infection. CD4+ regulatory T cells (Tregs) are suppressive in cancer and some infections. We found that Tregs were increased in both number and percentage and activated during HMPV infection. Treg depletion throughout infection significantly increased CTL functionality and reduced peak virus titer. Early depletion of Tregs led to reduced recruitment of HMPV-specific CTLs to the lung, while depletion late after infection maintained the proportion of HMPV-specific CTLs and accelerated virus clearance. These data suggest that Tregs may perform distinct functions at different stages of lung infection. Tregs may be beneficial during the priming stage of the immune response, but are overall detrimental in the setting of HMPV infection and could be a target for therapeutics.

Epidemiology of admissions with respiratory illnesses: a single tertiary centre experience

Background: Respiratory illnesses in children form a substantial disease burden in emergency care, outpatients and hospitalised patients. Studies exploring the pattern of emergency room visits and hospitalization for individuals with respiratory complaints could inform decisions regarding the effective organisation and planning of health services.Methods: The present prospective observational study was conducted in children between one month to 18 years of age admitted with acute respiratory illness at Institute of Child Health, Kolkata from1st of February 2015 - 28th of February 2015. Results: Preliminary data shows that most of them were diagnosed provisionally as pneumonia (30%) followed by wheeze associated lower respiratory infection (WALRI) (29%). Approximately 10% of admitted patients required PICU support. Antibiotics and bronchodilators were the most commonly used medications.Conclusions: CRP is significantly elevated in bacterial respiratory tract illnesses but a normal or low CRP does not exclude bacterial infection. Best practice may be to avoid antibiotics where possible unless clinically indicated and hospital courses determine so.

Human Metapneumovirus causing Pertussis-like Syndrome

Human metapneumovirus (hMPV), a common cause of respiratory illness in children, typically presents with clinical symptoms resembling that of respiratory syncytial virus. The unusual aspect in this case is the presentation of pertussis-like syndrome due to sole hMPV infection. To our knowledge, a case of pertussis-like syndrome caused by hMPV without concomitant Bordetella pertussis infection has not been reported.

Design and Implementation of a Telepediatric Primary-Level and Low-Cost System to Reduce Unnecessary Patient Transfers.

Most inhabitants in Latin America are concentrated in large urban foci with different access to facilities. Although the main hospitals offer specialized services, economically vulnerable populations cannot easily afford these services, the pediatric population being most affected. This article presents the design and implementation of a low cost telepediatric system, applied to primary care hospitals through a study in Bogotá, Colombia, mainly aimed to reduce the number of unnecessary transfers commonly sent to specialized medical services. The system was carried out over 6 months with a higher incidence of acute respiratory illness in children between 0 and 5 years in nine primary care hospitals in Bogotá. Nineteen (n = 19) pediatricians were trained by a group of engineers that supports the system permanently. The reduction of patient transfers was compared with previous reports of the National Statistical Department in Colombia. The system reduced both the number of patient transfers to higher level hospitals by 83% and the waiting times for patient transfer, improving healthcare in pediatric patients at a reasonable cost, affecting more than 700 patients. At the same time, a decrease of about 17% in the use of antibiotics was observed, which is an important current public health issue. The use of telemedicine improves the efficiency of public health resources, even in big cities such as Bogotá, reducing the number of unnecessary patient transfers and the optimization and appropriate use of medicines.

Respiratory illness in children with disability: a serious problem?

Key pointsChildren with neurocognitive impairment often present with chronic or recurrent respiratory problems.The respiratory problems have an important impact on quality of life and life expectancy.The underlying causes are multiple: risk of aspiration, insufficient cough, upper airway obstruction and progressive kyphoscoliosis.There is often a complex interplay between these known risk factors.The diagnostic and therapeutic approach should be multidisciplinary.Educational aimsTo provide data on the prevalence of respiratory problems in children with disability and to increase awareness on this topic.To provide insight into the complex interplay of the underlying causes and risk factors for chronic lung infection and respiratory failure.To give an overview of the diagnostic approaches relevant in this context.To highlight possible therapeutic approaches.To touch on ethical considerations in this group of vulnerable and complex patients.

Human enterovirus D68 in clinical and sewage samples in Israel

BackgroundSince mid-August 2014, North America experienced a wide outbreak of Enterovirus D68 (EV-D68) associated with severe respiratory illness in children. Several other countries also reported cases of EV-D68 in 2014. ObjectivesThe aim of this study was to determine whether EV-D68 circulated in Israel in 2014, caused severe respiratory illness in children and was the causative agent of Acute Flaccid Paralysis. Study designArchived clinical respiratory samples from a cohort of 710 hospitalized pediatric patient’s (<10years old) with respiratory illness were screened for clade B specific EV-D68 by real-time PCR. The patients were seen at four medical centers covering the entire country between August and November 2014. We also evaluated 49 patient stool samples from 26 AFP cases during 2014 for presence of EV-D68. In addition, RNA from sewage samples collected throughout Israel during the same study period was also tested for EV-D68. Partial VP1 sequencing was performed on all positive samples. ResultsOf the 710 clinical samples evaluated, 7 (1%) were positive for EV-D68. Two patients were from the central part of Israel, while the rest was from the southern part. The majority of the patients did not have any underlying disease. Not only that, but, none of the 26 suspected AFP cases had EV-D68 nucleic acid in their stool samples. EV-D68 RNA was detected in 9 out of 93 sewage samples, mainly from Southern Israel. Sequence analysis of EV-D68 VP1 gene from both sewage and clinical samples indicated that the Israeli EV-D68 RNA belonged to Clade B which was genetically similar to 2014 circulating European and North American EV-D68 virus. ConclusionsEV-D68 circulated in Israel during the 2014 summer-fall season and caused hospitalization of a small percent of the patients with respiratory illness.

Mutations in VP1 and 3A proteins improve binding and replication of rhinovirus C15 in HeLa-E8 cells

Viruses in the rhinovirus C species (RV-C) can cause severe respiratory illnesses in children including pneumonia and asthma exacerbations. A transduced cell line (HeLa-E8) stably expressing the CDHR3-Y529 receptor variant, supports propagation of RV-C after infection. C15 clinical or recombinant isolates replicate in HeLa-E8, however progeny yields are lower than those of related strains of RV-A and RV-B. Serial passaging of C15 in HeLa-E8 resulted in stronger cytopathic effects and increased (≥10-fold) virus binding to cells and progeny yields. The adaptation was acquired by two mutations which increased binding (VP1 T125K) and replication (3A E41K), respectively. A similar 3A mutation engineered into C2 and C41 cDNAs also improved viral replication (2–8 fold) in HeLa but the heparan sulfate mediated cell-binding enhancement by the VP1 change was C15-specific. The findings now enable large-scale cost-effective C15 production by infection and the testing of RV-C infectivity by plaque assay.

Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China.

BackgroundInfluenza is an important cause of respiratory illness in children, but data are limited on hospitalized children with laboratory‐confirmed influenza in China.MethodsWe conducted active surveillance for severe acute respiratory infection (SARI; fever and at least one sign or symptom of acute respiratory illness) among hospitalized pediatric patients in Jingzhou, Hubei Province, from April 2010 to April 2012. Data were collected from enrolled SARI patients on demographics, underlying health conditions, clinical course of illness, and outcomes. Nasal swabs were collected and tested for influenza viruses by reverse transcription polymerase chain reaction. We described the clinical and epidemiological characteristics of children with influenza and analyzed the association between potential risk factors and SARI patients with influenza.ResultsDuring the study period, 15 354 children aged <15 years with signs and symptoms of SARI were enrolled at hospital admission. severe acute respiratory infection patients aged 5–15 years with confirmed influenza (H3N2) infection were more likely than children without influenza to have radiographic diagnosis of pneumonia (11/31, 36% vs 15/105, 14%. P<.05). Only 16% (1116/7145) of enrolled patients had received seasonal trivalent influenza vaccination within 12 months of hospital admission. Non‐vaccinated influenza cases were more likely than vaccinated influenza cases to have pneumonia (31/133, 23% vs 37/256, 15%, P<.05). severe acute respiratory infection cases aged 5–15 years diagnosed with influenza were also more likely to have a household member who smoked cigarettes compared with SARI cases without a smoking household member (54/208, 26% vs 158/960, 16%, P<.05).ConclusionsInfluenza A (H3N2) virus infection was an important contributor to pneumonia requiring hospitalization. Our results highlight the importance of surveillance in identifying factors for influenza hospitalization, monitoring adherence to influenza prevention and treatment strategies, and evaluating the disease burden among hospitalized pediatric SARI patients. Influenza vaccination promotion should target children.

Contribution of influenza viruses to medically attended acute respiratory illnesses in children in high-income countries: ameta-analysis.

Aim:The burden of disease in children attributable to influenza viruses is difficult to quantify given the similarity of symptoms caused by infection due to influenza and other viruses. This uncertainty impacts clinical decision‐making and estimates of burden. We aimed to systematically review the literature to determine the proportion of healthy children presenting for health care with an acute respiratory illness (ARI) who have laboratory‐confirmed seasonal influenza (PROSPERO ID#CRD42014013896).Method:We searched Ovid MEDLINE, EMBASE, Scopus, and references of included articles. We included studies that used polymerase chain reaction methods to test for influenza in healthy children aged ≤5 years who presented for health care in high‐income countries with an influenza‐like or ARI. A standardized form was used to collect data on positivity and other relevant study elements.ResultsSeventeen studies covering 12 different influenza seasons were included. The proportion of influenza positivity ranged from 11% to 56%. Subgroup analyses were performed by influenza season, continent, healthcare setting, age group, and vaccination status. Higher influenza positivity was reported among children aged 3–5 years compared with children aged ≤2 years, and for unvaccinated children.ConclusionThe minority of healthy patients aged ≤5 years with medically attended influenza‐like or acute respiratory symptoms have laboratory‐confirmed influenza virus infection, although this varied by influenza season. Prevention efforts should be targeted accordingly.StatementMost influenza‐like illnesses are not laboratory‐confirmed and have similar clinical presentations. Consequently, the true contribution of influenza to acute respiratory infections in children remains uncertain. Our systematic review estimates that this proportion ranges from 11% to 56%. This finding can help both clinicians and public health professionals target prevention.

The effect of forest fires on the prevalence of respiratory illnesses in children in Chile

The effect of forest fires on the prevalence of respiratory illnesses in children in Chile

Parainfluenza Virus Infection.

Human parainfluenza viruses (HPIVs) are single-stranded, enveloped RNA viruses of the Paramyoviridaie family. There are four serotypes which cause respiratory illnesses in children and adults. HPIVs bind and replicate in the ciliated epithelial cells of the upper and lower respiratory tract and the extent of the infection correlates with the location involved. Seasonal HPIV epidemics result in a significant burden of disease in children and account for 40% of pediatric hospitalizations for lower respiratory tract illnesses (LRTIs) and 75% of croup cases. Parainfluenza viruses are associated with a wide spectrum of illnesses which include otitis media, pharyngitis, conjunctivitis, croup, tracheobronchitis, and pneumonia. Uncommon respiratory manifestations include apnea, bradycardia, parotitis, and respiratory distress syndrome and rarely disseminated infection. Immunity resulting from disease in childhood is incomplete and reinfection with HPIV accounts for 15% of respiratory illnesses in adults. Severe disease and fatal pneumonia may occur in elderly and immunocompromised adults. HPIV pneumonia in recipients of hematopoietic stem cell transplant (HSCT) is associated with 50% acute mortality and 75% mortality at 6 months. Though sensitive molecular diagnostics are available to rapidly diagnose HPIV infection, effective antiviral therapies are not available. Currently, treatment for HPIV infection is supportive with the exception of croup where the use of corticosteroids has been found to be beneficial. Several novel drugs including DAS181 appear promising in efforts to treat severe disease in immunocompromised patients, and vaccines to decrease the burden of disease in young children are in development.

Genetic Lineage and Reassortment of Influenza C Viruses Circulating between 1947 and 2014.

Since influenza C virus was first isolated in 1947, the virus has been only occasionally isolated by cell culture; there are only four strains for which complete genome sequences are registered. Here, we analyzed a total of 106 complete genomes, ranging from the first isolate from 1947 to recent isolates from 2014, to determine the genetic lineages of influenza C virus, the reassortment events, and the rates of nucleotide substitution. The results showed that there are six lineages, named C/Taylor, C/Mississippi, C/Aichi, C/Yamagata, C/Kanagawa, and C/Sao Paulo. They contain both antigenic and genetic lineages of the hemagglutinin-esterase (HE) gene, and the internal genes PB2, PB1, P3, NP, M, and NS are divided into two major lineages, a C/Mississippi/80-related lineage and a C/Yamagata/81-related lineage. Reassortment events were found over the entire period of 68 years. Several outbreaks of influenza C virus between 1990 and 2014 in Japan consisted of reassortant viruses, suggesting that the genomic constellation is related to influenza C virus epidemics. The nucleotide sequences were highly homologous to each other. The minimum percent identity between viruses ranged from 91.1% for the HE gene to 96.1% for the M gene, and the rate of nucleotide substitution for the HE gene was the highest, at 5.20 × 10(-4) substitutions/site/year. These results indicate that reassortment is an important factor that increases the genetic diversity of influenza C virus, resulting in its ability to prevail in humans. IMPORTANCE Influenza C virus is a pathogen that causes acute respiratory illness in children and results in hospitalization of infants. We previously demonstrated (Y. Matsuzaki et al., J Clin Virol 61:87-93, 2014, http://dx.doi.org/10.1016/j.jcv.2014.06.017) that periodic epidemics of this virus occurred in Japan between 1996 and 2014 and that replacement of the dominant antigenic group occurred every several years as a result of selection by herd immunity. However, the antigenicity of the HE glycoprotein is highly stable, and antigenic drift has not occurred for at least 30 years. Here, we analyzed a total of 106 complete genomes spanning 68 years for the first time, and we found that influenza C viruses are circulating worldwide while undergoing reassortment as well as selection by herd immunity, resulting in an increased ability to prevail in humans. The results presented in this study contribute to the understanding of the evolution, including reassortment events, underlying influenza C virus epidemics.

Emergency Department Management of Febrile Respiratory Illness in Children.

There are limited data regarding testing and treatment patterns for children presenting to the emergency department (ED) with a febrile respiratory illness. The aims of the study were to evaluate the rates of diagnostic testing, antibiotic use, and pneumonia diagnosis among children presenting to an ED with a febrile respiratory illness and to evaluate whether differences exist on the basis of care at a pediatric versus a general ED. Cross-sectional study of children presenting to an ED with a febrile respiratory illness from 2001 to 2010 used the National Hospital Ambulatory Medical Care Survey. Using extrapolated estimates from the weighted population sample, rates of laboratory and radiographic testing, antibiotic use, and pneumonia diagnosis were ascertained. Comparisons were made between children treated at a general versus pediatric ED. A subpopulation of children undergoing chest radiograph was identified to target those with concern for radiographic pneumonia. Fifteen percent of the 12 million visits for febrile respiratory illness occurred in a pediatric ED. Thirteen percent (95% confidence interval [CI], 11-15) of patients had a complete blood count, 4% (95% CI, 3-5) had a blood culture, and 33% (95% CI, 30-35) had a chest radiograph obtained; no differences were observed on the basis of ED type. Despite similar rates of pneumonia diagnosis, antibiotics were prescribed less often for children cared for in a pediatric (35% [95% CI, 30-41]) versus general ED (50% [95% CI, 47-53]). Similar findings were observed among the subgroup of children with febrile respiratory illness undergoing chest radiograph. High rates of diagnostic testing were observed among children with febrile respiratory illnesses, despite low rates of pneumonia diagnosis. Antibiotic use was higher among children cared for at a general ED compared with pediatric ED.

Systematic Review and Meta-analysis of the Association Between Exposure to Environmental Tobacco Smoke and Periodontitis Endpoints Among Nonsmokers.

A systematic review was conducted to summarize the epidemiological evidence on environmental tobacco smoke (ETS) exposure and prevalent periodontitis endpoints among nonsmokers. We searched PubMed, EMBASE, Web of Science, Pro-Quest dissertations, and conference proceedings of a dental research association. We included studies from which prevalence odds ratios (POR) could be extracted for periodontitis determined by examiner measurements of clinical attachment level (CAL) and/or probing pocket depth (PD) or self-report of missing teeth. Studies determined ETS exposure by self-report or biomarker (cotinine) levels. For studies reporting CAL and/or PD (n = 6), associations were stronger with cotinine-measured exposure (n = 3; random effects POR [95% prediction interval] = 1.63 (0.90, 2.96)) than self-reported exposure (n = 3; random effects POR = 1.15 (0.68, 1.96)). There was no meaningful difference in summary estimate for studies reporting CAL and/or PD endpoint (n = 6; random effects POR = 1.34 (0.93, 1.94)) as opposed to tooth loss (n = 2; random effects POR = 1.33 (0.52, 3.40)). There appears to be a positive association between exposure to ETS and prevalent periodontitis endpoints among nonsmokers, the magnitude of which depended mostly on the method of ETS assessment. The notoriety of ETS is often discussed in terms of its associations with cancer, chronic conditions like cardiovascular diseases, and respiratory illnesses in children. However, very little attention is paid to its association with oral diseases, especially periodontitis. Periodontitis affects a large proportion of the population and is a major cause of tooth loss. This study summarized the epidemiologic association between exposure to ETS and periodontitis among nonsmokers. Although the findings are consistent with a positive association, methodological weaknesses relating to study design, assessment of ETS, periodontitis, and adjustment covariates were highlighted and recommendations for improvement in future studies provided.

Incidence of Medically Attended Respiratory Syncytial Virus and Influenza Illnesses in Children 6-59 Months Old During Four Seasons.

Background. Respiratory syncytial virus (RSV) and influenza are significant causes of seasonal respiratory illness in children. The incidence of influenza and RSV hospitalization is well documented, but the incidence of medically attended, laboratory-confirmed illness has not been assessed in a well defined community cohort. Methods. Children aged 6-59 months with medically attended acute respiratory illness were prospectively enrolled during the 2006-2007 through 2009-2010 influenza seasons in a Wisconsin community cohort. Nasal swabs were tested for RSV and influenza by multiplex reverse-transcription polymerase chain reaction. The population incidence of medically attended RSV and influenza was estimated separately and standardized to weeks 40 through 18 of each season. Results. The cohort included 2800-3073 children each season. There were 2384 children enrolled with acute respiratory illness; 627 (26%) were positive for RSV and 314 (13%) for influenza. The mean age was 28 months (standard deviation [SD] = 15) for RSV-positive and 38 months (SD = 16) for influenza-positive children. Seasonal incidence (cases per 10 000) was 1718 (95% confidence interval [CI], 1602-1843) for RSV and 768 (95% CI, 696-848) for influenza. Respiratory syncytial virus incidence was highest among children 6-11 (2927) and 12-23 months old (2377). Influenza incidence was highest (850) in children 24-59 months old. The incidence of RSV was higher than influenza across all seasons and age groups. Conclusions. The incidence of medically attended RSV was highest in children 6-23 months old, and it was consistently higher than influenza. The burden of RSV remains high throughout the first 2 years of life.

Homeopathic treatment of respiratory illnesses in children: results from two randomized trials

These studies were done to determine if homeopathic preparations are useful in the treatment of URI's in children, especially when there are no conventional treatments available and/or antibiotics are to be avoided. In the first study, children 6 months – 11 years old, diagnosed with AOM and managed with a delayed antibiotic approach, were randomized to standard therapy alone or standard therapy plus a homeopathic ear drop preparation. The primary outcome was whether or not an antibiotic prescription given at the index visit was filled; any antibiotic use was a secondary outcome. During the 12–15 day follow-up period, significantly fewer parents of children randomized to the homeopathic ear drops group filled the antibiotic prescription compared to those of children receiving standard therapy alone (26.9% and 41.2%, respectively, P = .032). In the second study, children ages 2–5 years old diagnosed with upper respiratory infection were randomized to receive a homeopathic combination product for cold and cough or a placebo. Parents were instructed to give a dose of study medication as needed for relief of URI symptoms up to 6 times per day for three days. Parents recorded changes in symptoms 1 hour after each dose, as well as changes in overall severity of URI symptoms in twice daily diaries. There was no difference in symptoms one hour after the dose between those receiving the homeopathic preparation compared to placebo. However, the homeopathic group reported a statistically significant improvement in 3 of the 4 URI symptoms at 12 and 24 hours after enrolment as well in a composite cold score. These studies should encourage health care providers to utilize homeopathy as an alternative to conventional therapies in the treatment of URI's in children.

Detection and Molecular Typing of Human Adenoviruses Associated with Respiratory Illnesses in Kerala.

Adenoviruses are responsible for approximately 5-10% of acute respiratory infections globally. However, there are a limited number of reports on the types of circulating respiratory human adenoviruses (HAdV) in India. We detected HAdV in the post-mortem specimens of a young child who died as a result of an acute febrile illness. To retrospectively investigate the circulating adenovirus types in the Alappuzha region, samples (n = 235) collected from patients with influenza-like illnesses who participated in the influenza surveillance program were screened for HAdV. Fourteen samples were identified as positive for adenovirus by PCR analysis. Adenovirus was isolated from 3 of the 14 PCR-positive samples cultured using HEK-293 cell lines. The viral strains isolated in the study were from children between 6 and 10 years of age. The isolates were identified as adenovirus species C and E. Sequencing analysis of the fiber gene and a BLAST search revealed that 2 of the isolates were type HAdV-C2, and the third isolate was a HAdV-E4. A fiber gene sequence-based phylogenetic tree showed that the HAdV-E4 isolate was similar to the Japanese HAdV-E4 strain, whereas the HAdV-C2 isolates formed a distinct cluster. Respiratory infections due to HAdV-E4 are generally observed in adults; this study is the first to demonstrate the involvement of the HAdV-E4 strain in respiratory illnesses in children.

Molecular Evolution and Intraclade Recombination of Enterovirus D68 during the 2014 Outbreak in the United States.

In August 2014, an outbreak of enterovirus D68 (EV-D68) occurred in North America, causing severe respiratory disease in children. Due to a lack of complete genome sequence data, there is only a limited understanding of the molecular evolution and epidemiology of EV-D68 during this outbreak, and it is uncertain whether the differing clinical manifestations of EV-D68 infection are associated with specific viral lineages. We developed a high-throughput complete genome sequencing pipeline for EV-D68 that produced a total of 59 complete genomes from respiratory samples with a 95% success rate, including 57 genomes from Kansas City, MO, collected during the 2014 outbreak. With these data in hand, we performed phylogenetic analyses of complete genome and VP1 capsid protein sequences. Notably, we observed considerable genetic diversity among EV-D68 isolates in Kansas City, manifest as phylogenetically distinct lineages, indicative of multiple introductions of this virus into the city. In addition, we identified an intersubclade recombination event within EV-D68, the first recombinant in this virus reported to date. Finally, we found no significant association between EV-D68 genetic variation, either lineages or individual mutations, and a variety of demographic and clinical variables, suggesting that host factors likely play a major role in determining disease severity. Overall, our study revealed the complex pattern of viral evolution within a single geographic locality during a single outbreak, which has implications for the design of effective intervention and prevention strategies. Until recently, EV-D68 was considered to be an uncommon human pathogen, associated with mild respiratory illness. However, in 2014 EV-D68 was responsible for more than 1,000 disease cases in North America, including severe respiratory illness in children and acute flaccid myelitis, raising concerns about its potential impact on public health. Despite the emergence of EV-D68, a lack of full-length genome sequences means that little is known about the molecular evolution of this virus within a single geographic locality during a single outbreak. Here, we doubled the number of publicly available complete genome sequences of EV-D68 by performing high-throughput next-generation sequencing, characterized the evolutionary history of this outbreak in detail, identified a recombination event, and investigated whether there was any correlation between the demographic and clinical characteristics of the patients and the viral variant that infected them. Overall, these results will help inform the design of intervention strategies for EV-D68.

Effects of Multiple Cleaning and Disinfection Interventions on Infectious Diseases in Children: A Group Randomized Trial in China

ObjectiveTo assess the effectiveness of multiple cleaning and disinfection interventions in the homes and kindergartens, in reducing gastrointestinal and respiratory illnesses of children. MethodsFrom October 2010 to September 2011, we performed a prospective, controlled study in China. 408 children under 5 years old were recruited and group randomized into intervention and control groups. Families and kindergartens in the intervention group were provided with antibacterial products for hand hygiene and surface cleaning or disinfection for one year. Each child's illness symptoms and sick leave were recorded every day. ResultsA total of 393 children completed the study, with similar baseline demographics in each of the 2 groups. Except for abdominal pain, the odds of symptoms (fever, cough and expectoration, runny nose and nasal congestion, diarrhea), illness (acute respiratory illness and gastrointestinal illness), and sick leave per person each month were significantly reduced by interventions. The rates of fever, diarrhea, acute respiratory illness, gastrointestinal illness and sick leave per person per year were significantly decreased as well. ConclusionNot only the acute respiratory and gastrointestinal illness but the sick leave rate in children were significantly reduced by multiple interventions.

Factors Associated with Respiratory Illness in Children and Young Adults with Cerebral Palsy

To describe associations between respiratory illness and its potential predictors in children and young adults with cerebral palsy (CP). Cross-sectional survey of self- and caregiver-reported respiratory symptoms for individuals aged up to 26 years with CP. Respiratory illness was indicated by 2 outcomes: (1) ≥1 respiratory hospitalizations in the past year; and (2) ≥2 courses of antibiotics for respiratory symptoms in the past year. ORs were calculated using univariate and multivariate logistic regression. There were 551 participants, aged 1-26 years, distributed across all gross motor function classification scale (GMFCS) levels. In univariate analyses, factors significantly associated with respiratory hospitalizations were weekly respiratory symptoms (OR 2.31, 95% CI 1.78-3.00), respiratory symptoms during meals (OR 3.23, 95% CI 1.50-5.80), gastroesophageal reflux (OR 3.01, 95% CI 1.71-5.31), coughing or choking on saliva (OR 4.36, 95% CI 2.38-8.01), current asthma (OR 3.56, 95% CI 1.97-6.42), age (0-3 years) (OR 3.24, 95% CI 1.19-8.80, compared with 13-17 years), seizures (OR 3.45, 95% CI 1.96-6.08), and scoliosis (OR 2.14, 95% CI 1.16-3.97). Nonambulatory individuals (GMFCS IV-V) were at significantly increased risk of hospitalizations only if they had food modifications and/or nasogastric or gastrostomy tube feeds (OR 5.36, 95% CI 2.89-9.96, compared with GMFCS I-III with no food modifications and no tube). All factors, except seizures and scoliosis, were significantly associated with multiple courses of antibiotics in univariate analyses. Oromotor dysfunction is strongly associated with respiratory illness in patients with CP.