Episodes Of Acute Respiratory Infections Research Articles

BASIC INDICATORS OF PHYSICAL DEVELOPMENT IN CHILDREN AGED 5-6 YEARS WITH RECURRENT RESPIRATORY INFECTIONS

Background. Recently, scientific publications on various aspects of the problem of recurrent respiratory infections in preschool children have paid increasing attention to identifying influential factors contributing to frequent episodes of acute respiratory infections (ARI). In particular, these factors include significant deviations in children's physical development from standard values.
 Aim: to find out the relationship between the frequency of ARI episodes in children aged 60-83 months and their basic anthropometric indicators.
 Materials and methods. A total of 71 children (44 boys and 27 girls) aged 60-83 months, undergoing inpatient treatment on ARI, were involved in the clinical study.
 The number of ARI episodes during the previous year of their life was taken into account. Additionally, two integral indices of ARI recurrence, specifically the infection index (InI) and resistance index (RI), were calculated. The basic indicators of physical development were assessed in the children, including: 1) body weight; 2) body length; 3) body surface area; 4) body mass index; 5) chest circumference (CC); 6) integral index of dolichostenomelia. For the comparative analysis of the results obtained, the current standards of physical development indicators for children from the World Health Organization were used. The statistical processing of the digital data was performed with IBM SPSS Statistics 28 licensed software.
 Results. Rank correlation analysis and cross-tabulation did not demonstrate any interdependence between InI and RI, on the one hand, and the anthropometric indicators considered, on the other hand. Meanwhile, there was a very strong direct correlation between InI and RI (ρ=0.983; p<0.001; 95% CI: 0.972-0.989) in the examined children. Linear regression analysis revealed the dependence of InI and RI on CC size (p<0.001). At that, the degree of the impact of CC size on these clinical indices was almost the same, constituting 7.7% and 7.5%, respectively.
 Conclusion. Thus, according to the data obtained, the contribution of СС size to the susceptibility of children aged 60-83 months to recurrent respiratory infections among other potential risk factors is insignificant. However, given the widely recognized diversity of mentioned factors, the result deserves due attention. This should be accounted while developing the final integrated model for predicting the frequency of ARI episodes in preschool children.

Комплексна оцінка постнатальних факторів ризику рекурентних респіраторних інфекцій у дітей дошкільного віку

Purpose - to determine the influence degree of particular postnatal risk factors to the likelihood of the recurrent course of acute respiratory infections (ARI) in preschool children. Materials and methods. Three hundred and fourteen children (176 boys and 138 girls) aged 1 to 6 years old, undergoing inpatient treatment on ARI, were involved in the clinical study. The number of ARI episodes during their previous year of life, as well as the presence or absence of 19 potential postnatal risk factors associated with recurrent respiratory infections (RRI), were taken into account for the examined children. Additionally, two integral indices of ARI recurrence, namely the infection index (InI) and resistance index (InR), were calculated. The statistical processing of the primary digital data obtained was performed by IBM SPSS Statistics 28 licensed program. A сross-tabulation method was applied to compute the odds ratio (OR) and its 95% confidence interval (CI). Results. The difference between the age subgroups of the examined preschool children in the ARI episodes number during their previous year of life was demonstrated (H=11.243; p=0.047). First of all, the higher incidence of ARI was detected among the patients aged 36 to 71 months compared with those aged 12 to 35 months. Besides, the weak but significant correlation was revealed between six stratified age subgroups of children and their clinical diagnoses (φc=0.183; p=0.006). The studied integral indicators of the recurrent course of ARI (InI and InR) are inversely correlated with the majority of the postnatal risk factors considered, with the degree of the relationship strength being higher for InR than for InI. Conclusions. The majority of the potential RRI risk factors registered, namely 10 out of 19, separately increase the probability of children belonging to the group with more frequent ARI episodes. The most significant risk factors of RRI were as follows: 1) breastfeeding for 0-4 months after birth (OR=2.868; p<0.001; 95% CI: 1.681-4.895), 2) an older child in a family attending an organized childhood group (OR=2.814; p<0.001; 95% CI: 1.662-4.763); 3) second-hand smoke exposure (OR=2.537; p<0.001; 95% CI: 1.509-4.267). The prevalence of the studied RRI risk factors among the preschool children does not correlate with their significance in contributing to more frequent ARI episodes. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the author.

Лінійний регресійний аналіз впливу біоелементів на частоту гострих респіраторних інфекцій у дітей дошкільного віку

Purpose - to identify the bioelements having the most significant impact on the susceptibility of preschool children to frequent episodes of acute respiratory infections (ARI). Materials and methods. A total of 30 children (14 boys and 16 girls) aged 1-6 years, undergoing inpatient treatment on ARI, were involved in the clinical study. Two integral indicators of acute respiratory infections recurrence, i.e. the infection index and the resistance index, were taken into account for each patient. The children were tested by X-ray fluorescence analysis of 17 bioelements in their hair - Zn, Fe, Cu, Se, Mn, Cr, Co, Br, Ni, Rb, Sr, Sn, Pb, Ca, K, S, and Cl. The statistical processing of the obtained digital material was performed with IBM SPSS Statistics 28 licensed software. A linear regression analysis with stepwise involvement of predictors was applied. Results. In preschool children, there is a moderate negative correlation between hair Rb content and the calculated resistance index (ρ=-0.405; p=0.026; 95% CI: (-0.674)-(-0.042)), according to which lower concentrations of this bioelement are associated with more frequent episodes of ARI. Additionally, Rb has a statistically significant pairwise relationship with several other bioelements studied and the ratios between them. Rb was demonstrated to be directly and most closely correlated with K (ρ=0.842; p<0.001; 95% CI: 0.678-0.926). A prognostic model of the resistance index was obtained, using the linear regression analysis of independent factors. The formula of the prognostic model included only one of the factors studied - the ratio of Mn/Cr content in hair. The informativeness of the mentioned model was 24.9%, which is a quite significant value, taking into consideration a broad range of known predictors for recurrent respiratory infections. Conclusions. The findings are complementary to the available scientific data on the participation of the bioelements in providing resistance to frequent ARI in preschool children. It is planned to continue examining the status of particular bioelements in combination with other potential predictors of recurrent respiratory infections. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the authors.

Сімейні фактори ризику рекурентного перебігу гострих респіраторних інфекцій у дітей віком 2-5 років

Purpose - to find out the influence degree of particular family risk factors on the propensity of preschool children to the recurrent course of acute respiratory infections (ARI). Materials and methods. A total of 237 children (128 boys and 109 girls) aged 2-5 years, undergoing inpatient treatment on ARI, were involved in the clinical study. Initially, the number of ARI episodes were taken into account for the examined children during the previous year of their lives as well as the presence or absence of 19 potential family risk factors associated with recurrent respiratory infections (RRI). In addition, 2 integral indices of ARI recurrence - the infection index (InI) and the resistance index (RI) - were calculated. The statistical processing of the digital material obtained was performed using IBM SPSS Statistics 28 licensed software. The odds ratio (OR) was calculated by crosstabulation. Besides, the Kaplan-Meier method with adjusted indicators was applied for statistical analysis. Results. The studied integral indicators of ARI recurrent course - InI and RI - are inversely correlated with the majority of the considered family risk factors, and the degree of connection strength for InI and RI is approximately the same. Almost 50% of the examined risk factors for RRI, specifically 9 out of 19, rise the chance of children belonging to a group with more frequent episodes of ARI. The most significant RRI risk factors were as follows: 1) mother’s and father’s susceptibility to RRI during their preschool age (OR=3.529; p<0.001; 95% CI: 1.791-6.954); 2) the presence of other children in family who have or had a tendency to RRI (OR=2.945; p=0.009; 95% CI: 1.292-6.717); 3) mother’s susceptibility to RRI during her preschool age (OR=2.742; p<0.001; 95% CI: 1.495-5.029); 4) maternal full-time employment at work during the previous year (OR=2.364; p=0.005; 95% CI: 1.287-4.342); 5) maternal and paternal secondary education (OR=2.333; p=0.031; 95% CI: 1.069-5.095). Conclusions. The prevalence of reported RRI risk factors among preschool children does not correlate with their significance in contributing to more frequent episodes of ARI. The Kaplan-Meier method makes it possible to determine the average and median age of children when the frequency of ARI episodes reaches the established threshold level under the influence of the considered risk factors for RRI. The results obtained substantiate the reasonability of using combined statistical methods to detect the most significant RRI risk factors and their combinations in preschool children. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the authors.

1789. Comparison of influenza vaccine effectiveness estimates from the US Influenza Vaccine Effectiveness Network and Electronic Health Record Source Population Data, 2021-2022

Abstract Background The COVID-19 pandemic led to increased respiratory viral testing for patients presenting with acute respiratory infection (ARI). Electronic health record (EHR) data from these visits can be used to assess influenza and COVID-19 vaccine effectiveness (VE). We compared VE data from participating healthcare institutions with VE against medically attended influenza among systematically tested patients actively enrolled in the US Flu VE Network. Methods During the 2021-2022 influenza season, seven sites in the US Flu VE Network identified medically attended episodes of ARI in ambulatory settings based on ICD-10 diagnostic codes and clinical influenza and SARS-CoV-2 testing. Influenza status was determined from the clinical test results. Vaccination status was extracted from the EHR. During the same period, patients with ARI presenting at ambulatory clinics were actively enrolled and tested for influenza. VE and 95% confidence intervals (CI) were estimated comparing the odds of vaccination among influenza-positive versus influenza-negative patients using logistic regression models controlling for age, site, and calendar time. Results During the 2021-2022 season, 220,162 medical visits for ARI with clinical testing were identified; 2% of tests were influenza positive, 26% were SARS-CoV-2 positive and 73% were negative for both. Overall, 34% of influenza positive and 42% of influenza negative patients had received influenza vaccines; VE using EHR data was 34% [95% CI 29-38]. Among 6,260 enrolled patients, 7% tested positive for influenza, 34% were SARS-CoV-2 positive and 62% were negative for both. Overall, 42% of influenza positive and 59% of influenza negative patients had received influenza vaccines. VE using enrolled patient data was 36% [95% CI 20-49]. VE using EHR data was 35%, 34%, and 6% for patients aged 6 months-17 years, 18-49, and 50+ years versus 40%, 32%, and 10% for enrolled patients. Conclusion EHR based influenza VE estimates were similar to estimates from the US Flu VE study. Through continued widespread clinical testing, EHR-based platforms may present opportunities to assess VE in sub-groups with insufficient sample size in active surveillance. Disclosures MaryPatricia Nowalk, PhD, RDN, Merck & Co.: Grant/Research Support|Merck & Co.: Honoraria|Sanofi: Grant/Research Support Emily T. Martin, PhD, MPH, Merck: Grant/Research Support Edward Belongia, MD, Seqirus: Grant/Research Support Carlos G. Grijalva, MD, MPH, AHRQ: Grant/Research Support|CDC: Grant/Research Support|FDA: Grant/Research Support|Merck: Advisor/Consultant|NIH: Grant/Research Support|Syneos Health: Grant/Research Support

Risk factors of recurrent respiratory infections in early school-age children

Acute respiratory infections (ARIs) annually rank first in the structure of infectious diseases both in Ukraine and worldwide. ARIs are the leading cause of disability and death in preschool children, and with recurrent episodes, they can impact the physical and psychological aspects of children's health, imposing a significant medical burden on families, healthcare systems, and society as a whole. Preventing recurrent respiratory infections (RRIs) can only be achieved through timely intervention in risk factors.Aim: to determine the influence of risk factors on the development of recurrent episodes of acute respiratory infections in children aged 5 to 7 years and to develop preventive measures for their control in primary healthcare settings.Materials and Methods. The authors retrospectively analyzed medical records of 342 children aged 5 to 7 years. The main group included children with RRIs (264), and the control group consisted of children with sporadic illness episodes (78). Results: the incidence of RRIs in children has two peaks at ages 3 and 6, which is likely associated with the commencement of attendance in childcare settings (kindergarten and school). Key prenatal and postnatal, clinical-anamnestic, and social risk factors that increase the likelihood of recurrent respiratory infections in younger school-age children were identified.Conclusions. factors significantly increasing the likelihood of developing RRIs in a child include: ARI episode within the first 6 months of life (OR = 22, 95% CI 11.6 - 41.7), previous pneumonia (OR = 12, 95% CI 3.7 - 40), and the presence of chronic infection foci in the form of tonsillitis (OR = 8.2, 95% CI 4.3 - 15.6), p=0.0001. Primary healthcare practitioners should follow strategies to modify these risk factors and not wait for further depletion of the child's adaptive potential (sanitation of chronic infection foci, promotion of breastfeeding, and tobacco cessation).

The effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children

Background. Recurrent and prolonged course of respiratory infections leads to the formation of chronic foci of inflammation, the persistence of viruses, impaired physical and psychomotor development, and a decrease in the child’s immunity. Given the participation of vitamin D (VD) in the regulation of the body’s immune response, the study of its role in the development and course of recurrent respiratory diseases in children remains re­levant. The purpose is to study the effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children. Materials and methods. We examined 52 children with recurrent respiratory infections aged 4 to 10 years. Children were examined before and after VD supplementation according to the study criteria: the average frequency of acute respiratory infection (ARI) episodes per year, the severity of the clinical manifestations of ARI episode, its average duration, the frequency of antibiotic prescriptions and outpatient visits to the doctor. Results. It was found that at the beginning of the exa­mination, the level of 25(OH)D in the blood serum ranged from 11.1 to 29.9 ng/ml, 22 (42.3 %) children had VD deficiency. An analysis of the frequency of ARI episodes per year showed that children with VD deficiency were ill more often than children with a sufficient level of VD (p < 0.001). According to the results of the study, it was found that VD supplementation contributes to a decrease in the frequency of ARI episodes from 8.7 ± 1.7 to 6.8 ± 1.2 times a year (p < 0.001), a decrease in the average number of symptoms of an episode of acute respiratory infections per year from 5.5 ± 0.5 to 4.5 ± 0.5 and their manifestations from 9.2 to 7.41 points (p < 0.001), a decrease in the duration of ARI episode from 6.0 ± 1.7 to 5.7 ± 1.5 days (p = 0.003), as well as a decrease in the number of outpatient visits from 5 to 4 (p = 0.004) and antibiotic prescriptions from 61 to 38 (p < 0.001). Conclusions. VD supplementation improves the course of respiratory diseases in children. The study was carried out in accordance with the Declaration of Helsinki principles. The study protocol was adopted by the ethics committee of the institution indicated in the work. The informed consent of the children’s parents was obtained.

Role of low dose iron intake on acute respiratory tract infection in infants: A longitudinal study

Background: Anaemia and respiratory tract infections are common problems among infants and a complex relationship exists between iron status and infection. Studies on possible role of iron supplementation to prevent respiratory tract infection in healthy infants are needed so that strategies could be made at the community level to reduce its burden. Objectives: To study the effect of iron intake on the incidence of acute respiratory infection (ARI) in healthy infants. Method: A longitudinal study was done in 106 infants at the paediatric department of a teaching hospital, in which infants coming for routine vaccination with haemoglobin levels ≥10g/dl were divided into two groups after computer generated randomization. Group A received 2mg/kg/day of iron for 3 months and Group B received no supplementation. Episodes of respiratory tract infection were recorded. Follow up was done at 4, 8 and 12 weeks and at 6 months for new episodes of ARI. Growth was monitored. Data were analysed using Mann-Whitney U test, Chi square test and Student ‘t’ test via SPSS version 20.0. Results: After 6 months of follow up, mean haemoglobin in the iron supplemented group (12.76±0.63g/dl) was significantly higher than in the non-supplemental group (11.29±0.98g/dl) (p<0.001), when the baseline haemoglobin levels in both groups were comparable. The incidence of ARI was 66% lower in the iron supplemented group compared with the group with no supplementation (IRR=0.34, 95%CI=0.19-0.59, p=0.0001) Conclusions: Iron supplementation in infants improves their haemoglobin status and decreases episodes of ARI in them.

CATION COMPOSITION OF ORAL SECRETION IN PRIMARY SCHOOL-AGED CHILDREN

SUMMARY. Recurrent respiratory infections (RRIs) currently have the greatest medical and social burden among infectious diseases worldwide, with the highest prevalence and incidence rates of acute respiratory infections in children. Recent studies indicate the role of inadequate immune response and the development of recurrent acute respiratory infections (ARI) in children due to deficiencies in essential trace elements in the body, which are crucial for the proper functioning of physical barriers and the immune system. The hypothesis of our study assumed that, considering the recurrence of at least 6 episodes of ARI per year, children with RRIs may have changes in salivary ion levels, which could serve as a basis for local immune suppression of the upper respiratory mucosa. The aim – to investigate the levels of metals in the saliva of children of primary school age with recurrent respiratory infections in comparison with episodically ill peers and establish the relationship of these changes with the state of local immunity. Material and Methods. In the actual study, 40 children participated, with 30 of them (the main group) being children with recurrent respiratory infections and 10 other children who had episodic illnesses were assigned to the control group. The levels of metal cations in the saliva were examined using inductively coupled plasma atomic emission spectrometry, including essential metals such as copper, manganese, zinc, calcium, cobalt, potassium, magnesium, sodium, phosphorus, selenium, iron, chromium, and sulfur. Additionally, levels of conditionally essential metals like lithium, nickel, and boron were measured. The levels of secretory IgA and lysozyme in saliva were determined using the enzyme-linked immunosorbent assay method. Results. The main group was not homogeneous; therefore, we divided it into two clusters. Respondents in one cluster had significantly lower relative levels of essential ion content in saliva. Specifically, calcium was lower in 64 % (p=0.003), copper in 76.5 % (p=0.001), manganese in 41.1 % (p=0.008), magnesium in 64 % (p=0.02), and zinc in 58.8 % (p=0.027). This fact can be explained by their increased losses due to frequent inflammatory processes in the upper respiratory tract, resulting in higher daily replenishment needs compared to their peers. Correlation analysis revealed a connection between illness incidence and the levels of copper (p=0.008), sodium (p=0.00005), and phosphorus (p=0.028), indicating potential associations between saliva metal profiles and the frequency of ARI in children with RRIs. The presence of dental caries correlated with lithium (p=0.02), copper (p=0.032), and nickel levels (p=0.037). Integral indicators of local immunity, such as lysozyme and secretory IgA, exhibited correlations with metal levels in saliva (Li, Cu, Ni, Na, Co, P, Zn), confirming the hypothesis of their role in regulating immune reactions in the oral cavity. Conclusions. Cluster analysis of the metal profiles of the group of children with RRI shows its heterogeneity, 43 % of representatives of this cohort had significantly lower levels of calcium (p=0.003), copper (p=0.001), manganese (p=0.008), magnesium (p=0.02) and zinc (p=0.027) than the control group. Which may indicate the presence of deficient conditions in some children with PRI as a result of the increased need for their recovery. The presence of caries, the level of SIgA, lysozyme (clinical indicators of local immunity of the oral cavity) have certain relationships with the levels of essential and conditionally essential levels of salivary metals (Li, Cu, Ni, Na, Co, P, Zn), which indicates the benefit of the connection between the metal profile of saliva and the state of local immunity.

Randomised controlled trial of perinatal vitamin D supplementation to prevent early-onset acute respiratory infections among Australian First Nations children: the ‘D-Kids’ study protocol

IntroductionGlobally, acute respiratory infections (ARIs) are a leading cause of childhood morbidity and mortality. While ARI-related mortality is low in Australia, First Nations infants are hospitalised with ARIs up to...

Clinical and immunological characteristic of children with recurrent episodes of acute laryngotracheitis, acute respiratory infections, otorhinolaryngological deseases

Introduction. Researching on pathogenesis and immunopathogenesis of acute respiratory infections in conjunction with recurrent episodes of acute laryngotracheitis and otorhinolaringological diseases (tonsillopharyngitis, rhinosinusitis, otitis) — is a high priority task for pediatrics, what is necessary to do to create an approach for preventing chronic illnesses.The aim of the present work. Researching on clinical and immunological characteristics and efficiency of treatment with prescription of bacterial lysate (OM-85) for children with recurrent episodes of acute laryngotracheitis, acute respiratory infections (ARI), otorhinolaringological diseases.Materials and methods. Fifty children 3-9 years old (32 children 3-6 years, 18 children 7-9 years old; 32 boys, 28 girls) in the initial period of monitoring, with recurrent episodes of acute laryngotracheitis (ALT), acute respiratory infections (ARI), otorhinolaryngological diseases were examined. The treatment in according with pediatric clinical practice guidelines, consultations with a pediatrician, otorhinolaryngologist, allergologist were provided to all children.Twenty five children (subgroup I b) received bacterial lysate (OM-85, 4 courses in 3 years ) in complex treatment. Subgroups I a, I b were similar in clinical symptoms, gender and age related. Follow up period continued three years. The results were evaluated a year and three years after treatment. Experimental group was composed of 30 children 3-9 years old, additionally examined. This group had such characteristics as: frequency of acute respiratory infections 3-5 times in a year, absence of chronic respiratory diseases, of recurrent episodes of acute laryngotracheitis. Immunological survey included some parameters of innate immunity, serum immunoglobulins, chemiluminescence, interferons (IFN-alfa, IFN-gamma).Results. In children with repeated episodes of ALT and ARI and otorhinolaryngological diseases the expression of TLR2 and TLR4 on CD14+ cells, receptors for IFN-γ (CD14+CD119+) is significantly higher than in children without ALT and with a frequency of ARI 3-5 times a year, which is accompanied by a decrease in the level of IFN-γ and IFN-α and is associated with the development of dysregulation of the immune system, which decreases with the administration of bacterial lysate (OM-86). Complex treatment of children within 3 years with the prescription of the drug significantly reduces the frequency of ARI — 2.6 times, tonsillopharyngitis — 1.8 times, rhinosinusitis — 2.2 times, the need for the prescription of antibiotics — 2.2 times. In the group treated by standards after 3 years, the need for antibiotics decreased by 1.6 times, the frequency of ARI exacerbations — by 1.2 times, tonsillopharyngitis — by 1.5 times, rhinosinusitis — by 1.8 times.

Immunomodulating agent Galavit for the prevention of frequent acute respiratory viral infections after COVID-19: A review

Many convalescents of the new coronavirus infection caused by the SARS-CoV-2 virus, including mild and moderate severity, have frequent acute respiratory viral infections (ARVI) and other diseases of the ENT organs during the first 6 months after recovery. A well-known problem of COVID-19 is immune disorders due to the negative impact of the virus on the immune system, which is associated with various consequences described as a post-COVID syndrome. One of the manifestations of post-COVID syndrome is a decrease in infection resistance due to the immunodeficiency state. In particular, exacerbations of bacterial and viral ENT diseases, frequent ARVI, and exacerbation of herpes virus infection were reported. Moreover, the infections tend to be prolonged, cyclic, and often recurrent, significantly reducing patients' physical activity and quality of life. ARVI symptoms, accompanying the post-COVID syndrome, negatively affect the general condition of patients. Immunocorrection can interrupt the vicious circle of recurrent ARVI and restore impaired immunity after COVID-19. The immunomodulatory drug Galavit has a pathogenetic basis for use in the post-COVID period to restore the immune system. It was shown effective in preventing frequent recurrent ARVI and herpes virus infection in patients in the post-COVID period. The article shows the experience of using Galavit in coronavirus infection convalescents with frequent episodes of acute respiratory infections.

Sources of antibiotics for acute respiratory infection in children aged <5 years children in South Asia: A multicountry study

Background: In South Asia, a region of almost 2 billion people across 8 countries, acute respiratory infections (ARIs) are associated with significant morbidity and mortality in children aged <5 years. Although ~80% of ARIs are due to viral etiology and are often self-limiting, they remain the single largest reason for antibiotic use in children aged <5 years in South Asia. We investigated the sources and dispensing pattern of antibiotics for ARIs in children aged <5 years in South Asia. Methods: We analyzed nationally representative, population-based, publicly available household survey data from 6 South Asian countries’ Demographic and Health Surveys (DHS): Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. The outcome of interest was the source of antibiotics for children aged <5 years who reportedly had symptoms compatible with ARI (cough, fever, and runny nose) and had received antibiotics for the ARI episode in the 2 weeks preceding the survey. We used a generalized estimating equation with an exchangeable correlation structure to account for country-specific cluster-level correlation to estimate the odds of sources of antibiotics usage. Models were adjusted for age, sex, type of place of residence, wealth index, and parents’ education. To analyze the data, we used the sample weight supplied by the DHS to ensure that our results appropriately reflect the target population in each of the countries studied. Results: In total, across the 6 South Asian countries, 24,104 children aged <5 years had symptoms of ARI, 7,587 (31%; 95% CI, 30–33) from received antibiotics. A higher proportion of antibiotic usage for ARIs episodes occurred in Afghanistan (66%), followed by Maldives (53%), Pakistan (45%), and Nepal (43%). Regarding the source of antibiotics, a higher proportion of antibiotics was obtained from the private medical sector in India, followed by unqualified sources in Bangladesh, and the public sector in Afghanistan. Our adjusted multivariable analysis revealed that, in comparison to the public sector, participants were 2.6 times (aOR, 2.6; 95% CI, 1.6–4.3) more likely to receive antibiotics from private medical sector drug sources in Nepal and 1.3 times more likely (aOR, 1.3; 95% CI, 1.1–1.5) in Afghanistan. Conclusions: In South Asian countries, the private medical sector was the most common primary source of antibiotics for children with ARIs. Targeted efforts to create awareness around antibiotic dispensing and guidelines to improve practices may curtail the use of antibiotics for ARIs in children aged <5 years in South Asia.Disclosures: None

A Randomized Controlled Trial on Zinc Supplementation for Prevention of Acute Respiratory Infections in Infants

There is little evidence that zinc supplementation will be effective in treating acute respiratory infection (ARI), but it may prevent respiratory infections when taken in conjunction with antibiotics. Objective: To assess the zinc supplementation for acute respiratory infection prevention in infants. Methods: A randomized controlled trail was conducted on 120 acute respiratory infected infants in Pediatric Unit, Qazi Hussain Ahmad Medical Complex, Nowshera from 1st January 2022 to 30th June 2022. Infants having 6-14 months of age with acute respiratory infections were enrolled. Infants were allocated to two groups: Group-I infants receiving Zinc (20 mg/5 mL) in terms of Zinc sulphate (N=60) and Group-II infants taking syrup (Placebo) (N=60). Results: Of the total 220 episodes, the frequency of episodes in zinc and placebo group was 106 and 114 respectively, accounting for 7.78 and 8.68 per child year after 5 months. Based on GEE regression model observed an insignificant decrease of 8% (Adjusted IRR 0.89, 95% CI 0.79-1.01) in episodes of acute respiratory infections in zinc group as compared to placebo group. However, acute respiratory infections episodes (Adjusted IRR 0.36, 95% CI: 0.25-0.35) decreased by 60% in zinc group. Zinc supplementation reduced the acute respiratory days significantly by 14% (Adjusted RR 0.83, 95% CI: 0.76-0.92). Conclusions: Prophylactic zinc supplementation for two weeks decreased acute lower respiratory tract infection morbidity in apparently healthy infants and improved the infant’s recovery from acute respiratory infections and reduced their hospitalization as compared to placebo group

Роль витамина D в профилактике острых респираторных инфекций: систематический обзор и мета-анализ

Reducing the risk of acute respiratory infections (ARIs) through vitamin D administration is a common preventive strategy used in routine clinical practice. However, the results of clinical trials are often controversial, which makes it necessary to summarize data available so far in order to develop more clear and well-founded clinical guidelines. Materials and methods. This meta-analysis was conducted to summarize the evidence on the preventive efficacy of vitamin D3 (cholecalciferol) against ARIs among adults using the results of randomized clinical trials (RCTs). The primary endpoint in all included studies was the absolute proportion of participants diagnosed with at least one ARI episode (upper/lower respiratory tract infections or infections of mixed locations) during the follow-up period. Results. We found that vitamin D3 intake (n = 11,276) was effective for preventing ARIs vs placebo (n = 10,955): in a random effects model, the odds ratio (OR) was 0.82 (95% confidence interval (CI): 0.69–0.98; p = 0.0355), whereas the number needed to treat (NNT) was 20.43 (between 10.70 and 255.67). There were no differences in efficacy between daily, weekly, or monthly intake of vitamin D3 (p = 0.7884). Given that 7 out of 13 studies included in this meta-analysis analyzed daily vitamin D3 intake and only 1 study assessed weekly intake, we can conclude that daily dosing, in general, has a broader evidence base. Conclusion. Thus, daily intake of D3 at a dose of ≥ 2000 IU/day (NNT = 20.43) was the most effective and studied strategy for preventing ARIs among adults. Key words: acute respiratory viral infections, influenza, COVID-19, nonspecific prevention, vitamin D3, colecalciferol

Study on acute respiratory infection in children aged 1 year to 5 years-A hospital-based cross-sectional study.

Acute respiratory infections (ARIs) are the single greatest cause of death among children throughout the world. They are responsible every year for the deaths of 4.3 million children under 5 years of age worldwide. Community- or hospital-based surveys for finding out the prevalence and various factors associated with ARI are very few, especially in urban areas. Also, surveys to study the use of vaccines in preventing ARIs are scarce. Hence, we studied ARI in children aged 1 year to 5 years in a tertiary care hospital in Kerala. The aim was to determine the frequency of ARIs in the last 1 year in children aged 1 year to 5 years, attending the immunization clinic at Lourdes Hospital, Kochi, and assess the selected epidemiological, socio-demographic, nutritional and immunization factors associated with ARIs in the study group. Children attending the immunization clinic at a tertiary care hospital, Kochi, in the age group of 1 year to 5 years were selected. A brief introduction was given to the mother/caregiver of the child regarding the purpose of the study and was asked to fill out the questionnaire. Informed consent was taken. For the study, ARI is defined as the presence of one or more of the following: cough, running nose, blocked nose, sore throat, difficulty breathing, or ear problems; with or without fever. Results were analyzed. Mother was the caregiver in 67% of the cases. When the caregiver was the mother, ARI is found to be less. Among those mothers who had no formal education, 100% of their children got ARI. Children whose caregivers were 30 years and older had lesser ARI. The proportion of children with ARIs was more with a history of respiratory infection among family members (parents/siblings) compared to those with no such history. The occurrence of ARI was more frequent in rural compared to urban areas. There is a significant proportion of ARI in non-exclusively breastfed infants, bottle feeding, and early initiation of complementary feeding. Children with a history of exposure to cigarette smoke had an increased occurrence of ARI. Similar results followed for exposure to biomass fuel and exposure to cold and rain. Children who were not immunized to vaccines-pneumococcal, Hib, measles, vitamin A, showed a higher occurrence of ARI compared to immunization. The studies regarding factors influencing ARI are relatively rare in an urban setting, thus this calls for more studies in urban areas. Health education can change the healthcare-seeking behavior and attitude of parents for preventing ARI-related deaths. Family physicians can play a significant role by educating caregivers of children and giving timely services. Promoting and ensuring exclusive breastfeeding practices, timely weaning after 6 months, and avoidance of bottle feeds can dramatically decrease the episodes of ARI.

Роль функционального питания в снижении заболеваемости острыми респираторными инфекциями у детей

Objective. To study the role of adapted formulas and drinks in reducing the incidence of acute respiratory infections (ARIs) in infants and toddlers. Patients and methods. This study was conducted in two stages: stage 1 included infants (0–1 year) (n = 105), and stage 2 included the same children aged 1 to 3 years (n = 96). In the control group (n = 35, 0–1 year; n = 32, 1–3 years), children were breastfed during the first year of life. In the study group (n = 35, 0–1 year; n = 32, 1–3 years), children received adapted formulas and drinks based on New Zealand goat’s whole milk: between 1 and 5 months – NANNI 1; from 6 months – NANNI 2; between 1 and 3 years – NANNI 3 in the amount of 200 mL/day. In the comparison group (n = 35, 0–1 year; n = 32, 1–3 years), children received an adapted milk formula based on whole cow’s milk protein: formula 1 in the first 6 months of life, formula 2 in the second 6 months of life, and formula 3 between the ages of 1 and 3 years in the amount of 200 mL/day. At the first and second stages, we evaluated the incidence of ARI episodes during the year and mucosal immunity parameters: cellular composition of smears, cytomorphological features and functional activity of neutrophils (phagocytosis, intracellular biocide concentration, intraleukocytic enzyme systems: myeloperoxidase, cationic proteins, acid phosphatase). Results. The mean number of ARI episodes during the first and second stages in the study group (2.3) did not differ from the control group (1.8, p > 0.05). The incidence of ARIs was higher in the comparison group (3.6; p < 0.05). The content of the main cell populations in the rhinocytogram (neutrophils, lymphocytes, eosinophils, epithelial cells) at the first and second stages was comparable in children in the study and control groups; in these groups, fewer cells with pronounced damage and higher phagocytic activity of neutrophils were recorded. The maximum levels of enzyme systems were registered in children in the control group (myeloperoxidase: 0.41 OD × 10-3; acid phosphatase: 0.39 OD × 10-3; cationic proteins: 0.29 OD × 10-3). The levels of enzyme systems in the study group at the first and second stages were comparable. Conclusion. A lower incidence of ARIs, optimal body resistance both in infants and toddlers develop against the background of breastfeeding. Children who received formulas based on New Zealand goat’s milk had higher resistance compared to those who received adapted milk formulas based on whole cow’s milk protein, and their mucosal immunity parameters approached the values of these parameters in breastfed infants. Key words: children, infants and toddlers, functional nutrition, adapted formulas, acute respiratory infections

Association of household fuel with acute respiratory infection (ARI) under-five years children in Bangladesh.

In developing countries, acute respiratory infections (ARIs) cause a significant number of deaths among children. According to Bangladesh Demographic and Health Survey (BDHS), about 25% of the deaths in children under-five years are caused by ARI in Bangladesh every year. Low-income families frequently rely on wood, coal, and animal excrement for cooking. However, it is unclear whether using alternative fuels offers a health benefit over solid fuels. To clear this doubt, we conducted a study to investigate the effects of fuel usage on ARI in children. In this study, we used the latest BDHS 2017-18 survey data collected by the Government of Bangladesh (GoB) and estimated the effects of fuel use on ARI by constructing multivariable logistic regression models. From the analysis, we found that the crude (the only type of fuel in the model) odds ratio (OR) for ARI is 1.69 [95% confidence interval (CI): 1.06-2.71]. This suggests that children in families using contaminated fuels are 69.3% more likely to experience an ARI episode than children in households using clean fuels. After adjusting for cooking fuel, type of roof material, child's age (months), and sex of the child-the effect of solid fuels is similar to the adjusted odds ratio (AOR) for ARI (OR: 1.69, 95% CI: 1.05-2.72). This implies that an ARI occurrence is 69.2% more likely when compared to the effect of clean fuel. This study found a statistically significant association between solid fuel consumption and the occurrence of ARI in children in households. The correlation between indoor air pollution and clinical parameters of ARI requires further investigation. Our findings will also help other researchers and policymakers to take comprehensive actions by considering fuel type as a risk factor as well as taking proper steps to solve this issue.

Costs of management of acute respiratory infections in older adults: A systematic review and meta-analysis.

Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice. We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated. A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged <65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively. ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions.

Vitamin D3 in acute respiratory infections in patients under age five in a health institution in Colombia

Aim. describe the clinical behavior in acute respiratory infections in patients under age five in a Colombian health institution after VD3 administration. Trial studies are required to determine this potential benefit. Material and Methods. A performed series of 38 patients of both genders, aged 0-60 months to whom 50,000 units of VD3 were orrally administered per month for three months is described. The number of episodes, visits to the emergency room, and hospitalizations due to acute respiratory infections (ARI) before and after VD3 administration were described. Results. The average age of the participants was 25.81 ± 17.50 months. The average number of ARI clinical events per month was 4.02 (95% CI 3.64-4.40) prior to VD3 administration. The number of episodes reduced at the end of the three cycles was 2.23/month (95% CI 1.81-2.65; p = 0.0230). The average number of emergency room visits during three months prior to the VD3 administration was 2.15 (95% CI 1.77-2.53). After three months of treatment, the average number of emergency room visits decreased to 0.52 (95% CI 0.32-0.72; p = 0.0180). Prior to VD3 administration, 31.58% required hospitalization. After the administration of three VD3 doses, only one patient required hospitalization (2.63%; x̄:0.026 (95% CI 0.02-0.03; p = 0.0368). Conclusions. Vitamin D3 administration could have a benefit in reducing the number of ARI episodes, emergency room visits, and hospitalalizations in children under age five.