Episodes Of Respiratory Illness Research Articles

Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years.

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

Effect of maternal vaccination on infant morbidity in Bangladesh

BackgroundRisk factors of infant mortality in Africa and south Asian countries have been broadly discussed. However, infant morbidity is largely underestimated. We analyzed the data from a randomized vaccine trial in Bangladesh to identify and assess the effect of risk factors on infant morbidity.MethodsPregnant women were randomly assigned to receive either inactivated influenza vaccine or pneumococcal polysaccharide vaccine and the infants were randomly assigned to receive 7-valent pneumococcal conjugate vaccine or Hib conjugate vaccine at week 6, 10 and 14. The data were collected from August 2004 through December 2005. Each pair of infant and mother were followed for 24 weeks after birth with weekly visits. Generalized estimating equations (GEE) for repeated measurements and Poisson regression models were used to identify the risk factors and evaluate their effect on the longitudinal incidence and total number of episodes of respiratory illness with fever (RIF), diarrhea disease, ear problem and pneumonia.ResultsA total of 340 pregnant women were randomized with mean age of 25 years. The baseline mother and infant characteristics were similar between two treatment groups. Exclusive breastfeeding and higher paternal education level were common factors associated with lower infant morbidity of RIF (adjusted OR = 0.40 and 0.94 with p < 0.01 and p = 0.02, respectively), diarrhea disease (adjusted OR = 0.39 and 0.95 with p < 0.01 and p = 0.04, respectively), and ear problem (adjusted OR = 0.20 and 0.76 with p < 0.01 and p < 0.01, respectively). Maternal influenza vaccine significantly reduced the incidence of RIF (adjusted OR = 0.54; p < 0.01) but not diarrhea disease or ear problem (p > 0.05). Female infants had lower incidence of diarrhea disease (adjusted OR = 0.67; p = 0.01) and ear problem (adjusted OR = 0.12; p = 0.01).ConclusionsMaternal influenza vaccination, exclusive breastfeeding, female children, and higher paternal education level significantly reduced the infant morbidity within the 24 weeks after birth in Bangladesh.

Respiratory Health and Air Pollution in Opencast Coal Mining Region: A Study in Mahanadi Coalfield, Odisha, India

The present study is based on the remote opencast coal mining region of a mineral-rich Indian state, Odisha. Our estimation confirms our primary hypothesis that proximity to opencast mining, triggers the likelihood of respiratory illness (RI). Moreover, our investigation affirms the presence of selection bias possibly due to underreporting in the self-reported RI episodes. We try to address the above causality through the pathways of both exogeneity and endogeneity of RI. After controlling for the endogeneity of RI episodes, it is evident that the effect of RI reporting on related health expenditure is grossly overestimated under the assumption of exogeneity. In the regressions, the variable of prime importance, that is, the distance from mine, treatment dummy and per capita income are statistically significant, indicating the high likelihood of RI episodes in closer proximity to the mining region, in the treatment villages over control villages. The positive significance of per capita income also supports the presence of selection bias possibly associated with self-reported RI episodes. Both estimation methods indicate that the proximity to the pollution source increases the health expenditure on RI. For treatment villages, a higher distance to healthcare facilities reduces health expenditure. The pollution load and healthcare inaccessibility are implicated through a latent burden of disease which warrants a serious policy intervention towards partial correction of the externalities for achieving sustainable and equitable development. JEL Codes: C36, I15, Q53

Prospects for the application of kuril tea shoots in rehabilitating patients with frequently and long-term respiratory virus diseases

Introduction. Frequently and long-term ill children are an urgent problem in pediatrics. It is of interest to take into account the possibility of rehabilitation of frequently and long-term ill children using the natural resources of the region.Objective. To study the clinical and immunological parameters of children -residents of the Altai Territory, who are often prone to acute respiratory diseases, and the effect on these indicators of herbal tea from the shoots of Pentaphylloides fruticosa, used in complex therapy and rehabilitation of frequently and long-term ill children.Materials and methods. The study involved 49 children aged 3.5 to 7 years of both sexes, who are in the dispensary group of frequently and long-term ill children. During the study, a retrospective analysis of primary medical documentation was carried out, as well as a comprehensive clinical and laboratory, microbiological and parasitological examination, and determination of the immune status. In a prospective cohort study, the effect of the use of herbal tea from the shoots of Pentaphylloides fruticosa on the clinical and immunological parameters of frequently and long-term ill children was evaluated as part of complex therapy with bacterial lysates and endogenous interferon inducers.Results. The age-sex structure of frequently and long-term ill children is dominated by children of preschool age (up to 70%), mostly males (53%), who have a burdened anamnesis (31%). Frequent episodes of respiratory diseases are not a consequence of immune deficiency and develop against the background of an associated, persistent viral and bacterial infection that occurs against the background of transient functional instability of the immune system. The quantitative analysis of immunograms showed a significant immunocorrective role of Pentaphylloides fruticosa extraction preparations in comparison with baseline values.Conclusions. The conducted clinical and immunological study did not reveal any significant clinically significant disorders of the immune system in frequently and long-term ill children -residents of the Altai Territory. At the same time, the use of extractive preparations of Pentaphylloides fruticosa has a significant immunocorrective effect on the parameters of the immune system and can be considered as an important component in the complex rehabilitation of frequently and long-term ill children from the age of 3.5 years.

Identification, Biochemical Characterization, and In Vivo Detection of a Zn-Metalloprotease with Collagenase Activity from Mannheimia haemolytica A2.

Respiratory diseases in ruminants are a main cause of economic losses to farmers worldwide. Approximately 25% of ruminants experience at least one episode of respiratory disease during the first year of life. Mannheimia haemolytica is the main etiological bacterial agent in the ruminant respiratory disease complex. M. haemolytica can secrete several virulence factors, such as leukotoxin, lipopolysaccharide, and proteases, that can be targeted to treat infections. At present, little information has been reported on the secretion of M. haemolytica A2 proteases and their host protein targets. Here, we obtained evidence that M. haemolytica A2 proteases promote the degradation of hemoglobin, holo-lactoferrin, albumin, and fibrinogen. Additionally, we performed biochemical characterization for a specific 110 kDa Zn-dependent metalloprotease (110-Mh metalloprotease). This metalloprotease was purified through ion exchange chromatography and characterized using denaturing and chaotropic agents and through zymography assays. Furthermore, mass spectrometry identification and 3D modeling were performed. Then, antibodies against the 110 kDa-Mh metalloprotease were produced, which achieved great inhibition of proteolytic activity. Finally, the antibodies were used to perform immunohistochemical tests on postmortem lung samples from sheep with suggestive histology data of pneumonic mannheimiosis. Taken together, our results strongly suggest that the 110-Mh metalloprotease participates as a virulence mechanism that promotes damage to host tissues.

Air Quality in Dhaka City is a Growing Concern

One of the precious and necessary natural resources for all life is air. The levels of pollution in Dhaka far exceed those recommended by the World Health Organization (WHO). It is estimated that urban air pollution in South Asia results in more than 400,000 fatalities and billions of episodes of respiratory illness each year. According to WHO predictions for 2019, there are around 250,000 air pollution-related deaths per year in Bangladesh. Dhaka is one of the crowded cities on earth. City streets are jam-packed with push carts, rickshaw vans, three-wheeled auto-rickshaws with two-stroke engines, buses, trucks, and cars. As a result of the rapid industrialization and economic expansion, there will likely be an increase in the number of motor vehicles in the next days, which will make the issue worse. This essay tries to outline the current state of air pollution in Dhaka and offer some specific suggestions for lowering air pollution in order to improve the city's quality of life.

Determinants of influenza and pneumococcal vaccine uptake among preschool children in Singapore.

Young children are at increased risk of severe illness from influenza and pneumococcal infections. The World Health Organization (WHO) recommends vaccination with influenza and pneumococcal conjugate vaccine (PCV). However, in Singapore, vaccine uptake remains suboptimal relative to other routine childhood immunisations. Limited information exists regarding determinants of influenza and pneumococcal vaccine uptake in children. We estimated vaccine uptake and investigated factors associated with influenza and pneumococcal vaccination status by age group using data from a cohort study on acute respiratory infections in children attending preschools in Singapore. We recruited children aged two to six years at 24 participating preschools from June 2017 to July 2018. We determined the proportion of children immunised with influenza vaccine and PCV, and investigated socio-demographic factors associated with vaccine uptake using logistic regression models. Among 505 children, 77.5% were of Chinese ethnicity, and 53.1% were male. History of influenza vaccination was 27.5% of which 11.7% had been vaccinated within the past 12 months. In multivariable analyses, factors associated with influenza vaccine uptake were 'children living in landed property' (aOR = 2.25, 95% CI [1.07-4.67]) and 'history of hospitalisation due to cough' (aOR = 1.85, 95% CI [1.00-3.36]). Nearly three-quarters of participants (70.7% 95%CI: [66.6-74.5]) reported prior PCV vaccination. PCV uptake was higher for younger children. 'Higher parental education' (OR = 2.83, 95% CI [1.51,5.32]), 'household income' (OR = 1.26, 95% CI [1.08,1.48]) and 'smokers in household' (OR = 0.48, 95% CI [0.31,0.74]) were significantly associated with PCV uptake in univariable analyses. Only 'smokers in household' remained significantly associated with PCV uptake (aOR = 0.55, 95% CI [0.33,0.91]) in the adjusted model. Our results indicate that episodes of severe respiratory illness are a cue to influenza vaccination suggesting that doctors are more likely to recommend influenza vaccines to high-risk children. For PCV, our findings suggest overall greater awareness and education on the benefit of PCV vaccination is required.

Mortality associated with Omicron and influenza infections in France before and during the COVID-19 pandemic.

For many deaths associated with influenza and Omicron infections, those viruses are not detected. We applied previously developed methodology to estimate the contribution of influenza and Omicron infections to all-cause mortality in France for the 2014-2015 through the 2018-2019 influenza seasons, and the period between week 33, 2022 and week 12, 2023. For the 2014-2015 through the 2018-2019 seasons, influenza was associated with annual average of 15,654 (95% CI (13,013, 18,340)) deaths, while between week 33, 2022 and week 12, 2023, we estimated 7,851 (5,213, 10,463) influenza-associated deaths and 32,607 (20,794, 44,496) SARS-CoV-2 associated deaths. For many Omicron-associated deaths for cardiac disease, mental&behavioural disorders, and other causes, Omicron infections are not characterised as a contributing cause of death - for example, between weeks 33-52 in 2022, we estimated 23,983 (15,307, 32,620) SARS-CoV-2-associated deaths in France, compared with 12,811 deaths with COVID-19 listed on death certificate. Our results suggest the need for boosting influenza vaccination coverage in different population groups in France, and for wider detection of influenza infections in respiratory illness episodes (including pneumonia) in combination with the use of antiviral medications. For Omicron epidemics, wider detection of Omicron infections in persons with underlying health conditions is needed.

Longitudinal Household Assessment of Respiratory Illness in Children and Parents During the COVID-19 Pandemic

In the early COVID-19 pandemic, SARS-CoV-2 testing was only accessible and recommended for symptomatic persons or adults. This restriction hampered assessment of the true incidence of SARS-CoV-2 infection in children as well as detailed characterization of the SARS-CoV-2 disease spectrum and how this spectrum compared with that of other common respiratory illnesses. To estimate the community incidence of SARS-CoV-2 infection in children and parents and to assess the symptoms and symptom severity of respiratory illness episodes involving SARS-CoV-2-positive test results relative to those with SARS-CoV-2-negative test results. This cohort study randomly selected Dutch households with at least 1 child younger than 18 years. A total of 1209 children and adults from 307 households were prospectively followed up between August 25, 2020, and July 29, 2021, covering the second and third waves of the COVID-19 pandemic. Participation included SARS-CoV-2 screening at 4- to 6-week intervals during the first 23 weeks of participation (core study period; August 25, 2020, to July 29, 2021). Participants in all households finishing the core study before July 1, 2021, were invited to participate in the extended follow-up and to actively report respiratory symptoms using an interactive app until July 1, 2021. At new onset of respiratory symptoms or a SARS-CoV-2 positive test result, a household outbreak study was initiated, which included daily symptom recording, repeated polymerase chain reaction testing (nose-throat swabs and saliva and fecal samples), and SARS-CoV-2 antibody measurement (paired dried blood spots) in all household members. Outbreaks, households, and episodes of respiratory illness were described as positive or negative depending on SARS-CoV-2 test results. Data on participant race and ethnicity were not reported because they were not uniformly collected in the original cohorts and were therefore not representative or informative. SARS-CoV-2-positive and SARS-CoV-2-negative respiratory illness episodes. Age-stratified incidence rates, symptoms, and symptom severity for SARS-CoV-2-positive and SARS-CoV-2-negative respiratory illness episodes. Among 307 households including 1209 participants (638 female [52.8%]; 403 [33.3%] aged <12 years, 179 [14.8%] aged 12-17 years, and 627 [51.9%] aged ≥18 years), 183 household outbreaks of respiratory illness were observed during the core study and extended follow-up period, of which 63 (34.4%) were SARS-CoV-2 positive (59 outbreaks [32.2%] during the core study and 4 outbreaks [2.2%] during follow-up). SARS-CoV-2 incidence was similar across all ages (0.24/person-year [PY]; 95% CI, 0.21-0.28/PY). Overall, 33 of 134 confirmed SARS-CoV-2 episodes (24.6%) were asymptomatic. The incidence of SARS-CoV-2-negative respiratory illness episodes was highest in children younger than 12 years (0.94/PY; 95% CI, 0.89-0.97/PY). When comparing SARS-CoV-2-positive vs SARS-CoV-2-negative respiratory illness episodes in children younger than 12 years, no differences were observed in number of symptoms (median [IQR], 2 [2-4] for both groups), symptom severity (median [IQR] maximum symptom severity score, 6 [4-9] vs 7 [6-13]), or symptom duration (median [IQR], 6 [5-12] days vs 8 [4-13] days). However, among adults, SARS-CoV-2-positive episodes had a significantly higher number (median [IQR], 6 [4-8] vs 3 [2-4]), severity (median [IQR] maximum symptom severity score, 15 [9-19] vs 7 [6-11]), and duration (median [IQR] 13 [8-29] days vs 5 [3-11] days; P < .001 for all comparisons) of symptoms vs SARS-CoV-2-negative episodes. In this cohort study, during the first pandemic year when mostly partial or full in-person learning occurred, the SARS-CoV-2 incidence rate in children was substantially higher than estimated from routine testing or seroprevalence data and was similar to that of adult household members. Unlike in unvaccinated adults, SARS-CoV-2 symptoms and symptom severity in children were similar to other common respiratory illnesses. These findings may prove useful when developing pediatric COVID-19 vaccine recommendations.

Comparison of Rhinovirus A-, B-, and C-Associated Respiratory Tract Illness Severity Based on the 5'-Untranslated Region Among Children Younger Than 5 Years.

BackgroundRhinoviruses (RVs) are among the most frequently detected viruses from hospitalized children with severe acute respiratory infections, being classified into RV-A, RV-B, and RV-C (4 clades: C, GAC1, GAC2, and A2). This study aimed to compare the clinical characteristics and respiratory tract illness severity between the RV species and RV-C clades in children in primary care and hospital settings in rural communities in the Philippines.MethodsClinical samples and information of children <5 years old in the Philippines were collected from 2014 to 2016. The samples were tested by reverse-transcription polymerase chain reaction (RT-PCR) targeting the 5′-untranslated region. PCR-positive samples were sequenced, and RV species were identified by phylogenetic analysis.ResultsOverall, 3680 respiratory tract illness episodes in 1688 cohort children were documented; 713 of those were RV positive and identified as RV-A (n = 271), RV-B (n = 47), and RV-C (n = 395: C [n = 76], GAG1 [n = 172], GAG2 [n = 8], A2 [n = 138], and unidentified [n = 1]). Severe illnesses, low oxygen saturation, cough, and wheezing were more common in patients with RV-C, especially with GAC1, than in those with RV-A or RV-B. Furthermore, severe illness was significantly more common in RV-C (GAC1)–positive cases than in RV-A–positive cases (odds ratio, 2.61 [95% CI, 1.17–4.13]).ConclusionsChildren infected with RV-C had more severe illnesses than children infected with RV-A and RV-B. Moreover, emerging clades of RV-C were associated with increased severity.

Drivers of respiratory health care demand in Acre state, Brazilian Amazon: a cross-sectional study

BackgroundThe scarce knowledge about the drivers of demand for respiratory health care in the Brazilian Amazon, where the gap of human and physical health care resources is wide, is expanded with two surveys conducted in the west of the region, in Acre state. Potential drivers, informed by a review of twelve recent papers, were classified into seven categories capturing the individual, household, community and macroeconomic dimensions.MethodsQuantitative field surveys were conducted in 2017 and 2019 based on coupled conglomerate-quota randomization sampling. Adults responded about their own health or their children’s health. The probability of seeking physician care for the latest episode of respiratory illness or dry cough was analysed with multiple nonlinear regressions, having as covariates the potential predictors informed by the literature.ResultsThe propensity to seek health care and to purchase medication was larger for children. Influenza-like illness (Despite the exact diagnostic stated by respondents being “influenza”, a virus detection test (such as the PCR test) is not commonly applied, as informed by the Acre state public health service. In consistency, the term “influenza-like illness” is used.) was the most frequently diagnosed disease, followed by pneumonia, suggesting that a health care-seeking rate below 40% may perpetuate health impairment and local contagion. Illnesses’ severity, including the pain experienced, was the main predictor, revealing that subjective perception was more influential than objective individual and household characteristics.ConclusionsThe results suggest that subjective underestimation of respiratory illnesses’ consequences for oneself and for local society could prevent health care from being sought. This is in line with some previous studies but departs from those emphasizing the role of objective factors. Social consequences, of, for instance, a macroeconomic nature, need to be highlighted based on studies detecting long-run relationships among health care demand, health and economic performance at the national level. Depending on the intensity of the trade-off between the costs imposed on the health system by increased demand and on the economy by the reduced productivity of the ill, policy could be adopted to change subjective perceptions of illnesses with nudges and educational and informational interventions.

The Effect of High and Low Ambient Temperature on Infant Health: A Systematic Review.

Children, and particularly infants, have physiological, anatomic, and social factors that increase vulnerability to temperature extremes. We performed a systematic review to explore the association between acute adverse infant outcomes (children 0–1 years) and exposure to high and low ambient temperatures. MEDLINE (Pubmed), Embase, CINAHL Plus, and Global Health were searched alongside the reference lists of key papers. We included published journal papers in English that assessed adverse infant outcomes related to short-term weather-related temperature exposure. Twenty-six studies met our inclusion criteria. Outcomes assessed included: infant mortality (n = 9), sudden infant death syndrome (n = 5), hospital visits or admissions (n = 5), infectious disease outcomes (n = 5), and neonatal conditions such as jaundice (n = 2). Higher temperatures were associated with increased risk of acute infant mortality, hospital admissions, and hand, foot, and mouth disease. Several studies identified low temperature impacts on infant mortality and episodes of respiratory disease. Findings on temperature risks for sudden infant death syndrome were inconsistent. Only five studies were conducted in low- or middle-income countries, and evidence on subpopulations and temperature-sensitive infectious diseases was limited. Public health measures are required to reduce the impacts of heat and cold on infant health.

Topical antibiotics for acute rhinosinusitis in children

The authors presented an overview of the existing data on inhalation therapy with antibacterial drugs in acute rhinosinusitis and exacerbation of chronic rhinosinusitis in children. The overview includes general information about the etiology and features of the course of acute rhinosinusitis. It also contains indications for systemic and topical antibiotic therapy in acute rhinosinusitis specified in the Russian clinical guidelines. The advantages of using a combination preparation of thiampheni-col and N-acetylcysteine by inhalation therapy for acute rhinosinusitis in children and adults are considered separately. A clinical case of a 15-year-old female patient with complaints of persistent rhinitis over the past 4-5 years is discussed. Historical information: a patient had a runny nose over the last 4-5 years: persistent, viscous nasal discharge with moderate nasal congestion. Nasal symptoms worsened with episodes of acute respiratory illness, and nasal discharge became mucopurulent. The child was preliminarily diagnosed with chronic rhinosinusitis (incomplete remission), moderate course. To reduce the severity of the symptoms of the disease, which were present at the time of examination, the following were recommended: daily one-to-two irrigation of the nasal cavity with slightly hypertonic (1.5-3%) solutions of sea water, followed by a toilet of the nasal cavity; in case of episodes of colds with the appearance of mucopurulent secretions, inhalation therapy in a pulsating mode of the inhaler with a solution of thiamphenicol and N-acetylcysteine at a dose of 500 mg once a day (in the first half of the day) for the next 10 days and further; the use of a nasal spray of mometasone furoate, 200 mcg per day during inhalation therapy for another 3 weeks. At the follow-up examination after 10 days of treatment, the patient reported a significant decrease in the severity of nasal symptoms, which coincided with an improvement in the rhinoscopic status. It can be concluded that the use of topical antibacterial drugs by inhalation therapy for acute rhinosinusitis, despite all its advantages, is not an equivalent substitute for systemic antibiotic therapy in the treatment of severe and especially complicated forms of the disease. The inhalation therapy is recommended in the presence of indications for systemic antibiotic therapy, since it is an auxiliary method of treatment, the action of which is aimed at enhancing the effect of systemic antibiotics.

Working with Respiratory Illness: Presenteeism Among Healthcare Personnel at Tertiary-Care Hospitals in Bangladesh, 2008–2016

Background: Healthcare personnel (HCP) in crowded and resource-poor countries (eg Bangladesh), might be at risk of exposure to and transmission of respiratory illnesses to coworkers, patients, and caregivers. The infection control practices in public hospitals are inadequate in Bangladesh. We estimated the incidence of respiratory illness episodes among HCP, and proportion of HCP who worked during respiratory illnesses, including influenza virus infection, at 2 tertiary-care public hospitals in Bangladesh. Methods: From May 2008 to February 2016, HCP (defined as physicians, nurses, interns, patient care assistant, cleaners, and administrative staff working in adult and pediatric medicine wards) were asked to self-report to study physicians when they experienced new onset of cough, rhinorrhea, difficulty breathing, or fever during the April–September influenza epidemic period each year. Study physicians followed HCP throughout their respiratory illness episodes and recorded respiratory symptoms, onset dates, duration of illness, and days of presenteeism and absenteeism during illness. Nasopharyngeal and oropharyngeal swabs were collected after informed written consent and were tested for influenza by rRT-PCR. We used hospital records to enumerate total HCP working in the study wards during influenza season and multiplied by 6-months follow-up per year to calculate person-time contribution for estimating respiratory illness incidence. Results: HCP self-reported 107 episodes of respiratory illness during 656 person years of follow-up, for an estimated incidence of 16.3 per 100 person years (95% CI, 13–20). Of 107 episodes, 33 (31%) included fever and cough. The mean illness length was 3.9 days (SD, ±1.8). HCP worked an average of 3.4 days (SD, ±1.4) while ill. HCP missed work for a median of 1 day (IQR, 1–2) during 29 (27%) of 107 illness episodes. HCP consented to collect swabs during 56 (52%) episodes, and among them 8 (14%) of 56 tested positive for influenza (flu-A, n = 5; flu-B, n = 3). Also, 63% of HCP with influenza reported fever and cough. HCP experiencing either respiratory illness or influenza worked for similar periods of days while ill: mean, 4 (SD, ±2.2) versus mean, 3.3 (SD, ±1.4) (P = .257). HCP worked during 105 (98%) of 107 respiratory illness and 7 (88%) of 8 influenza episodes. Conclusions: Most HCP in Bangladesh, including those with influenza, worked during respiratory illnesses. The potential value of stay-at-home policies, compensation for sick days, and influenza vaccination in reducing HCP-associated respiratory pathogen transmission could be assessed in Bangladesh and similar settings.Funding: NoDisclosures: None

Case report: a step-wise management of concurrent presentation of congenital single lung and aberrant right subclavian artery in an infant girl

IntroductionCongenital single lung (CSL) is a rare condition, and symptomatic patients often present with respiratory distress or recurrent respiratory infection due to mediastinal shift causing vascular or airway compression. Aberrant right subclavian artery (ARSA) is another rare congenital anomality that can lead to tracheal or esophageal compressions. There is only one other case of concurrent presentation of CSL and ARSA reported, which presented unique challenge in surgical management of our patient. Here we present a step-wise, multidisciplinary approach to manage symptomatic CSL and ARSA.Case presentationAn infant girl with a prenatal diagnosis of CSL developed worsening stridor and several episodes of respiratory illnesses at 11 months old. Cross-sectional imaging and bronchoscopic evaluation showed moderate to severe distal tracheomalacia with anterior and posterior tracheal compression resulting from severe mediastinal rotation secondary to right-sided CSL. It was determined that her tracheal compression was mainly caused by her aortic arch wrapping around the trachea, with possible additional posterior compression of the esophagus by the ARSA. She first underwent intrathoracic tissue expander placement, which resulted in immediate improvement of tracheal compression. Two days later, she developed symptoms of dysphagia lusoria due to increased posterior compression of her esophagus by the ARSA. She underwent transposition of ARSA to the right common carotid with immediate resolution of dysphagia lusoria. As the patient grew, additional saline was added to the tissue expander due to recurrence in compressive symptoms.ConclusionsConcurrent presentation of CSL and ARSA is extremely rare. Asymptomatic CSL and ARSA do not require surgical interventions. However, if symptomatic, it is crucial to involve a multidisciplinary team for surgical planning and to take a step-wise approach as we were able to recognize and address both tracheomalacia and dysphagia lusoria in our patient promptly.

Human metapneumovirus infection in haematopoietic stem cell transplant recipients: a case series.

Human metapneumovirus (hMPV) is an enveloped virus that causes serious respiratory tract infection among immunocompromised populations especially haematopoietic stem cell transplant (HSCT) recipients. Here, we describe 3 cases of hMPV infection which led to mortality among post HSCT adults. 66 post HSCT adults enrolled between January 2017 and March 2019 at Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, were followed up for a period varying from 16 days to 18 months for any episode of respiratory illness until March 2019. Real time reverse transcriptase polymerase chain reaction (rRT-PCR) was used to detect the virus from appropriate specimens when symptoms of acute respiratory infection appeared. Samples from 88 out of a total of 172 episodes of suspected acute respiratory infection could be tested by rRT-PCR. Of these, 9 episodes were positive for hMPV. Three patients with hMPV associated lower respiratory tract infection (LRTI) expired within 30 days of HSCT. The possible risk factors associated with mortality included LRTI, infection during early post-transplant period (first week following HSCT), absolute lymphocyte count less than 200/µl, absolute neutrophil count less than 500/µl, use of steroid within 30 days prior to infection and need for mechanical ventilation.

Knowledge and use of antibiotics among low-income small-scale farmers of Peru

The extensive use and misuse of antibiotics in the livestock sector is one of the main drivers of the emergence and spread of antimicrobial resistance. Although small-scale farms constitute most of the livestock production in low and middle-income countries, knowledge and use of antibiotics among these populations is sparse. We conducted 201 questionnaires to estimate the use and knowledge of antibiotics by small-scale farmers located in the coastal area of the Lima region of Peru. Our results show that farmers had a small number of livestock (e.g. average of 11 cows, 7 pigs and 19 chickens per farm) and 80 % earned less than minimum wage. More than half of farmers reported at least one episode of respiratory disease, diarrhea, mastitis, skin lesion or post-parturition infection in their animals during the previous year, and 40 % of these episodes were treated with antibiotics. Farmers reported using 14 different antibiotics, most commonly oxytetracycline (31 % of episodes treated with antibiotics), penicillin (21 %), gentamicin (19 %) and trimethoprim-sulfamethazine (18 %). The third-generation cephalosporin ceftiofur was occasionally used to treat mastitis. Most farmers relied on veterinarians to prescribe (95 % of respondents) and administer (59 %) antibiotics. Only half of farmers knew what micro-organisms can be treated with antibiotics and the degree of knowledge of antibiotics (based on a 5-question metric) was positively correlated with respondents’ educational level, monthly income, knowledge of the animal health authority, farm area, number of cows and knowledge of an antiparasitic drug. In contrast, knowledge of antibiotics was not correlated with respondents’ age, gender, main occupation, knowledge of a veterinarian or household size. Potential misuse of antibiotics was reported, including 21 % of framers reporting stopping the treatment when clinical signs disappear and infrequent use of antibiotics to treat parasites or animals not eating. Our study highlights poor knowledge and potential misuse of antibiotics among small-scale farmers in coastal Peru, but high reliance on veterinarians for prescription and administration. Strengthening farmers' relationships with veterinarians and improving the diagnostic capacity of the veterinary sector could result in more judicious antibiotic use on these farms.

An exploratory cross-sectional study of the impact of farm characteristics and calf management practices on morbidity and passive transfer of immunity in 202 Chianina beef-suckler calves

There are no published data on the risk factors associated with morbidity, mortality and passive transfer failure in Chianina beef-suckler calves. To implement prevention strategies in beef enterprises, gaining management information and identifying risk factors are essential. This cross-sectional study aimed to identify calf-level management practices and farm characteristics associated with disease incidence, mortality and serum IgG concentration in Chianina beef-suckler calves from farms in Umbria, Italy. In total, 202 Chianina beef-suckler calves aged 2–7 days from nine farms were enrolled. For each calf born, blood samples were collected and specific information on management practices and farm characteristics was obtained through farmer interviews. Serum immunoglobulin concentrations were measured using radial immunodiffusion. Mortality and morbidity data were extracted from the farm’s cow file six months after the last farm visit. The impact of farm characteristics and calf management practices on the mortality rate could not be assesses due to low case fatality in our enrolled calves (10/202). A multivariable logistic regression model indicated that prepartum vaccination against Escherichia coli, rotavirus and coronavirus, and bottle-fed colostrum were associated with serum IgG concentration. Birth season and serum IgG concentration were associated with the development of neonatal calf diarrhoea and the development of both neonatal calf diarrhoea and respiratory disease, respectively. Furthermore, family-owned farms represent an important factor related to respiratory disease episodes. The possible influence of these factors on passive immunity and neonatal calf diarrhoea and respiratory disease appearance should be considered when advising farmers. Highlights Effects of farm characteristics and management practices on health were investigated in 202 Chianina calves. Dam vaccination against Escherichia coli, Rotavirus and Coronavirus, and colostrum feeding assistance affect calf passive immunity. Calves with low serum IgG concentrations became sick; diarrhoea was common during cold months; respiratory disease was more common in family-run farms.

Estimating the Economic Impact of Respiratory Syncytial Virus and Other Acute Respiratory Infections Among Infants Receiving Care at a Referral Hospital in Malawi.

Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants globally, yet economic burden data are scant, especially in low-income countries. We collected data from 426 infants enrolled in the Queen Elizabeth Central Hospital respiratory disease surveillance platform to estimate the household and health system costs of managing RSV and other respiratory pathogens in Malawian infants. Total household cost per illness episode, including direct and indirect costs and lost income, was reported by parents/guardians at the initial visit and 6 weeks post discharge. The total cost to the health system was based on patient charts and hospital expenditures. All-cause acute respiratory infections (ARIs) and RSV costs for inpatient and outpatients are presented separately. All costs are in the 2018 US Dollar. The mean costs per RSV episode were $62.26 (95% confidence interval [CI]: $50.87-$73.66) and $12.51 (95% CI: $8.24-$16.79) for inpatient and outpatient cases, respectively. The mean cost per episode for all-cause ARIs was slightly higher among inpatients at $69.93 (95% CI: $63.06-$76.81) but slightly lower for outpatients at $10.17 (95% CI: $8.78-$11.57). Household costs accounted for roughly 20% of the total cost per episode. For the lowest-income families, household cost per inpatient RSV episode was about 32% of total monthly household income. Among infants receiving care at a referral hospital in Malawi, the cost per episode in which RSV was detected is comparable to that of other episodes of respiratory illnesses where RSV was not detected. Estimates generated in this study can be used to evaluate the economic and financial impact of RSV and acute respiratory illness preventive interventions in Malawi.

Вплив реабілітаційно-профілактичного комплексу на стан імунної системи в дітей з рекурентною респіраторною патологією на тлі гастроезофагеальної рефлюксної хвороби

Вплив реабілітаційно-профілактичного комплексу на стан імунної системи в дітей з рекурентною респіраторною патологією на тлі гастроезофагеальної рефлюксної хвороби