Rate Of Acute Respiratory Infections Research Articles

Analysis of the Causes and Conditions for the Formation of a High Incidence of Acute Respiratory Infections in the Population of the Altai Krai (Part 2. Environmental factors, diagnosis of coxiellosis and tick­borne rickettsiosis)

Relevance. Altai Krai (AK) is one of the least prosperous subjects of the Russian Federation in terms of the incidence of acute respiratory infections (ARI). Results of studying long-term and intra-annual dynamics of the incidence of ARI and community-acquired pneumonia (CAP) in various population groups of the AK in 2011–2021 led to a conclusion about possible connection between the characteristics of the epidemic process of ARI and environmental factors, primarily air pollution, as well as the widespread distribution of natural and atropurgic foci of tick-borne transmissible and zoonotic infections in the territory of the AK, along with the problems of diagnostics. Aim. Assessment of the possible influence of environmental factors on the formation of a high level of registered incidence of ARI in the Altai Territory, as well as diagnostics of some natural focal and zoonotic infections with fever and respiratory symptoms. Materials and methods. A retrospective epidemiological study was conducted based on annual and monthly official statistical reporting during 2011–2021 about the morbidity of the population, demographic and environmental features of the territory of the AK for each of the municipalities (MU), the average long-term incidence rates of ARI, VBP, tuberculosis, Siberian tick typhus (STT), ixodid tick-borne borreliosis, tick-borne viral encephalitis were calculated; appeals of the population regarding tick bites; population density and annual average sulfur dioxide (SO2) emissions. Pearson correlation coefficient was used to assess the strength of the relationship between the analyzed indicators; and seasonality coefficients and the method of trend-seasonal decomposition were used to assess the intra-annual dynamics of the incidence of ARI and CAP (for the period 2011-2019). To study seroprevalence of antibodies to C. burnetii, R. sibirica and SARS-CoV-2 in febrile patients with symptoms of ARI blood samples were collected in October 2022 from ten rural districts of the AK. Results and discussion. It was established that there was a significant direct correlation between the incidence of ARI and the amount of SO2 emissions into the atmosphere (r = 0.61, p < 0.001), as well as between the incidence of ARI and population density (r = 0.53, p < 0.001). The largest share (69%) of the total number of ARI cases in the Altai Territory in 2011–2021 was attributed to the cities of Barnaul, Biysk, Rubtsovsk, Zarinsk and Novoaltaisk, which are characterized by maximum SO2 emissions and population density. An additional contribution (8% total) to the incidence of ARI in the Altai Territory was attributed to 7 rural areas with the highest levels of SO2 emissions. Regardless of the ranking for the incidence of ARI and CAP, in 9 out of 10 areas selected for the study, patients had both anamnestic and diagnostic titers of antibodies to C. burnetii and/or R. sibirica. At the same time, coxiellosis cases in these areas were not registered for 12 years, and the number of cases of STT was much less than the probable number based on the proportion of patients which were seropositive to R. sibirica and had symptoms of ARI. IgM to SARS-CoV-2 were detected in 5 out of 203 examined samples, IgG – in 188 out of 203 examined samples, moreover 13.8% of samples had 118 to 499 BAU/ml, 40.9% of samples had 500 to 5000 BAU/ml, and the rest of samples had more than 5000 BAU/ml. Conclusion. Among all the variables analyzed in the study, the greatest role in the formation of the high level of registered incidence of ARI in the AK for many years belong to the high level of air pollution with SO2 emissions, high population density and, especially, their combination. Underdiagnosis of tick-borne rickettsioses and coxiellosis is of particular importance due to the unavailability of test kits for laboratory verification. Starting from 2020, a new coronavirus infection made some contribution to the registered incidence of ARI.

Population-based Influenza and Respiratory Syncytial Virus Hospitalizations and In-hospital Mortality Rates Among Mexican Children Less Than Five Years of Age.

Population-based information regarding the impact of respiratory syncytial virus (RSV) and influenza on hospital admissions and mortality is scant for many countries. Prospective testing of RSV and influenza virus was undertaken in patients <5 years old admitted to hospital with acute respiratory infection (ARI) between July, 2014 and June, 2015, and mortality rates for children living in 3 municipalities in the state of San Luis Potosí were calculated. During the 12-month study period, 790 children living in these municipalities were admitted with ARI. RSV was detected in 245 (31%) and influenza in 47 (5.9%). History of preterm birth was recorded for 112 children on admission. For children <5 years old, ARI-, RSV- and influenza-associated admission rates were 23.2, 7.2 and 1.4 (per 1000 population), respectively. The corresponding admission rates per 1000 infants <1 year old were 78, 25.2 and 4.4. Preterm infant admission rates were 2 times higher than those of term infants. Six children died; RSV was detected in 4 (66.6%) of the deceased, while no deaths were associated with influenza. ARI and RSV in-hospital mortality rates for children <5 years were 0.18 and 0.12 per 1000 population. ARI and RSV mortality rates in preterm infants were 7 and 14 times higher than in term infants, respectively. RSV was associated with both high admission and in-hospital mortality rates in children <5 years old. Specific interventions, such as active or passive immunization, to prevent RSV infections are required to reduce ARI-associated infant mortality.

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.

Respiratory infections in children and adolescents in Germany during the COVID-19 pandemic.

Before the COVID-19 pandemic, acute respiratory infections (ARIs) in children were mainly characterised by three pathogens: respiratory syncytial viruses (RSV), influenza viruses and rhinoviruses. The impact of the COVID-19 pandemic and the measures taken in Germany (especially until the end of 2021) on the incidence of ARI in children and adolescents aged 0 to 14 years and the pathogens causing them has not yet been comprehensively analysed. The evaluation is based on data from population-based, virological and hospital-based surveillance instruments up to the end of 2022. After the onset of the COVID-19 pandemic in early 2020, ARI rates remained almost consistently below prepandemic levels until autumn 2021, with only rhinoviruses continuously continuing to cause ARI. Only when the Omicron variant became predominant in 2022, there were measurable COVID-19 rates at population level in children, although COVID-19 hospitalisation rates remained comparatively low. RSV and influenza waves were initially absent and then occurred 'out of season', but were more severe than usual. While the measures taken were effective in inhibiting the number of respiratory infections for almost 1.5 years, moderately frequent but rather mild COVID-19 cases occurred when measures were lifted. When Omicron emerged in 2022 COVID-19 became moderately frequent but led predominantly to mild illnesses. For RSV and influenza, the measures resulted in changes in their annual timing and intensity.

The relationship between hand hygiene and rates of acute respiratory infections among Umrah pilgrims: A pilot randomised controlled trial

BackgroundThere is a lack of randomised controlled trials (RCTs) investigating the role of hand hygiene in preventing and containing acute respiratory infections (ARIs) in mass gatherings. In this pilot RCT, we assessed the feasibility of establishing a large-scale trial to explore the relationship between practising hand hygiene and rates of ARI in Umrah pilgrimage amidst the COVID-19 pandemic. MethodsA parallel RCT was conducted in hotels in Makkah, Saudi Arabia, between April and July 2021. Domestic adult pilgrims who consented to participate were randomised 1:1 to the intervention group who received alcohol-based hand rub (ABHR) and instructions, or to the control group who did not receive ABHR or instructions but were free to use their own supplies. Pilgrims in both groups were then followed up for seven days for ARI symptoms. The primary outcome was the difference in the proportions of syndromic ARIs among pilgrims between the randomised groups. ResultsA total of 507 (control: intervention = 267: 240) participants aged between 18 and 75 (median 34) years were randomised; 61 participants were lost to follow-up or withdrew leaving 446 participants (control: intervention = 237:209) for the primary outcome analysis; of whom 10 (2.2 %) had developed at least one respiratory symptom, three (0.7 %) had ‘possible ILI’ and two (0.4 %) had ‘possible COVID-19′. The analysis of the primary outcome found no evidence of difference in the proportions of ARIs between the randomised groups (odds ratio 1.1 [0.3–4.0] for intervention relative to control). ConclusionThis pilot trial suggests that conducting a future definitive RCT to assess the role of hand hygiene in the prevention of ARIs is feasible in Umrah setting amidst such a pandemic; however, outcomes from this trial are inconclusive, and such a study would need to be very large given the low rates of outcomes observed here. Trial registrationThis trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12622001287729), the full protocol can be accessed there.

Acute respiratory infection rates in primary care anticipate ICU bed occupancy during COVID-19 waves.

Bed occupancy in the ICU is a major constraint to in-patient care during COVID-19 pandemic. Diagnoses of acute respiratory infection (ARI) by general practitioners have not previously been investigated as an early warning indicator of ICU occupancy. A population-based central health care system registry in the autonomous community of Catalonia, Spain, was used to analyze all diagnoses of ARI related to COVID-19 established by general practitioners and the number of occupied ICU beds in all hospitals from Catalonia between March 26, 2020 and January 20, 2021. The primary outcome was the cross-correlation between the series of COVID-19-related ARI cases and ICU bed occupancy taking into account the effect of bank holidays and weekends. Recalculations were later implemented until March 27, 2022. Weekly average incidence of ARI diagnoses increased from 252.7 per 100,000 in August, 2020 to 496.5 in October, 2020 (294.2 in November, 2020), while the average number of ICU beds occupied by COVID-19-infected patients rose from 1.7 per 100,000 to 3.5 in the same period (6.9 in November, 2020). The incidence of ARI detected in the primary care setting anticipated hospital occupancy of ICUs, with a maximum correlation of 17.3 days in advance (95% confidence interval 15.9 to 18.9). COVID-19-related ARI cases may be a novel warning sign of ICU occupancy with a delay of over two weeks, a latency window period for establishing restrictions on social contacts and mobility to mitigate the propagation of COVID-19. Monitoring ARI cases would enable immediate adoption of measures to prevent ICU saturation in future waves.

ERYTHROCYTIC AND THROMBOCYTIC INDICATORS IN PRESCHOOL CHILDREN SUFFERING FROM RECURRENT RESPIRATORY INFECTIONS

Anemia is both a significant cause of frequent acute respiratory infections in preschool children and a complication of these infections. While, it is quite often accompanied by deterioration of immunity functioning. Moreover, there has been reported that acute respiratory infections can combine with thrombocytosis in children of different ages. It is also important to focus vision to the relationship between particular indicators of immune status, the acute respiratory infections occurrence, and the expression degree of undifferentiated connective tissue dysplasia. The study is aimed to assess the erythrocytic and thrombocytic indicators in preschool children having the different anamnestic occurrence rate of acute respiratory infections and the different expression degree of particular signs of undifferentiated connective tissue dysplasia. Materials and Methods. Seventy-six children (43 boys and 33 girls) aged from one to six years old, undergoing inpatient treatment on acute respiratory infection, were involved in the clinical study. A wide range of erythrocytic and thrombocytic parameters was taken into consideration. Two markers of acute respiratory infections recurrence (infectious index, resistance index) and dolichostenomelia integral indicator were calculated for each child as well.&#x0D; The statistical processing of the obtained primary digital material was performed by IBM SPSS Statistics&#x0D; 26 licensed program. Results. Such indicators as blood haemoglobin concentration, mean corpuscle haemoglobin concentration, mean cell volume, platelet number, thrombocytocrit, microcytic anaemia factor and volume haemoglobin distribution width factor (coefficient of variation) were statistically lower in the children of the younger age group compared to the older children. The microcytic anaemia factor was lower than its reference values in 40 (52,63 %) patients, and erythrocyte hypochromia was diagnosed in 48 (63.16%) clinical cases. Conclusion. The higher infectious index values in preschool children have been found against the background of the lower mean cell haemoglobin and mean cell volume. The volume haemoglobin distribution width factor (coefficient of variation) and the microcytic anaemia factor among the examined patients are in inverse correlation with the infectious index. There is linear regression dependence between the infectious index on the erythrocyte anisocytosis index and the mean cell volume. The studied integral indicators of acute respiratory infections occurrence among the children do not demonstrate a statistically significant relationship between the platelet parameters and the dolichostenomelia integral indicator.

Роль применения высококомплаентных форм эфирных композиций в профилактике и комплексной терапии ОРИ у детей дошкольного возраста

Aim: to assess the efficacy of the composition of natural essential oils (inhaler patch) for the prevention and complex treatment of acute respiratory infections (ARIs) in pre-school children. Patients and Methods: this prospective study enrolled 102 children aged 3–7 attending kindergarten. The study was conducted simultaneously in four groups of children attending pre-schools (study and control groups, respectively). Study group children received passive inhalations of essential oils (inhaler patches), i.e., in combination with complex treatment for ARIs (group 1) or as a preventive measure after contact with sick children (group 3). Control group children (groups 2 and 4) did not receive passive inhalations. The rate of ARIs, disease severity, fever duration, catarrhal period duration, and inhaler patch tolerability were assessed. Results: in children who used inhaler patch to prevent ARI but still got sick (group 3), fever duration was 1.5 days (i.e., 2.3 days shorter than in group 4) irrespective of age. The number of sick children in group 3 was 2.2-times lower than in group 4. The disease was mild, not associated with any complications, and characterized by a shorter duration of the catarrhal period. In group 1 (compared to group 2), body temperature was less than 38°C, and more rapid rhinorrhea, nasal congestion, and cough relief were reported. Conclusions: our findings, in combination with the lack of adverse effects, allow us to recommend an inhaler patch to prevent ARIs during epidemics or seasonal peaks in pre-schools as a highly adherent entity characterized by excellent safety, no addiction, and long-term use. KEYWORDS: prevention, ARIs, essential oils, children, efficacy, inhaler patch. FOR CITATION: Sergeeva I.V. Highly adherent essential oils compositions for the prevention and complex treatment of ARIs in pre-school children. Russian Journal of Woman and Child Health. 2022;5(1):58–62 (in Russ.). DOI: 10.32364/2618-8430-2022-5-1-58-62.

Longitudinal Changes in Early Nasal Microbiota and the Risk of Childhood Asthma

To explore the association between longitudinal changes in early nasal microbiota and the risk of developing asthma.In the study, researchers included 704 children (aged 0 to 7 years old) born in the Hospital District of Southwest Finland between January 2008 and April 2010.This was a prospective, population-based birth cohort study. Children with a qualified baseline nasal microbiota sample at 2 months old and at least 1 follow-up sample were included in the analysis. Samples were collected by using nasal and nasopharyngeal swabs. The nasal microbiota were tested by using 16S ribosomal RNA gene sequencing. An unsupervised machine learning approach was used to identify mutually exclusive, longitudinal nasal microbiota profiles. Changes in profiles between the ages of 2 to 13 months and 2 to 24 months were examined. The profile with persistent Moraxella dominance was used as the reference group because this was the largest group, a finding also supported by the literature. The primary outcome was the risk of physician-diagnosed asthma at the ages of 6.5 to 7.5 years old. The secondary outcome was the number of acute respiratory infections (ARIs) during 13 to 24 months of age. The association of the microbiota longitudinal profiles with the risk of developing asthma and rate of ARIs was measured by using multivariable logistic regression and negative binomial models.Of the 704 children in the analytic cohort, 57 (8%) developed asthma. Across all samples, the nasal airway microbiota was dominated by Moraxella, which generally increased with age. During age 2 to 13 months, 4 distinct longitudinal nasal microbiota profiles were identified: (1) persistent Moraxelladominance profile (reference group), (2) Streptococcus to Moraxella transition profile, (3) persistent Dolosigranulum and Corynebacteriaceae dominance profile, and (4) persistent Moraxella sparsity profile. During 2 to 24 months of age, an additional distinct longitudinal nasal microbiota profiles was identified: (5) a mixed longitudinal pattern profile. Overall, children with a persistent Moraxella sparsity profile were at a significantly higher risk of developing asthma (adjusted odds ratio: 2.74; 95% confidence interval: 1.20 to 6.27 for those in this profile at 2 to 13 months of age, which persisted in the 2 to 24 month profile) and had significantly higher incidence rates of ARIs (incidence rate ratio: 1.16; 95% confidence interval: 1.01 to 1.32, from 13 to 24 months of age).In this study, researchers found that, compared with the reference group (Moraxella dominant profile), children with an altered longitudinal nasal microbiota pattern (Moraxella sparsity profile) during early childhood had a higher risk of developing asthma and ARIs.This is the first study to reveal an association between longitudinal changes in early airway microbiota and later development of childhood asthma. Further efforts to develop primary prevention strategies aimed at modifying the microbiota may help to lower the incidence of childhood asthma and ARIs.

Burden of Influenza-Associated Respiratory Hospitalizations, Vietnam, 2014-2016.

Influenza burden estimates are essential to informing prevention and control policies. To complement recent influenza vaccine production capacity in Vietnam, we used acute respiratory infection (ARI) hospitalization data, severe acute respiratory infection (SARI) surveillance data, and provincial population data from 4 provinces representing Vietnam’s major regions during 2014–2016 to calculate provincial and national influenza-associated ARI and SARI hospitalization rates. We determined the proportion of ARI admissions meeting the World Health Organization SARI case definition through medical record review. The mean influenza-associated hospitalization rates per 100,000 population were 218 (95% uncertainty interval [UI] 197–238) for ARI and 134 (95% UI 119–149) for SARI. Influenza-associated SARI hospitalization rates per 100,000 population were highest among children <5 years of age (1,123; 95% UI 946–1,301) and adults >65 years of age (207; 95% UI 186–227), underscoring the need for prevention and control measures, such as vaccination, in these at-risk populations.

Brushing Teeth and Acute Respiratory Infections in Day Care Facilities: An Ecological Study in Selected Regions of Lower Saxony, Germany (2013-2018)

Dental group prophylaxis in day-care centers with teeth brushing as one of its components is intended to reduce caries incidence and promote dental health. However, various barriers can hinder implementation of this preventive measure. One concern relates to an increased risk of transmission of acute respiratory infections (ARI) in day-care centers. The ZINFEKT study aimed at determining whether and to what extent there are differences in the occurrence of ARI between day-care centers that implement vs. those that do not implement teeth brushing. In an ecological study, 2013-2018 data from the ARI surveillance of the Public Health Agency of Lower Saxony were merged with information from the Dental Services on teeth brushing for n=33 day-care facilities from the urban municipality of Braunschweig, the region of Hannover, and the administrative district of Osnabrück (all Lower Saxony, Germany). Following the concept of patient days from hospital infection surveillance, "ill child weeks" were specified as observational units, defined as weeks for which an ARI had been reported for a registered child. Besides cross-tabulations, relative risks for ill child weeks by teeth brushing and Breslow-Day Tests for interactions with area, size of day-care center, ARI season and time slot with ARI seasons were computed. Overall, the ARI-rate, defined at the proportion of ill child weeks, was 4.6% higher in day-care centers in which teeth brushing took place, vs. centers in which this measure was not implemented (17.9 vs. 13.3%, p<0.0001). In analyses stratified by the geographic and temporal co-variables, the direction of this difference did not change (with one exception: day-care centers with 50 or less registered children) . The assumption that regular teeth brushing is associated with higher ARI rates in day-care centers does seem to have an empirical basis. However, despite the study's limitations (primarily its ecological design and possibly limited representativeness of the day-care centers), the identified difference - due both to its magnitude and possibly improvable hygiene compliance - to our assessment does not speak against brushing teeth as a component of dental group prophylaxis in day-care centers.

The wealth gradient in diarrhoea, acute respiratory infections, and malaria in childhood over time: A descriptive analysis using DHS and MICS from Western and Central Africa between 1995 and 2017.

BackgroundWhile the prevalence of childhood diseases and related mortality have been decreasing over the past decades, progress has been unequally distributed. The poorest households often carry the highest disease burden. As morbidity and mortality also decline most slowly among children of the poorest households, socioeconomic status may become a more relevant risk factor for childhood diseases.MethodsWe analysed the association between socioeconomic status and highly prevalent childhood diseases, specifically diarrhoea, acute respiratory infections (ARI), and malaria, and how this association changed over time. For this observational study, we used repeated cross-sectional data, namely all available Demographic and Health Surveys as well as Multi-Indicator Cluster Surveys from Western and Central Africa between 1995 and 2017. We estimated the predicted prevalence of each disease for the entire region in three time periods. We repeated the analysis separately for each country to highlight heterogeneity between countries.ResultsA notable wealth gradient can be seen in the prevalence rates of diarrhoea, ARI, and malaria in Western and Central Africa. Children in the poorest quartile have a much higher morbidity than children in the richest quartile and have experienced a considerably slower decline in prevalence rates. In the period 2010-2017, predicted prevalence of diarrhoea was 17.5% for children in the poorest quartile and 12.5% for children in the richest quartile. Similarly, the predicted prevalence was 11.1% and 8.6% for ARI, and 54.1% and 24.4% for malaria in endemic countries. The pattern does not differ between boys and girls. While exact prevalence rates vary between countries, only few countries have seen a decline in the wealth gradient for childhood diseases.ConclusionsThe increasing wealth gradient in health raises concerns of increasing inequality that goes beyond wealth. It suggests a need to further improve targeting of health programmes. Moreover, these programmes should be adapted to address the interlinked challenges which burden the poorest households.

Place of combination drugs in the therapy of acute bronchitis in children

Acute respiratory tract infections accompanied by cough play a significant role in respiratory pathology in childhood. The incidence of acute respiratory infections among children is 4–5 times higher than among the adult population and accounts for more than 90% of all infectious and parasitic diseases registered in Russia. The highest rates of acute respiratory infections are observed among children of preschool age, especially in the first three years of life. As in adults, children’s cough, described as a symptom of «upper respiratory infection» or «acute bronchitis», is the most commonly diagnosed acute manifestation in primary care. These 2 diagnoses represent 75% of all cough cases. The most common etiological agents in acute bronchitis are respiratory viruses: adenovirus, influenza viruses and parainfluenza viruses, respiratory syncytial virus, rhinovirus, human Bocavirus, Coxsackievirus, herpes simplex virus, etc. Drug therapy for coughing is prescribed when there is a nonproductive cough that does not perform its protective function, meaning it does not contribute to the purification of the respiratory tract, and is aimed at dilution of sputum, reducing its adhesiveness (viscosity) and thus increase the effectiveness of coughing. The main groups of mucoactive drugs that are usually considered in this case are mucolytics, mucoregulators, mucokinetics, expectorants, and combination drugs. Combination drugs created to eliminate various elements of pathogenesis of respiratory diseases, accompanied by a nonproductive cough and bronchoobstruction, deserve close attention due to the possibility of using several active substances in fixed drug combinations with accurate dosages and proven clinical effectiveness, reducing the number of simultaneously taken drugs, reducing the risk of developing undesirable events. Oral administration of combined medicines becomes especially important in conditions when inhalation therapy is impossible.

ARVI in children: choice of approach in the treatment of cough

According to official statistics, acute respiratory infections (ARI) always rank highest among the infectious diseases, especially among children. In Russia, the annual rate of ARI is at least 70–80,000 diseases per 100,000 children’s population (3.3 times higher than in adults) without downward trend. Reduction and relief of symptoms is one of the main objectives in the treatment of acute respiratory infections in children. Fever, runny nose, sore throat, and cough are the most common symptoms that affect the health condition of children. Cough is one of the top five reasons for patients to seek medical treatment, as it is a common symptom in both outpatient and hospital practice. In particular, the majority of acute and chronic bronchopulmonary diseases are almost always accompanied by cough, and patients with chronic cough of unclear etiology account for 10 to 38% of patients in the practice of a pulmonologist. Many articles give much attention to cough and its causes, describe treatment methods. The rational choice and use of antitussive therapy in pediatrics involve the knowledge of at least two main factors: the causes of cough and the features of the mechanism of cough reflex in children, as well as the mechanisms of action of antitussive drugs used. The necessity to treat cough as such i.e. to prescribe the so-called antitussive therapy arises when a child has unproductive, dry, persistent cough. The article discusses the potential causes and mechanisms of the production of cough in children, in particular dry cough, and considers using central and peripheral antitussive drugs in paediatric practice. Special attention is given to the efficacy and safety of the antitussive drug butamirate citrate.

Ventilation and laboratory confirmed acute respiratory infection (ARI) rates in college residence halls in College Park, Maryland

Strategies to protect building occupants from the risk of acute respiratory infection (ARI) need to consider ventilation for its ability to dilute and remove indoor bioaerosols. Prior studies have described an association of increased self-reported colds and influenza-like symptoms with low ventilation but have not combined rigorous characterization of ventilation with assessment of laboratory confirmed infections. We report a study designed to fill this gap. We followed laboratory confirmed ARI rates and measured CO2 concentrations for four months during the winter-spring of 2018 in two campus residence halls: (1) a high ventilation building (HVB) with a dedicated outdoor air system that supplies 100% of outside air to each dormitory room, and (2) a low ventilation building (LVB) that relies on infiltration as ventilation. We enrolled 11 volunteers for a total of 522 person-days in the HVB and 109 volunteers for 6069 person-days in the LVB, and tested upper-respiratory swabs from symptomatic cases and their close contacts for the presence of 44 pathogens using a molecular assay. We observed one ARI case in the HVB (0.70/person-year) and 47 in the LVB (2.83/person-year). Simultaneously, 154 CO2 sensors distributed primarily in the dormitory rooms collected 668,390 useful data points from over 1 million recorded data points. Average and standard deviation of CO2 concentrations were 1230 ppm and 408 ppm in the HVB, and 1492 ppm and 837 ppm in the LVB, respectively. Importantly, this study developed and calibrated multi-zone models for the HVB with 229 zones and 983 airflow paths, and for the LVB with 529 zones and 1836 airflow paths by using a subset of CO2 data for model calibration. The models were used to calculate ventilation rates in the two buildings and potential for viral aerosol migration between rooms in the LVB. With doors and windows closed, the average ventilation rate was 12 L/s in the HVB dormitory rooms and 4 L/s in the LVB dormitory rooms. As a result, residents had on average 6.6 L/(s person) of outside air in the HVB and 2.3 L/(s person) in the LVB. LVB rooms located at the leeward side of the building had smaller average ventilation rates, as well as a somewhat higher ARI incidence rate and average CO2 concentrations when compared to those values in the rooms located at the windward side of the building. Average ventilation rates in twenty LVB dormitory rooms increased from 2.3 L/s to 7.5 L/s by opening windows, 3.6 L/s by opening doors, and 8.8 L/s by opening both windows and doors. Therefore, opening both windows and doors in the LVB dormitory rooms can increase ventilation rates to the levels comparable to those in the HVB. But it can also have a negative effect on thermal comfort due to low outdoor temperatures. Simulation results identified an aerobiologic pathway from a room occupied by an index case of influenza A to a room occupied by a possible secondary case.

Respiratory syncytial virus acute respiratory infection-associated hospitalizations in preterm Mexican infants: A cohort study.

BackgroundRespiratory syncytial virus (RSV) is the leading cause of severe acute respiratory infections (ARI) in preterm infants. The incidence of RSV‐associated hospitalizations has not been defined in Mexico.ObjectivesTo determine the incidence of ARI‐ and RSV‐associated hospitalizations in preterm infants during the first year of life.MethodsProspective cohort study of 294 preterm infants followed up through monthly telephone calls and routine outpatient visits. Hospitalized children were identified through daily visits to pediatric wards of participating hospitals and through telephone calls. Respiratory samples were tested for RSV by RT‐PCR.ResultsMean gestational age of participating infants was 33 weeks. Ninety‐six infants were diagnosed with bronchopulmonary dysplasia (BPD) and 17 with congenital heart disease (CHD); 11 had both conditions. There were 71 hospitalization episodes in 53 infants. Respiratory samples for RSV detection were available in 44 hospitalization episodes, and the result was positive in 16 (36.3%). At least one hospitalization for ARI was recorded in 33 of 96 participants with BPD, in seven of 17 with CHD, and 18 of 192 infants without these diagnoses. Five (71.4%) of CHD infants who required admission also had BPD. RSV‐confirmed hospitalization rates were 9.4%, 5.9%, and 2.6% for infants with BPD, CHD, and otherwise healthy preterm infants, respectively. Attributable RSV admission frequencies were estimated to be 13.6%, 16.5%, and 4.1%, respectively.ConclusionsMexican preterm infants, particularly those with BPD, have high rates of ARI‐ and RSVassociated hospitalizations. Specific interventions to reduce the incidence of severe infections in this highrisk group are required.

Incidence Rate of Acute Respiratory Infections in General Medicine as a Tool to Correcting Official Data of Covid-19 in Places where the Tests of Polymerase Chain Reaction are not Accessible

Incidence Rate of Acute Respiratory Infections in General Medicine as a Tool to Correcting Official Data of Covid-19 in Places where the Tests of Polymerase Chain Reaction are not Accessible

Prevalence of acute respiratory infections among under five children in a rural area of Kozhikode district, Kerala

Background: Although childhood acute respiratory infections (ARI) is a significant public health problem in India, robust epidemiological data on its prevalence is not available. This study was done to estimate the prevalence of ARI in under five children and study the factors responsible for the same in a rural area of Kozhikode District.Methods: This cross sectional study was conducted in 386 under-5 children in Kunnamangalam panchayat of Kozhikode district from June 2015 to June 2016. Employing cluster sampling technique, data regarding socio demographic factors, prevalence of ARI and selected factors were collected using a pre tested semi structured questionnaire.Results: The overall prevalence of ARI in children was 31.9 %. Prevalence was slightly higher in boys (32.7%) than in girls (31.1%). The prevalence of ARI was more in lower social class children (36.1%), compared to those from upper social class (26.3%). ARI was higher in children living in overcrowded houses (40.2%), poorly ventilated houses (37.8%), houses in which there were no smoke outlets (43.1%), houses having pets (58.6%). Underweight children were also found to have higher rates of ARI (46.5%). Binary logistic regression revealed that after adjusting for all other factors, age less than 1 year (OR 0.48, p=0.02) and nuclear family (OR 0.10, p=0.01) are significant independent protective factors for ARI.Conclusions: Among under-5 children, younger age and membership in a nuclear family are significant protective factors for ARI.

Early nasal microbiota and acute respiratory infections during the first years of life

BackgroundEmerging evidence shows that airway microbiota may modulate local immune responses, thereby contributing to the susceptibility and severity of acute respiratory infections (ARIs). However, there are little data on the...

Impact of a multicomponent hand hygiene–related intervention on the infectious risk in nursing homes: A cluster randomized trial

The aim of this study was to assess the impact of a multifaceted hand hygiene (HH) program on the infectious risk in nursing homes (NHs). This was a 2-arm cluster randomized trial; French NHs were allocated randomly to the intervention (13 NHs) or control (13 NHs) groups. The intervention consisted of implementing a bundle of HH-related measures over 1 year, including increased availability of alcohol-based handrub, HH promotion, staff education, and local work groups. The primary end point was the incidence rate of acute respiratory infections and gastroenteritis reported in the context of clustered cases episodes. Secondary end points were mortality, hospitalization, and antibiotic prescription rates. Baseline characteristics did not differ between groups. The overall handrub consumption was higher in the intervention group over the 1-year intervention period. Because of underreporting, data on the primary end points were of insufficient quality for analysis. Hospitalizations did not differ between the 2 groups. However, the intervention group showed significantly lower mortality (2.10 vs 2.65 per 100 residents per month, respectively; P = .003) and antibiotic prescriptions (5.0 vs 5.8 defined daily doses per 100 resident days, respectively; P < .001). These results were confirmed by the longitudinal multivariate analysis adjusted for NH and resident characteristics and for seasonality (mortality rate ratio, 0.76). A multifaceted HH intervention may have a short-term impact on mortality in NHs. Nevertheless, other strategies may remain necessary to reduce morbidity.