Respiratory Hospital Research Articles

Associations between short-term ambient PM2.5, oxidant gases and respiratory hospitalizations in children: effect modification by PM2.5 transition metals, sulfur and oxidative potential

Background and Aim: Exposure to particulate and gaseous pollutants impair the respiratory health of children. Mass-based measures of PM2.5 do not capture spatiotemporal variability in particle composition/toxicity. The aim of this study is to examine whether associations between short-term ambient PM2.5 or oxidant gases and respiratory hospitalizations in children are modified by metals or sulfur content in PM2.5, or particle oxidative potential. Methods: This is a case-crossover study of 10,500 children (0-17 years) in Canada. Daily PM2.5 mass concentration and the combined weighted oxidant capacity of NO2 and O3 (Ox) were collected. Monthly estimates of transition metals (copper, iron, nickel, manganese, zinc) and sulfur in PM2.5, and three metrics of particle oxidative potential (OPAA, OPGSH, OPDTT) were measured at each monitoring site. Conditional logistic regression models were used to estimate associations between PM2.5 or Ox and respiratory hospitalizations, above and below median metals, sulfur, and particle oxidative potential. Results: Without stratifying above and below median metals, sulfur, or particle oxidative potential, there were no associations between PM2.5 mass and respiratory hospitalizations (OR and 95% CI per 10 μg/m3 increase in PM2.5: 1.004 [0.955, 1.056]). However, when the analyses were performed above/below median metals, sulfur, and oxidative potential, positive associations were observed when metals, sulfur and OPGSH were above the median. For example, when copper was above the median, the OR and 95% CI per 10 μg/m3 increase in PM2.5 was 1.084 [1.007, 1.167], while the OR and 95% CI was 0.970 [0.929, 1.014] when copper was below the median. Stronger associations between Ox and respiratory hospitalizations were also observed when metals, sulfur and oxidative potential were above the median. Conclusions: Stronger associations between short-term PM2.5, oxidant gases and respiratory hospitalizations in children were observed when metals, sulfur and particle oxidative potential were elevated. Keyword: PM2.5, respiratory health, children, oxidant gases

Contributions of Biomass Burning Events to Daily PM10 Concentrations and The Short-Term Associations with Hospital Admissions in Malaysia

Background and Aim: Despite serious biomass burning in the Southeast Asian region, there is a lack of epidemiological studies that directly evaluate the health effects of particulate matter attributed to biomass burning. This study aims to estimate the short-term effects of particulate matter ≤10µm (PM₁₀) on hospital admissions in Peninsular Malaysia, distinguishing between PM₁₀ originating from biomass burning and other sources. Methods: We identified biomass burning by evaluating daily hotspot information from MODIS satellite sensor and the HYSPLIT backward wind trajectories at five districts during 2005 – 2015. Days with wind trajectories passing through biomass burning were known as "haze days”. We estimated PM₁₀ concentrations attributed to biomass burning by decomposing total concentrations using the moving mean of PM₁₀ on non-haze days. We fitted district-specific quasi-Poisson regression models to estimate associations of PM₁₀ attributable to biomass burning and non-biomass burning with daily hospitalizations due to respiratory and cardiovascular diseases (ICD-10: J00-J99 and I00-I99, respectively). To obtain a regional average, we pooled district-specific results using random-effects meta-analysis. Results: We analyzed respiratory (210,960 cases) and cardiovascular (178,952 cases) hospitalizations. On average, 50% of study period was identified as haze days (PM₁₀ due to biomass burning >0µg/m³). Average PM₁₀ levels attributed to biomass burning and non-biomass burning were 6.6µg/m³ (SD: 51.7) and 41.6µg/m³ (SD: 20.6) respectively. Increases of 10µg/m³ biomass burning PM₁₀ and non-biomass burning PM₁₀ during non-haze day (lag 0–1 days) were associated with increases in respiratory hospital admissions of 0.44% (95% CI: 0.06, 0.82%) and 0.86% (95% CI: 0.31, 1.41%), respectively. We could not see any significant associations for cardiovascular hospital admissions. District-specific estimates of the associations appeared to be homogeneous. Conclusions: PM₁₀ from both biomass burning and other emission sources were positively associated with respiratory hospitalizations in Peninsular Malaysia. Keywords: Biomass burning event, Particulate matter, Hospital admission, Respiratory disease

Short-term effects of heat on respiratory mortality and morbidity in Germany – small-area analysis in the framework of the EXHAUSTION project

Background and Aim: Short-term associations between heat and respiratory mortality and morbidity have been well recognized. However, most studies were conducted in major cities, whereas evidence for more rural areas is limited. In this study, we assessed the short-term associations between air temperature and cause-specific respiratory mortality and hospital admissions in the warm season (May-September) in Germany at a small-area level. Methods: Daily counts of mortality and hospital admissions for respiratory diseases, chronic obstructive pulmonary disease, asthma, lower respiratory tract infections, and pneumonia from 2000 to 2016 were obtained for Germany at the small-area level. Small areas were defined as districts for mortality data and municipalities for hospital admission data. Daily mean air temperatures estimated by a spatio-temporal model were assigned to each small area. We first applied small area-specific Poisson regression allowing for overdispersion, using Distributed Lag Non-linear Models to assess the heat effects at lag 0-1 days (average of same- and previous-day temperatures). Random-effects meta-analysis was then used to pool the small area-specific estimates. Besides, we conducted subgroup analyses to investigate effect modification by age and sex. Results: We observed increased risks for all investigated cause-specific respiratory mortality and hospital admissions associated with heat. The strongest heat effect was found for pneumonia. For an increment from the 75th to the 99th percentile of the temperature distribution, the pooled risk ratio was 1.49 (95% CI: 1.42, 1.57) for pneumonia mortality and 1.20 (95% CI: 1.19, 1.22) for pneumonia hospital admissions. The heat effects were stronger among the elderly (75+ years) and females. Conclusions: Using data from both urban and rural areas, our study suggests the adverse heat effects on respiratory mortality and morbidity in the warm season in Germany. These heat effects were more pronounced among the elderly and females. Keywords: Air temperature, heat, respiratory, mortality, hospital admissions

Associations of greenness, public parks, and blue space with cardiovascular and respiratory disease hospitalization in the US Medicare cohort

Background and Aim: Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. Our aim was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (~63 million individuals). Methods: Our open cohort included all fee-for-service Medicare beneficiaries (2000-2016), aged ≥65, living in the contiguous U.S. We assessed zip code-level average greenness (Normalized Difference Vegetation Index, NDVI), public park cover based on the United States Geological Survey Protected Areas Database, and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (≥1000 persons/mile2). Results: NDVI was weakly negatively correlated with percent public park cover (Spearman ρ = -0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, an IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). Percent public park cover was not associated with CVD or RSD hospitalization in the full or urban population. In stratified analyses, percent public park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. Conclusions: This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.

Spatio-temporal modeling of airborne pollen concentrations

Keywords: Pollen, Machine Learning, Allergic Disease Abstract Background and aim High concentrations of airborne pollen trigger seasonal allergies and possibly severe adverse respiratory and cardiovascular health events. Predicting pollen concentration accurately is valuable for epidemiological studies to determine the effects on cardiovascular, respiratory, and cognitive health. We aimed to develop a spatiotemporal land-use regression model for pollen, predicting daily concentrations at a fine spatial resolution of 1x1km across Switzerland between 2003 and 2020. Methods Daily pollen concentrations for hazel, alder, ash, birch, and grasses were available from 14 sites. We considered a range of spatial (elevation, tree type), temporal (date, season, month, week and day of the year, national daily pollen concentration) and spatiotemporal predictors (wind speed, wind direction, temperature, precipitation, relative humidity, satellite-observed Normalized Difference Vegetation Index (NDVI), and land-use (CLC, Landsat satellite) to explain variation in total pollen concentration for five specific pollen species. We applied a range of feature engineering techniques to encode categorical variables (land-use) and fill in missing values (Landsat). We applied a random forest model with 5-fold cross-validation. Results The median grass pollen concentration was 24 pollen/m3 (P5-P95 range 0-187 pollen/m3) during the main grass pollen season (May-July for all years). Preliminary results of a model predicting grass pollen concentration achieved an overall R2 of 0.74 and a root mean squared error (RMSE) of 24.12 pollen/m3 (cross-validation). Temperature, humidity, wind speed, NDVI, Landsat, average national daily pollen concentration and date features were the most important predictors for grass pollen concentration. Conclusions Building upon national observed pollen concentrations and using random forest machine learning, these spatiotemporal pollen models will serve to estimate individual residential pollen exposure. Resulting estimates will enable us to study respiratory and cardiovascular mortality and hospital admissions using historical data from the Swiss National Cohort and the Swiss Federal Office of Statistics.

The protective effect of green space on heat-related respiratory hospitalization among children under five years of age in Hanoi, Vietnam

The protective effect of green space on heat-related respiratory hospitalization among children under five years of age in Hanoi, Vietnam

Short-term heat effects on cardiopulmonary morbidity using national small area data – Results of the EXHAUSTION project

BACKGROUND AND AIM: Short-term associations between heat and cardiopulmonary morbidity have been examined mostly in major cities. Given potential differences in the effects of heat between urban and rural areas, it is important to analyze areas of various degrees of urbanization to better understand the health effects of heat. This study investigated heat effects on cardiopulmonary hospital admissions in the warm season (May-September) in Italy and Germany at the small-area level. METHODS: Daily counts of cardiovascular and respiratory hospital admissions were obtained for each municipality in Italy (2001–2015) and Germany (2000–2016). Spatio-temporal models estimated daily mean air temperatures at the municipality level. In each municipality-aggregated district, we first assessed heat effects at lag 0-1 days using district-specific Poisson regression with adjustment for a 4-way interaction between municipality, year, month, and day of the week, using the distributed lag non-linear model approach. Multivariate meta-analysis was then applied to pool the district-specific estimates in each country. Effect modification by age and sex was examined in subgroup analyses. RESULTS: For an increment in daily temperature from the 75th to the 99th percentile, the risk for respiratory hospital admissions increased in both Italy [pooled risk ratio (RR): 1.112, 95% CI: 1.098-1.126] and Germany (pooled RR: 1.074, 95% CI: 1.067-1.081). We did not observe adverse heat effects on cardiovascular hospital admissions in either country. The heat effects on respiratory hospital admissions were stronger in the elderly (75+ years) and females. CONCLUSIONS: Our study provides evidence for an adverse heat effect on respiratory morbidity, which was stronger in Italy with lower latitude. In both countries, the observed heat effects were more prominent in the elderly and females. Further analyses are ongoing to disentangle effects between urban and rural areas. KEYWORDS: air temperature, heat, cardiopulmonary hospital admissions, small area

Case-crossover study between PM2.5 and hospital admissions for respiratory diseases in Pretoria

Background: Particulate matter air pollution has been associated with adverse health effects. Air pollution epidemiology traditionally focuses on the relationship between individual air pollutants and health outcomes (e.g., mortality). To account for potential co-pollutant confounding, individual pollutant associations are often estimated by adjusting or controlling for other pollutants in the mixture. The objective of the study is control for components within the mixture which are highly correlated. Method: An overall study is performed where PM2.5, BC, UV-PM and trace elements were controlled for Tapp and public holidays, stratified for age and sex. A second model, where PM2.5 is also controlled, was performed. Results: In total, there were 15 155 reported hospitalisations for respiratory diseases (J00-J99) over the 34-month period. The increase in respiratory hospital admissions was significantly increased by an increase in total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg/m3 increase. respiratory hospital admissions significantly increased for Ca by 4.0 % (95% CI: 1.4% - 6.8%), Cl by 0.7 % (95% CI: 0.0% - 1.4%), Fe by 3.3 % (95% CI: 0.5% - 6.1%), K by 1.8% (95% CI: 0.2 – 3.5) and Si by 1.3 % (95% CI: 0.1% - 2.5%). When controlling for PM2.5, respiratory hospital admissions increased significantly for total Ca by 3.2 % (95% CI: 0.3, 6.1) and for the 0 – 14 age group by 5.2 % (95% CI: 1.5, 9.1). Hospital admissions was positive and significantly increased with an increase in resuspended dust matrix by 2.9 % (95% CI: 0.1% - 5.7%) and for biofuel burning by 1.6 % (95% CI: 0.1% - 3.2%) sources. Conclusion: Controlling for a co-pollutant which is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis. Keywords: Tapp, PM2.5, sources, respiratory

Age-specific hospitalization risk of primary and secondary respiratory syncytial virus infection among young children

ObjectivesElucidating the infection dynamics that lead to severe respiratory syncytial virus (RSV) pneumonia and hospitalization among young children are critical. We explored the role of infection parity as well as age in months for RSV-associated hospitalization among young children in Japan. MethodsWe used a sequential transmission catalytic model to capture the transmission mechanisms of RSV among infants in an endemic state. We investigated data on the age-dependent seroprevalence and incidence rate of hospitalization in Japan, and jointly estimated the age-specific risk of hospitalization during primary RSV infection and relative risk of hospitalization during secondary infection in children aged <5 years. ResultsThe estimated risk of hospitalization with primary infection was 0.08 (95% CI: 0.05-0.14) in infants aged 0-2 months. The estimated relative risk of hospitalization owing to secondary infection was 0.18 (95% CI: 0.01-2.04). ConclusionOur simple models successfully captured the infection dynamics of RSV among young children in Japan. The age group of early infancy may be most vulnerable to infection and hospitalization, offering key insights into future vaccinations. The burden of hospitalization from secondary infection may be less important in young children.

Gastroesophageal Reflux Disease Increases Susceptibility to Nontuberculous Mycobacterial Pulmonary Disease

Gastroesophageal reflux disease (GERD) is a common comorbidity of nontuberculous mycobacteria (NTM) pulmonary disease (PD). Although GERD is associated with more symptoms and severe disease in patients with NTM PD, whether GERD is associated with an increased risk of NTM PD developing is unknown. Does GERD influence the development of NTM PD? Are there any factors associated with an increased risk of NTM PD among patients with GERD? What is the impact of NTM PD on the health-care use of patients with GERD? Data from the Korean National Health Insurance Service National Sample Cohort between 2002 and 2015 were used. The incidence and risk of NTM PD were compared between patients with GERD (GERD cohort; n= 17,424) and patients matched for age, sex, type of insurance, and Charlson Comorbidity Index (matched cohort; n= 69,696). Using the GERD cohort, the factors associated with incident NTM PD also were evaluated. During a median follow-up duration of 5.1 years, the age- and sex-adjusted incidence of NTM PD was significantly higher in the GERD cohort (34.8 per 100,000 person-years [PY]) than in the matched cohort (10.5 per 100,000 PY; P< .001), with a subdistribution hazard ratio (HR) of 3.36 (95%CI, 2.10-5.37). Regarding risk factors associated with NTM PD, age of 60 years or older (adjusted HR, 3.57; 95%CI, 1.58-8.07) and bronchiectasis (adjusted HR, 18.69; 95%CI, 6.68-52.28) were associated with an increased risk of incident NTM PD in the GERD cohort. Compared with patients with GERD who did not demonstrate NTM PD, those with NTM PD showed higher all-cause (13,321 PY vs5,932 PY; P= .049) and respiratory disease-related (5,403 vs801; P= .011) ED visits or hospitalizations. GERD is associated with an increased incidence of NTM PD. Older age and bronchiectasis are risk factors for NTM PD in patients with GERD. NTM PD in patients with GERD is associated with increased health-care use.

Association between Obesity and Length of COVID-19 Hospitalization: Unexpected Insights from the American Heart Association National COVID-19 Registry.

BackgroundThe mechanism for possible association between obesity and poor clinical outcomes from Coronavirus Disease 2019 (COVID-19) remains unclear.MethodsWe analyzed 22,915 adult COVID-19 patients hospitalized from March 2020 to April 2021 to non-intensive care using the American Heart Association National COVID Registry. A multivariable Poisson model adjusted for age, sex, medical history, admission respiratory status, hospitalization characteristics, and laboratory findings was used to calculate length of stay (LOS) as a function of body mass index (BMI). We similarly analyzed 5,327 patients admitted to intensive care for comparison.ResultsRelative to normal BMI subjects, overweight, class I obese, and class II obese patients had approximately half-day reductions in LOS (–0.469 days, P<0.01; –0.480 days, P<0.01; –0.578 days, P<0.01, respectively).ConclusionThe model identified a dose-dependent, inverse relationship between BMI category and LOS for COVID-19, which was not seen when the model was applied to critically ill patients.

Associations of Ambient NO2 with Daily Hospitalization, Hospitalization Expenditure and Length of Hospital Stay of Cause-Specific Respiratory Diseases - Shanxi, China, 2017-2019.

What is already known about this topic?Numerous epidemiological studies have documented the association between ambient nitrogen dioxide (NO2) and mortality and morbidity of respiratory diseases, however, research on the effect of NO2 on the length of hospital stay (LOS) and hospitalization expenditure is limited.What is added by this report?This study collected the respiratory hospitalization, hospital expenditure, and LOS for respiratory diseases from 2017–2019 in Shanxi, China, and comprehensively evaluated the association between ambient NO2 exposure and respiratory hospitalization, expenditure, and LOS.What are the implications for public health practice?This study provides evidence on the association between ambient NO2 and respiratory burden, suggesting that continuously reducing the NO2 concentrations could prevent respiratory disease-associated hospital admissions and decrease the relative burden in Shanxi Province and other similar regions.

Quantifying the multiple environmental, health, and economic benefits from the electrification of the Delhi public transport bus fleet, estimating a district-wise near roadway avoided PM2.5 exposure

This study investigates the co-benefits from the utilization of the battery-electric bus (BEB) fleet in the Delhi public transportation system as a part of the Delhi electric vehicles policy 2020. To this aim, an integrated quantitative assessment framework is developed to estimate the expected environmental, health, and economic co-benefits from replacing the currently existing public bus fleet with the new BEBs in Delhi. First, the model estimates the avoided emissions from deploying the BEB fleet, using a detailed battery energy simulation model, considering the impact of the battery capacity loss on the annual operational time (hours of service) of the BEB. The annual operational time of the BEB is greatly affected by its battery degradation, which results in time lost due to charging the battery. This indicates that the annual passenger-kilometer (PKM) delivered by the BEB is less than the regular bus, under the same traveling condition. Second, considering fine particles (PM2.5) as the most health-harming pollutant, the model calculates the near roadway avoided PM2.5 exposure in the selected traffic zones of 11 major districts of Delhi, using a Gaussian dispersion model. Third, the near roadway avoided PM2.5 exposure is further used in a health impact assessment model, which considers concentration-response functions for several diseases to evaluate the public health benefits from introducing the BEB fleet in Delhi. The research findings indicate that, the utilization of the new BEB fleet leads to a 74.67% reduction in the total pollutant emissions from the existing bus fleet in Delhi. The results of the integrated co-benefits assessment reveal a significant reduction in PM2.5 emissions (44 t/y), leading to avoidance of mortality (1370 cases) and respiratory diseases related hospital admissions (2808 cases), respectively, and an annual savings of about USD 383 million from the avoided mortality and morbidity cases in Delhi.

Associations of parks, greenness, and blue space with cardiovascular and respiratory disease hospitalization in the US Medicare cohort

Natural environments have been linked to decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality. However, few cohort studies have looked at associations of natural environments with CVD or RSD hospitalization. The aim of this study was to evaluate these associations in a cohort of U.S. Medicare beneficiaries (∼63 million individuals). Our open cohort included all fee-for-service Medicare beneficiaries (2000–2016), aged ≥65, living in the contiguous U.S. We assessed zip code-level park cover based on the United States Geological Survey Protected Areas Database, average greenness (Normalized Difference Vegetation Index, NDVI), and percent blue space cover based on Landsat satellite images. Cox-equivalent Poisson models were used to estimate associations of the exposures with first CVD and RSD hospitalization in the full cohort and among those living in urban zip codes (≥1000 persons/mile2). NDVI was weakly negatively correlated with percent park cover (Spearman ρ = −0.23) and not correlated with percent blue space (Spearman ρ = 0.00). After adjustment for potential confounders, percent park cover was not associated with CVD or RSD hospitalization in the full or urban population. An IQR (0.27) increase in NDVI was negatively associated with CVD (HR: 0.97, 95%CI: 0.96, 0.97), but not with RSD hospitalization (HR: 0.99, 95%CI: 0.98, 1.00). In urban zip codes, an IQR increase in NDVI was positively associated with RSD hospitalization (HR: 1.02, 95%CI: 1.00, 1.03). In stratified analyses, percent park cover was negatively associated with CVD and RSD hospitalization for Medicaid eligible individuals and individuals living in low socioeconomic status neighborhoods in the urban population. We observed no associations of percent blue space cover with CVD or RSD hospitalization. This study suggests that natural environments may benefit cardiorespiratory health; however, benefits may be limited to certain contexts and certain health outcomes.

Cost Savings Without Increased Risk of Respiratory Hospitalization for Preterm Children after the 2014 Palivizumab Policy Update.

Our objective was to compare rates of hospitalizations for respiratory illnesses in preterm and full-term (FT) children for 4 years before and after the 2014 update to the American Academy of Pediatrics (AAP) respiratory syncytial virus (RSV) immunoprophylaxis guidance, which restricted eligibility among infants born at 29 to 34 weeks in the first winter and all preterm infants in the second winter after neonatal discharge. We conducted pre-post and interrupted time series analyses on claims data from a commercial national managed care plan. We compared the number of RSV and all respiratory hospital admissions in the first and second RSV seasons after neonatal discharge among a cohort of preterm children, regardless of palivizumab status, in the 4 years before and after the implementation of the 2014 palivizumab eligibility change. A FT group was included for reference. The cohort included 821 early preterm (EP, <29 weeks), 4,790 moderate preterm (MP, 29-34 weeks), and 130,782 FT children. Palivizumab use after the policy update decreased among MP children in the first and second RSV seasons after neonatal discharge, without any change in the odds of hospitalization with RSV or respiratory illness. For the EP group, there was no change in the rate of palivizumab or the odds of hospitalization with RSV or respiratory illness after the policy update. For the FT group, there was a slight decrease in odds of hospitalization post-2014 after the policy update. The interrupted time series did not reveal any secular trends over time in hospitalization rates among preterm children. Following the policy change, there were cost savings for MP children in the first and second RSV seasons, when accounting for the cost of hospitalizations and the cost of palivizumab. Hospitalizations for RSV or respiratory illness did not increase, and cost savings were obtained after the implementation of the 2014 AAP palivizumab prophylaxis policy. · Palivizumab use decreased among children born moderate preterm (29 to34 weeks) after the 2014 palivizuamb policy update.. · There was no change in odds of hospitalization with respiratory syncitial virus or respiratory illness among preterm infants after the policy update when compared to before.. · There were cost savings, when accounting for the cost of hospitalizations and the cost of palivizumab, after the policy update among children born moderate preterm..

Assessing the Clinical and Socioeconomic Burden of Respiratory Syncytial Virus in Children Aged Under 5 Years in Primary Care: Protocol for a Prospective Cohort Study in England and Report on the Adaptations of the Study to the COVID-19 Pandemic.

BackgroundRespiratory syncytial virus (RSV) commonly causes lower respiratory tract infections and hospitalization in children. In 2019-2020, the Europe-wide RSV ComNet standardized study protocol was developed to measure the clinical and socioeconomic disease burden of RSV infections among children aged <5 years in primary care. RSV has a recognized seasonality in England.ObjectiveWe aimed to describe (1) the adaptations of the RSV ComNet standardized study protocol for England and (2) the challenges of conducting the study during the COVID-19 pandemic.MethodsThis study was conducted by the Oxford-Royal College of General Practitioners Research and Surveillance Centre—the English national primary care sentinel network. We invited all (N=248) general practices within the network that undertook virology sampling to participate in the study by recruiting eligible patients (registered population: n=3,056,583). Children aged <5 years with the following case definition of RSV infection were included in the study: those consulting a health care practitioner in primary care with symptoms meeting the World Health Organization’s definition of acute respiratory illness or influenza-like illness who have laboratory-confirmed RSV infection. The parents/guardians of these cases were asked to complete 2 previously validated questionnaires (14 and 30 days postsampling). A sample size of at least 100 RSV-positive cases is required to estimate the percentage of children that consult in primary care who need hospitalization. Assuming a swab positivity rate of 20% in children aged <5 years, we estimated that 500 swabs are required. We adapted our method for the pandemic by extending sampling planned for winter 2020-2021 to a rolling data collection, allowing verbal consent and introducing home swabbing because of increased web-based consultations during the COVID-19 pandemic.ResultsThe preliminary results of the data collection between International Organization for Standardization (ISO) weeks 1-41 in 2021 are described. There was no RSV detected in the winter of 2020-2021 through the study. The first positive RSV swab collected through the sentinel network in England was collected in ISO week 17 and then every week since ISO week 25. In total, 16 (N=248, 6.5%) of the virology-sampling practices volunteered to participate; these were high-sampling practices collecting the majority of eligible swabs across the sentinel network—200 (43.8%) out of 457 swabs, of which 54 (N=200, 27%) were positive for RSV.ConclusionsMeasures to control the COVID-19 pandemic meant there was no circulating RSV last winter; however, RSV has circulated out of season, as detected by the sentinel network. The sentinel network practices have collected 40% (200/500) of the required samples, and 27% (54/200) were RSV positive. We have demonstrated the feasibility of implementing a European-standardized RSV disease burden study protocol in England during a pandemic, and we now need to recruit to this adapted protocol.International Registered Report Identifier (IRRID)DERR1-10.2196/38026

Estimated public health benefits of a low-emission zone in Malmö, Sweden

Air pollution is one of the leading causes of morbidity and mortality worldwide. Low-emission zones (LEZ) have been increasingly implemented in cities throughout Europe as a measure to reduce the adverse health effects and premature deaths associated with traffic-related air pollution. In the present study, a health impact analysis was conducted to estimate the effect of a hypothetical LEZ on mortality and morbidity in Malmö, Sweden. Baseline health statistics were gathered from health registers and applied to each resident according to individual-level data on age and/or sex. Concentration-response parameters were derived from current epidemiological literature, specifically meta-analyses. A Gaussian dispersion model (AERMOD) combined with a detailed emission database was used to calculate NO2 emissions from traffic, which could be applied on an individual-level using data on each person's residential coordinates. The adjusted exposure scenario replaced all vehicles on municipal roads having Euro 5 or lower emission standards with Euro 6 equivalents. This LEZ would, on average, decrease NO2 concentrations by 13.4%, preventing an estimated 9–26 deaths in Malmö each year. Additionally, 12 respiratory disease hospitalizations, 8 childhood asthma cases, and 9 cases of hypertensive disorders of pregnancy were estimated to be avoided annually. These results suggest that LEZs can effectively improve air quality, reduce greenhouse gas emissions, and safeguard public health.

Early risk of acute myocardial infarction following hospitalization for severe influenza infection in the middle-aged population of Hong Kong.

IntroductionDespite evidence suggesting an association between influenza infection and increased risk of acute myocardial infarction (AMI) in the older adult population (aged 65 years or above), little is known about its near-term risks in middle-aged adults (aged 45 to 64 years). This study aims to estimate the risks of and association between severe influenza infection requiring hospitalization and subsequent AMI within 12 months in middle-aged adults.MethodThis is a retrospective case-control analysis of territorywide registry data of people aged 45 to 64 years admitting from up to 43 public hospitals in Hong Kong during a 20-year period from January 1997 to December 2017. The exposure was defined as severe influenza infection documented as the principal diagnosis using International Classification of Diseases codes and non-exposure as hospitalization for orthopedic surgery. Logistic regression was used to analyze the risk of subsequent hospitalization for AMI within 12 months following the exposure.ResultsAmong 30,657 middle-aged adults with an indexed hospitalization, 8,840 (28.8%) had an influenza-associated hospitalization. 81 (0.92%) were subsequently rehospitalized with AMI within 12 months after the indexed hospitalization. Compared with the control group, the risk of subsequent hospitalization for AMI was significantly increased (odds ratio [OR]: 2.54, 95% confidence interval [CI]: 1.64–3.92, p<0.001). The association remained significant even after adjusting for potential confounders (adjusted OR: 1.81, 95% CI: 1.11–2.95, p = 0.02). Patients with a history of hypertension, but not those with diabetes mellitus, dyslipidemia or atrial fibrillation/flutter, were at increased risk (adjusted OR: 5.01, 95% CI: 2.93–8.56, p<0.001).ConclusionSubsequent hospitalization for AMI within 12 months following an indexed respiratory hospitalization for severe influenza increased nearly two-fold compared with the non-cardiopulmonary, non-exposure control. Recommendation of influenza vaccination extending to middle-aged adult population may be justified for the small but significant increased near-term risk of AMI.

Summary of the National Advisory Committee on Immunization (NACI) statement update on the recommended use of palivizumab to reduce complications of respiratory syncytial virus infection in infants.

Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in young children worldwide. Underlying health conditions, especially premature birth, chronic lung disease and congenital heart disease, predispose to severe RSV illness. The only means of prophylaxis against RSV disease is passive prophylaxis with the monoclonal antibody, palivizumab (PVZ) (SynagisTM). The National Advisory Committee on Immunization (NACI) published a statement for PVZ use in 2003. The purpose of this article is to update previous NACI recommendations for the use of PVZ, taking into consideration recent data on RSV burden of illness, effectiveness of PVZ in infants at risk of more severe RSV disease and economic implications of PVZ use. The NACI Working Group and external experts performed systematic literature reviews on three topics to support updated NACI guidance: 1) RSV burden of disease; 2) PVZ effectiveness; and 3) cost effectiveness of PVZ prophylaxis. Full details and results are presented in the statement and supporting documents. Respiratory syncytial virus hospitalization (RSVH) rates are highest in children younger than one year of age and especially in the first two months of life. In various populations of infants at risk of severe RSV infection, PVZ prophylaxis is associated with reductions of 38%-86% in the risk of RSVH. Only rare cases of anaphylaxis have been reported after decades of use. Palivizumab is expensive and only cost-saving in rare scenarios. Updated NACI recommendations on use of PVZ for the prevention of complications of RSV in infants are now available.

Hospitalization Costs of Respiratory Diseases Attributable to Temperature in Australia and Projections for Future Costs in the 2030s and 2050s under Climate Change

This study aimed to estimate respiratory disease hospitalization costs attributable to ambient temperatures and to estimate the future hospitalization costs in Australia. The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010–2016 were analyzed using distributed non-linear lag models. Future hospitalization costs were estimated based on three predicted climate change scenarios-RCP2.6, RCP4.5 and RCP8.5. The estimated respiratory disease hospitalization costs attributable to ambient temperatures increased from 493.2 million Australian dollars (AUD) in the 2010s to more than AUD 700 million in 2050s in Sydney and from AUD 98.0 million to about AUD 150 million in Perth. The current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1–20.1%) and (5.1–6.6%), respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Limitations of this study should be noted, such as lacking information on individual-level exposures, local air pollution levels, and other behavioral risks, which is common in such ecological studies. Nonetheless, this study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change may result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location.