Respiratory Illness In Children Research Articles

Indoor Air Pollution and Respiratory Illness in Children from Rural India: A Pilot Study

Indoor air pollution measured in terms of particulate matter < 2.5 microm in diameter (PM2.5), is an important cause of respiratory illness in children. Therefore, PM2.5 levels in rural households and its correlation with respiratory illness-related symptoms in children were studied. A questionnaire-based survey of children for respiratory illness-related symptoms was conducted in 37 households of a village (Khanpurjupti, Delhi-NCR, India) from September 2011 to October 2011. Assessment of 24-hour PM2.5 level was done using University of California-Berkeley Particle and Temperature Sensor (UCB-PATS). Thirty-seven households in a rural area were studied. These were divided into 20 respiratory households, i.e. those with children with respiratory illness-related symptoms and 17 control households. The 24-hour PM2.5 was measured in all the houses. The average minimum and maximum PM2.5 levels were 7.24 mg/m3 and 22.70 mg/m3, respectively (mean = 10.47 mg/m3) among the 20 respiratory households. The average minimum and maximum PM2.5 levels were 1.10 mg/m3 and 18.17 mg/m3, respectively (mean = 4.99 mg/m3) in the 17 control households. The PM2.5 levels were significantly greater (p < 0.05) in houses where children had respiratory symptoms compared to the control households. Further, biomass fuel use and number of family members were significantly associated with respiratory illness in children. Increased PM2.5 levels, biomass fuel use and number of family members were found to be associated with increased occurrence of respiratory illness in children.

Commentary: Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age.

Commentary: Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age.

Role of Diet, Lifestyle and Yoga in the Prevention and Management of Respiratory Illnesses in Children

Acute respiratory infection is the biggest cause for mortality among children aged less than 5 years, especially in developing countries. A community-based survey study showed that prevalence of respiratory infections was found to be 63.7% and 53.7% in urban and rural areas respectively. Respiratory infections account for 40% of child mortality globally. Burden of acute respiratory infection is increasing day by day due to the growing trend of modernization and urbanization. Overcrowding, repeated exposure to several allergens, poor nutrition are the other major etiological factors in the development of respiratory illness. After Corona virus 2019 (Covid-19) pandemic, the number of cases rose to millions and several countries across the globe were impacted severely.&#x0D; Ayurveda is a holistic science which aims at health protection, promotion and strengthening immunity to overcome diseased condition. Diet and lifestyle modification, Yogic methods like Asana, Pranayama and Neti improve respiratory health by cleansing airways, strengthening respiratory muscles, enhancing lung capacity and tissue oxygenation. Assessment of Prakriti, cause behind the illness, treating the existing morbidity, Rasayana prayoga, following necessary precautions and using certain home remedies at an early stage are important to maintain respiratory as well as overall health.&#x0D; This paper highlights preventive modalities in every level of health condition, both physical and mental, stressing especially on diet and lifestyle practices of a child.

Water, Sanitation, and Hygiene and Nutritional Risk Factors for Acute Respiratory Illness in the Democratic Republic of the Congo: REDUCE Prospective Cohort Study.

The objective of this cohort study was to examine the prevalence of acute respiratory illness among children under 5 years of age and to identify water, sanitation, and hygiene (WASH) and nutritional risk factors. This prospective cohort study was conducted in Walungu Territory, South Kivu, and Democratic Republic of the Congo (DRC), and enrolled 512 participants. Spot checks of the household environment were conducted at baseline. Baseline minimum dietary diversity (MDD) was defined by consumption of five or more of the following food groups: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A rich fruits and vegetables; and 8) other fruits and vegetables. Acute respiratory illness was defined as caregiver reported rapid breathing, difficulty breathing, lower chest wall in drawing, or coughing in the previous 2 weeks obtained at a 6-month follow-up based on the use of this definition in previous studies in Bangladesh and Kenya. A total of 58% of children had acute respiratory illness, 19% had soap present in the cooking area, and 4% in the defecation area, and 21% of children met MDD. A decreased odds of acute respiratory illness was associated with soap being present in the cooking area (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.38-0.88) and MDD (OR: 0.62, 95% CI: 0.38-1.00). These findings highlight the need for interventions targeting hygiene and improved dietary diversity among rural DRC households to reduce the rate of respiratory illnesses in children under 5 years.

School Closures in the United States and Severe Respiratory Illnesses in Children: A Normalized Nationwide Sample.

To determine the association between nationwide school closures and prevalence of common admission diagnoses in the pediatric critical care unit. Retrospective cohort study. National database evaluation using the Virtual Pediatric Systems LLC database. All patients admitted to the PICU in 81 contributing hospitals in the United States. Diagnosis categories were determined for all 110,418 patients admitted during the 20-week study period in each year (2018, 2019, and 2020). Admission data were normalized relative to statewide school closure dates for each patient using geographic data. The "before school closure" epoch was defined as 8 weeks prior to school closure, and the "after school closure" epoch was defined as 12 weeks following school closure. For each diagnosis, admission ratios for each study day were calculated by dividing 2020 admissions by 2018-2019 admissions. The 10 most common diagnosis categories were examined. Significant changes in admission ratios were identified for bronchiolitis, pneumonia, and asthma. These changes occurred at 2, 8, and 35 days following school closure, respectively. PICU admissions decreased by 82% for bronchiolitis, 76% for pneumonia, and 76% for asthma. Nonrespiratory diseases such as diabetic ketoacidosis, status epilepticus, traumatic injury, and poisoning/ingestion did not show significant changes following school closure. School closures are associated with a dramatic reduction in the prevalence of severe respiratory disease requiring PICU admission. School closure may be an effective tool to mitigate future pandemics but should be balanced with potential academic, economic, mental health, and social consequences.

Serum Calprotectin Is a Valid Biomarker in Distinction of Bacterial Urinary Tract Infection From Viral Respiratory Illness in Children Under 3 Years of Age.

BackgroundFebrile illnesses in young children can be a major diagnostic challenge, despite the routine use of various laboratory markers. Recent advancements in the understanding of inflammatory processes have highlighted the role of calprotectin, a heterodimer consisting of S100A8 and S100A9 proteins, with many studies suggesting its clinical value as a biomarker of inflammation. This research aimed to evaluate the usefulness of serum calprotectin (sCal) as a biomarker of urinary tract infection (UTI), which was due to its high pooled prevalence and feasibility of urine culture as a diagnostic reference standard selected for a model of bacterial infection in children.MethodsFebrile children aged 0–36 months with suspected UTI based on positive urinalysis or viral respiratory tract infection were included. Children with significant bacteriuria in urine culture were labeled as cases (n = 58), while those with confirmed viral infection (n = 51), as well as those with suspected UTI but sterile urine culture who went on to develop symptoms consistent with viral respiratory infection (n = 7), were labeled as controls. sCal levels were determined by a commercial immunoassay. Conventional inflammation markers (C-reactive protein, procalcitonin, white blood cell count, absolute neutrophil count, and neutrophil percentage) were measured on the day of the clinical examination. Differences in measured inflammatory markers between cases and controls were analyzed with Mann-Whitney U-test. ROC analysis reported cut-off values with the best sensitivity and specificity to distinguish bacterial UTI from viral respiratory infection.ResultsAll analyzed inflammatory biomarkers, including sCal, were significantly higher in cases than in controls. Median concentration of sCal was 4.97 μg/mL (IQR 3.43–6.42) and 2.45 μg/mL (IQR 1.63–3.85) for cases and controls, respectively (p < 0.001). For identifying bacterial UTI, sensitivity and specificity of sCal were 77.6 and 69.0%, respectively, at an adjusted cut-off point of >3.24 μg/mL (AUC 80.2%).ConclusionsCal could have substantial added value in the management of a child with fever and positive urinalysis and is a promising biomarker in distinction between bacterial UTI and viral respiratory causes of febrile illness in children under the age of 3 years.

Weather events and respiratory diseases in children: case studies in the metropolitan region of São Paulo, Brazil

This paper presents a preliminary analysis of meteorological variables and their relationship with respiratory morbidity in children under two years old of São Paulo city, taking into account the synoptical systems and their constructive structures of residences. Measurements of indoor air temperature and relative humidity were collected using a thermohygrographic across of 378 residences, between years 2003 to 2006. Outdoor meteorological variables have been obtained from meteorological station. A summary with four case studies is shown relating the thermal behavior in each residence and the onset of respiratory illness in children (wheezing). The results show associations of children respiratory crises and air temperature fall and increase of relative humidity, associated with maritime polar air masses and frontal systems (cold front). Specific residences have higher indoor humidity values than others, due to their constructive types and it is an important factor to bring out wheezing problems. Considering such results, acknowledging periods favorable to occurrences of wheezing in children, as well as the constructive type of residences, it is feasible to predict respiratory morbidity and to establish public policy in order to alert the population, minimizing weather/climate impacts on children's health

Clinical assessment and management of children with bronchiolitis.

Bronchiolitis is a common seasonal viral illness in babies and children aged under two years. Its significance has increased in the light of a predicted surge in respiratory illness in children this winter and the continuing effect of the coronavirus disease 2019 (COVID-19) pandemic on parental anxiety and cross-infection. Children's nurses will have a central role in delivering high-quality care and support to children and families during this time. To support children's nurses to prepare for a surge, this article summarises the pathophysiology of bronchiolitis, risk factors, transmission, diagnosis and clinical management of children with the illness, including recent national policy changes. It also considers the potential effect of the COVID-19 pandemic on the healthcare system, children and families.

Pattern and risk factor of lower respiratory illness in children who survived meconium aspiration syndrome

Pattern and risk factor of lower respiratory illness in children who survived meconium aspiration syndrome

Impact of Covid 19 preventive measures on hospital admission due to respiratory illness in children at Professorial Paediatric unit Teaching Hospital Jaffna

Respiratory diseases are common causes of hospital admission in children. Droplet transmission is the primary route of transmition in respiratory infections. The objective was to assess the burden of respiratory diseases on hospital admission of children during this Covid 19 pandemic and to assess the impact of Covid 19 preventive measures on it. An institutional based retrospective descriptive study based on secondary data was carried out at Professorial Paediatric unit Teaching hospital Jaffna. The data was extracted from the electronic patient management system. All the records of children who were primarily diagnosed with respiratory disease during the period of June 2020 to May 2021 were extracted. This data was compared with that of 2017. The total hospital admission has reduced from 4127 to 1049 during the pandemic. There was a significant decrease in total hospital admission during the covid 19 pandemic compared to before the pandemic {t (11.488) = 8.015 p&lt;0.001}. Similarly, there was a significance decrease in the admissions due to respiratory diseases during the covid 19 pandemic {t(11.355) =5.982 p&lt;0.001}. The percentage of respiratory admission has significantly reduced during the pandemic {t(21.997) =5.173 p&lt;0.001}. Hospital admission due to respiratory illness has significantly reduced when compared to total admission during this pandemic. This may be attributed to social distancing, wearing mask and good hand hygiene.

Helical ordering of envelope‐associated proteins and glycoproteins in respiratory syncytial virus

Human respiratory syncytial virus (RSV) causes severe respiratory illness in children and the elderly. Here, using cryogenic electron microscopy and tomography combined with computational image analysis and three‐dimensional reconstruction, we show that there is extensive helical ordering of the envelope‐associated proteins and glycoproteins of RSV filamentous virions. We calculated a 16 Å resolution sub‐tomogram average of the matrix protein (M) layer that forms an endoskeleton below the viral envelope. These data define a helical lattice of M‐dimers, showing how M is oriented relative to the viral envelope. Glycoproteins that stud the viral envelope were also found to be helically ordered, a property that was coordinated by the M‐layer. Furthermore, envelope glycoproteins clustered in pairs, a feature that may have implications for the conformation of fusion (F) glycoprotein epitopes that are the principal target for vaccine and monoclonal antibody development. We also report the presence, in authentic virus infections, of N‐RNA rings packaged within RSV virions. These data provide molecular insight into the organisation of the virion and the mechanism of its assembly.

Did the National Lockdown in Saudi Arabia Reduce Lower Respiratory Illnesses in Children?

Objectives: This study aims to explore the effect of lockdown and early precautionary measures implemented in Saudi Arabia on number of pediatric hospitalizations due to lower respiratory illnesses (bronchiolitis, asthma, and pneumonia).Methods: This is a retrospective cross-sectional study aims to review patients from four major hospitals in Saudi Arabia. All pediatric hospitalizations secondary to asthma, bronchiolitis, and pneumonia during the months of the lockdown (March, April, and May) in 2020 were documented. Then, they were compared to the previous 2 years. Variables like number of hospitalizations, oxygen requirement, mechanical ventilation, admission to the intensive care unit (ICU), length of stay, and results of viral studies were collected.Results: We included 1,003 children from four different centers. Males were slightly higher than females (55.8% vs. 44.2%). Total number of hospitalizations in 2020 was 201, significantly lower than 399 and 403 hospitalizations in 2019 and 2018, respectively (P < 0.01). The major drop happened on the months of April and May. Although bronchiolitis hospitalizations' dropped by more than half in 2020 compared to the previous 2 years, it was not statistically significant (P = 0.07). But, asthma hospitalizations were significantly less in 2020 compared to the previous 2 years (49–65% reduction, P = 0.003). Number of pneumonia cases were lowered in 2020 compared to the previous 2 years. However, proportion of pneumonia diagnosis to total hospitalizations increased in 2020 (55% compared to 50% and 35%). There was a surge of viral testing during a period of uncertainty in the early phase of the pandemic. This total reduction in hospitalization was not associated with higher oxygen requirements, mechanical ventilation, ICU admissions or longer hospital stay.Conclusions: Lockdown and precautionary measures executed during the early phase of COVID-19 pandemic helped decrease the number of hospitalizations due to lower respiratory illnesses in Saudi Arabia. Reduction in hospitalizations seems less likely to be secondary to hospital avoidance or delayed presentations as number of ICU admission and oxygen requirements did not increase. The post pandemic pattern of respiratory illnesses among children needs further research.

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup

AbstractCroup is a common respiratory illness in children with a substantial variation in the severity of symptoms. Most of the patients present with mild symptoms, but patients with severe croup require intensive care unit (ICU) management. The aim of this study was to investigate the airway management of patients with severe croup who required intubation and determine the risk factors for prolonged intubation. We performed an 18-year retrospective observational cohort study at the pediatric ICU of a tertiary children's hospital in Japan. A total of 16 patients with croup who were intubated for upper airway obstruction were included in the study. Most patients (13of 16, 81%) were intubated with an endotracheal tube (ETT) smaller than their age-appropriate size. The median difference in the internal diameter (ID) between the selected ETT and the age-appropriate size was 1.0 mm (interquartile range: 0.5–1.0). Multivariate analysis performed on factors affecting the cumulative incidence of extubation revealed that the difference in ID between the selected ETT and age-appropriate size (mm) significantly reduced the duration of intubation (hazard ratio: 0.092, p = 0.03). A downsized ETT without a cuff may be recommended for intubation of patients with croup.

Acute Respiratory Illnesses in Children in the SARS-CoV-2 Pandemic: Prospective Multicenter Study.

Nonpharmaceutical interventions against coronavirus disease 2019 likely have a role in decreasing viral acute respiratory illnesses (ARIs). We aimed to assess the frequency of respiratory syncytial virus (RSV) and influenza ARIs before and during the coronavirus disease 2019 pandemic. This study was a prospective, multicenter, population-based ARI surveillance, including children seen in the emergency departments and inpatient settings in 7 US cities for ARI. Respiratory samples were collected and evaluated by molecular testing. Generalized linear mixed-effects models were used to evaluate the association between community mitigation and number of eligible and proportion of RSV and influenza cases. Overall, 45 759 children were eligible; 25 415 were enrolled and tested; 25% and 14% were RSV-positive and influenza-positive, respectively. In 2020, we noted a decrease in eligible and enrolled ARI subjects after community mitigation measures were introduced, with no RSV or influenza detection from April 5, 2020, to April 30, 2020. Compared with 2016-2019, there was an average of 10.6 fewer eligible ARI cases per week per site and 63.9% and 45.8% lower odds of patients testing positive for RSV and influenza, respectively, during the 2020 community mitigation period. In all sites except Seattle, the proportions of positive tests for RSV and influenza in the 2020 community mitigation period were lower than predicted. Between March and April 2020, rapid declines in ARI cases and the proportions of RSV and influenza in children were consistently noted across 7 US cities, which could be attributable to community mitigation measures against severe acute respiratory syndrome coronavirus 2.

Detection of respiratory syncytial virus defective genomes in nasal secretions is associated with distinct clinical outcomes.

Respiratory syncytial virus (RSV) causes respiratory illness in children, immunosuppressed individuals and the elderly. However, the viral factors influencing the clinical outcome of RSV infections remain poorly defined. Defective viral genomes (DVGs) can suppress virus replication by competing for viral proteins and by stimulating antiviral immunity. We studied the association between detection of DVGs of the copy-back type and disease severity in three RSV A-confirmed cohorts. In hospitalized children, detection of DVGs in respiratory samples at or around the time of admission associated strongly with more severe disease, higher viral load and a stronger pro-inflammatory response. Interestingly, in experimentally infected adults, the presence of DVGs in respiratory secretions differentially associated with RSV disease severity depending on when DVGs were detected. Detection of DVGs early after infection associated with low viral loads and mild disease, whereas detection of DVGs late after infection, especially if DVGs were present for prolonged periods, associated with high viral loads and severe disease. Taken together, we demonstrate that the kinetics of DVG accumulation and duration could predict clinical outcome of RSV A infection in humans, and thus could be used as a prognostic tool to identify patients at risk of worse clinical disease.

Breath can discriminate tuberculosis from other lower respiratory illness in children

Pediatric tuberculosis (TB) remains a global health crisis. Despite progress, pediatric patients remain difficult to diagnose, with approximately half of all childhood TB patients lacking bacterial confirmation. In this pilot study (n = 31), we identify a 4-compound breathprint and subsequent machine learning model that accurately classifies children with confirmed TB (n = 10) from children with another lower respiratory tract infection (LRTI) (n = 10) with a sensitivity of 80% and specificity of 100% observed across cross validation folds. Importantly, we demonstrate that the breathprint identified an additional nine of eleven patients who had unconfirmed clinical TB and whose symptoms improved while treated for TB. While more work is necessary to validate the utility of using patient breath to diagnose pediatric TB, it shows promise as a triage instrument or paired as part of an aggregate diagnostic scheme.

Respiratory Symptoms and Urinary Cotinine Levels in Pre-school Children Exposed to Environmental Tobacco Smoke.

Objective: Preschool children exposed to environmental tobacco smoke (ETS) are at risk of developing adverse respiratory health effects. The present study aimed to investigate the relationship between the effects of cigarette-smoking caregivers on respiratory symptoms and urinary cotinine (UC) levels in children.Methods: A cross-sectional study consisting of 543 children (aged between 5 and 6 years) from 5 kindergartens in central China was conducted using a structured questionnaire. We also analyzed UC levels to investigate the relationship between respiratory symptoms and ETS exposure. We further performed logistic regression analyses to establish the relationship between respiratory symptoms (coughing, rhinorrhea, and sneezing) and UC levels.Results: A total of 71 (13.08%) children had a history of hospital admission with respiratory illnesses including bronchitis and pneumonia over the last 6 months. In addition, 102 (18.78%) children presented coughing symptoms, 114 (20.99%) experienced rhinorrhea and 79 (14.55%) presented sneezing symptoms over the last 6 months. After adjusting the confounders, odds ratio (OR) indicated that the number of cigarettes smoked by a caregiver was associated with coughing (OR = 11.02; 95% CI, 3.72–33.66), rhinorrhea (OR = 41.83; 95% CI, 5.58–313.05) and sneezing (OR = 4.71; 95% CI, 1.33–16.48). Furthermore, UC levels in children with coughing, rhinorrhea and sneezing were significantly higher than in children without respiratory symptoms (P = 0.002, P < 0.001, P < 0.001, respectively).Conclusions: This study reveals that children exposed to ETS have higher levels of UC. Compared with caregiver who non-smoked live with children, smoked cigarettes were highly risk of developing respiratory illnesses in children. Notably, the higher the UC levels the greater the respiratory risk. Our results also signify that UC can be used as an indicator of ETS exposure to inform caregivers of the associated risks, and inform efforts to reduce related effects.

78. Acute Respiratory Illnesses in Children During the sars-cov-2 Pandemic: A Prospective Multicenter Surveillance Study

BackgroundA state of emergency was declared in the United States (US) on March 13, 2020 in response to the SARS-CoV-2 pandemic. Healthcare providers had to alter practice patterns and research priorities. We assessed the frequency of acute respiratory illnesses (ARI) in children, notably those due to respiratory syncytial virus (RSV) and influenza, before and during the pandemic.MethodsWe conducted multi-center active prospective ARI surveillance in children as part of the New Vaccine Surveillance Network. Children < 18 years with fever and/or respiratory symptoms were enrolled in emergency department and inpatient settings at seven US medical centers over four respiratory seasons during 2016–2020 (Fig 1). Pandemic-related restrictions to patient access limited enrollment in some sites beginning March 2020. Respiratory specimens were collected and tested at each site for RSV and influenza by qRT-PCR. Data were analyzed by calendar weeks. We compared the cumulative proportions of RSV and influenza detection after week 13 in 2020 to the previous seasons using Fisher’s exact test.Figure 1. Numbers of Eligible and Enrolled Acute Respiratory Illness Cases, and Proportions of RSV and Influenza Detection by Week, Stratified by Study Season ResultsOf 44,247 eligible children, 25,375 (57%) were enrolled and tested for RSV and/or influenza. A total of 6351/25375 (25%) and 3446/25372 (14%) children were RSV and influenza-positive over the four seasons, respectively. In 2020, we noted a rapid drop in eligible and enrolled ARI subjects after weeks 11–13 (Fig 1). During weeks 13–18 in 2016–2019, the three-year average of eligible and enrolled subjects was 1802 and 978, respectively. However, over the same period in 2020, there were 675 eligible and 278 enrolled subjects, representing declines of 62.5% and 71.6% respectively (Fig 1). In 2020, there were no RSV or influenza cases detected in weeks 15–18, and the cumulative proportions of RSV and influenza detection after week 13 were lower compared to previous seasons (p< 0.001) (Figs 1 and 2).Figure 2. Cumulative Proportions of Weekly RSV and Influenza Detection by Study Season ConclusionThere was a considerable decline in ARI visits and the proportion of RSV and influenza detection across seven distinct geographic sites during the pandemic compared with previous seasons. These findings might be attributable to social distancing measures to lessen the spread of SARS-CoV-2, changes in healthcare-seeking behaviors, and limited access to medical care.Disclosures Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member)IDConnect (Advisor or Review Panel member)Quidel (Advisor or Review Panel member) Christopher J. Harrison, MD, GSK (Grant/Research Support, Infant menigiciccal B conjugate vaccine trial)Merck (Research Grant or Support, Infant pneumococcal conjugate vaccine trial) Janet A. Englund, MD, AstraZeneca (Scientific Research Study Investigator)GSK group of companies (Scientific Research Study Investigator)Meissa vaccines (Consultant)Merck (Scientific Research Study Investigator)Sanofi Pasteur (Consultant) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)

Nasopharyngeal colonization with pathobionts is associated with susceptibility to respiratory illnesses in young children.

Some children are more susceptible to viral and bacterial respiratory infections in the first few years of life than others. However, the factors contributing to this susceptibility are incompletely understood. In a retrospective analysis of clinical samples collected from a prospectively-enrolled cohort of 358 children we sought associations between physician-attended illness visits and bacterial colonization in the first five years of life. A subset of children was identified by unsupervised clustering analysis as infection and allergy prone (IAP). Several respiratory infection- and allergy-mediated illnesses co-occurred at higher rates in IAP children, while the rates of other illnesses were not significantly different between the groups. Analyses of nasopharyngeal (NP) pathobionts and microbiota commensals showed that early age of first colonization with pathobionts Streptococcus pneumonia, non-typeable Haemophilus influenzae, and Moraxella catarrhalis was associated with IAP children, and particularly Moraxella abundance was negatively associated with NP microbiome diversity. We conclude that mucosal pathobiont exposures in early life can influence susceptibility to respiratory illnesses in children.

Assessing the epidemiology and seasonality of influenza among children under two hospitalized in Amman, Jordan, 2010-2013.

BackgroundThe disease burden of influenza‐associated hospitalizations among children in Jordan is not well established. We aimed to characterize hospitalizations attributed to influenza in a pediatric population.MethodsWe conducted a cross‐sectional study from our viral surveillance cohort in children under 2 years hospitalized with acute respiratory symptoms and/or fever from March 2010 to March 2013. We collected demographic and clinical characteristics, and calculated the frequency of children who met the severe acute respiratory illness (SARI) criteria. Nasal specimens were tested using real‐time reverse transcriptase polymerase chain reaction to detect influenza A, B, or C. Further subtyping for influenza A‐positive isolates was conducted.ResultsOf the 3168 children enrolled in our study, 119 (4%) were influenza‐positive. Influenza types and subtypes varied by season but were predominantly detected between December and February. Codetection of multiple respiratory pathogens was identified in 58% of children with the majority occurring among those <6 months. Bronchopneumonia and rule‐out sepsis were the most common admission diagnoses, with influenza A accounting for over 2/3 of children with a rule‐out sepsis admission status. One‐third of children under 6 months compared to 3/4 of children 6‐23 months met the SARI criteria.ConclusionsInfluenza was an important cause of acute respiratory illness in children under 2 years. Children <6 months had the highest burden of influenza‐associated hospitalizations and were less likely to meet the SARI global surveillance case definition. Additional surveillance is needed in the Middle East to determine the true influenza burden on a global scale.