Risk Factors For Respiratory Infections Research Articles

Nghiên cứu cộng đồng về một số yếu tố dịch tễ và hiểu biết của cha/mẹ khi sử dụng kháng sinh cho trẻ tại Thái Nguyên và Hà Giang năm 2020-2021

This study was conducted in 2020-2021 to investigate several epidemiological factors and parents' knowledge of antibiotic use in children in Thai Nguyen and Ha Giang. Methods: 459 eligible subjects were investigated for epidemiological information and knowledge of antibiotic use. 275 bacterial culture were successfully done from nasopharyl swabs of participants. Results: Some epidemiological factors such as parents' smoking, a high percentage of pipe tobacco smoking (21.6%), and up to 30.7% of relatives living in the same house (including Ha Giang at 31.4% and Thai Nguyen at 30.0%). In children, medical history of tonsillitis accounted for 37.3%, with otitis media accounting for 11.5%. The average influenza incidence was 1.7 times per year in Ha Giang and 1.9 times per year in Thai Nguyen. The proportion of children with antibiotic consumption over the past year was 47.3% in Thai Nguyen and 34.7% in Ha Giang. Commonly used antibiotics were amoxicillin and cephalexin, and most parents did not remember or knew the names of the antibiotics their children were taking. There were 42.0% of parents who knew about the use of antibiotics that the effects of antibiotics could treat bacteria. This rate was 46.9% in Ha Giang and 36.8% in Thai Nguyen, both statistical significance with p< 0.05. Of those 275 bacterial culture from nasopharyl swab, 78 (28.4%) was detected S. pneumoniae, which concordance with previous literature review. Recommendations: Conduct communication and education programs to better understand the use of antibiotics and reduce risk factors for respiratory infections. Further investigation, intervention may needed to reduce risk in S. pneumoniae carriers.

Carriage of oropharyngeal bacteria among children in a vulnerable rural population living in a tropical region in São Paulo, Brazil

This study aimed to detect the carriage of _Streptococcus pneumoniae_, _Haemophilus influenza_, and _Moraxella catarrhalis_ in the oropharynx and a possible association for airway infections in children of a vulnerable population living in a tropical rural settlement, São Paulo, Brazil. Demographic data were collected through standard questionnaires. Oropharyngeal samples were cultured and examined using the multiplex polymerase chain reaction. The molecular method had higher sensitivity and revealed a high rate of colonization by _S. pneumoniae _and _M. catarrhalis_. _H. influenza_ was not detected, highlighting the strength of Brazil's national immunization program. Low income was reported by 61.4% of participants. Carriage of _S. pneumoniae _was positively associated with being female (_P_=0.004) and being brown color (_P= _0.042). We identified risk factors for respiratory infections and vulnerabilities that may be widely applicable to other rural communities in Brazil and other settings of developing countries.

Respiratory infection risk in primary Sjögren's syndrome complicated with interstitial lung disease: a retrospective study.

To explore clinical and laboratory characteristics of primary Sjögren's syndrome (pSS) complicated with interstitial lung disease (ILD) and investigate the risk factors for respiratory infections in pSS-ILD. A cohort of 162 pSS-ILD patients in Peking University People's Hospital from 2015 to 2020 were included, and all medical records were completely collected. We screened 53 patients suffering from respiratory infections as study cases, compared with 109 age- and sex-matched controls. Differences between infection group and control group were compared. Univariate and multivariate binary logistic regression tests were conducted to identify potential risk factors for respiratory infections in pSS-ILD patients. Among 162 pSS-ILD patients, 32.72% (53/162) suffered from respiratory infections. The most frequent type of ILD was nonspecific interstitial pneumonia (32.08%, 51/159), and the most common type of pathogen was bacteria (64.25%, 34/53). Infection group showed higher levels of ESSDAI (P < 0.001), CRP (P < 0.001), ESR (P = 0.003), and C3 (P = 0.020) but lower level of DLCO-SB (P = 0.015). Univariate logistic model revealed that PAH and the use of glucocorticoid increased infection risk in pSS-ILD patients. On multivariate logistic regression analysis, PAH (OR = 3.993, 95% CI = 1.192-13.373, P = 0.025) and severe reduction of DLCO (DLCO-SB < 40%, OR = 4.625, 95% CI = 1.281-16.702, P = 0.019) were significantly associated with increased risk of respiratory infections in pSS-ILD patients. Among pSS-ILD patients, the most frequent type of ILD was nonspecific interstitial pneumonia. In patients with infection, bacteria were the most common pathogen. Higher levels of ESSDAI, CRP, ESR, and C3 may be correlated with increased infection risk. PAH and reduction of DLCO were identifiedas independent risk factors. Key Points • ILD and infectious diseases severely affect pSS patient conditions. • Higher levels of ESSDAI, CRP, ESR, and C3 may be correlated with increased infection risks in pSS-ILD. • PAH and reduction of DLCO were identified as independent risk factors for lower respiratory infection.

Environmental risk factors for respiratory infection and wheeze in young children: A multicentre birth cohort study.

Respiratory infections and wheeze have a considerable impact on the health of young children and consume significant healthcare resources. We aimed to evaluate the effect of environmental factors on respiratory infections and symptoms in early childhood. Environmental risk factors including: daycare attendance; breastfeeding; siblings; damp within the home; environmental tobacco smoke (ETS); child's bedroom flooring; animal exposure; road traffic density around child's home; and solid fuel pollution within home were assessed in children recruited to the GO-CHILD multicentre prospective birth cohort study. Follow-up information on respiratory infections (bronchiolitis, pneumonia, otitis media and cold or flu), wheeze and cough symptoms, healthcare utilisation and medication prescription was collected by postal questionnaires at 12 and 24 months. Log binomial and ordered logistic regression models were fitted to the data. Follow-up was obtained on 1344 children. Daycare was associated with increased odds of pneumonia (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.04-5.49), bronchiolitis (OR = 1.40, 1.02-1.90), otitis media (OR = 1.68, 1.32-2.14) and emergency department attendance for wheeze (RR = 1.81, 1.17-2.80). Breastfeeding beyond 6 months was associated with a reduced odds of bronchiolitis (OR = 0.55, 0.39-0.77) and otitis media (OR = 0.75, 0.59-0.99). Siblings at home was associated with an increased odds of bronchiolitis (OR = 1.65, 1.18-2.32) and risk of reliever inhaler prescription (RR = 1.37, 1.02-1.85). Visible damp was associated with an increased odds of wheeze (OR = 1.85, 1.11-3.19), and risk of reliever inhaler (RR = 1.73, 1.04-2.89) and inhaled corticosteroid prescription (RR = 2.61, 1.03-6.59). ETS exposure was associated with an increased odds of primary care attendance for cough or wheeze (OR = 1.52, 1.11-2.08). Dense traffic around the child's home was associated with an increased odds of bronchiolitis (OR = 1.32, 1.08-2.29). Environmental factors likely influence the wide variation in infection frequency and symptoms observed in early childhood. Larger population studies are necessary to further inform and guide public health policy to decrease the burden of respiratory infections and wheeze in young children.

Protein kinase Cβ is involved in cigarette smoke gas phase-induced ferroptosis in J774 macrophages

Cigarette smoking is a risk factor for respiratory infection caused by immune cell dysfunction. Cigarette smoke is divided into tar and gas phases. Although the gas phase induces cell death in various cell types, the mechanism for gas phase-induced cell death remains to be clarified. In this study, we have examined the effects of cigarette smoke gas phase on J774 macrophages. Cigarette smoke gas phase and cytotoxic factors in the gas phase induced protein kinase C (PKC)-dependent ferroptosis. Pharmacological studies using isoform-specific PKC inhibitors have revealed that PKCβ is involved in cigarette smoke gas phase-induced ferroptosis in J774 macrophages.

Respiratory infections among junior high school students in upper northern Thailand: The role of building dampness and mould, biomass burning and outdoor relative air humidity (RH)

BackgroundFew studies exist on environmental risk factors for respiratory infections in Thai school children. AimTo study associations between home and outdoor environment and respiratory infections among school children in Northern Thailand in dry and wet season. MethodsA repeated questionnaire survey among the children (N = 1159). Data on ambient temperature and relative air humidity (RH) and PM10 and ozone was collected from nearby monitoring stations. We used logistic regression to calculate odds ratios (OR). Results14.1% had current respiratory infections (last 7 days), 32.1% had any respiratory infection last 3 months, and 26.1% had any respiratory infection last 12 months with antibiotic treatment. Students with diagnosed allergy (7.7%) and diagnosed asthma (4.7%) had more often respiratory infections (ORs 1.40–5.40; p < 0.05). Current respiratory infections were more common in dry (18.1%) than in wet season (10.4%) (p < 0.001) and was associated with indoor mould (OR 2.16; p = 0.024) and outdoor RH (OR 1.34 per 10% RH; p = 0.004.) in the total material. In wet season, mould (OR 2.32; p = 0.016), window pane condensation (OR 1.79; p = 0.050), water leakage (OR 1.82; p = 0.018), environmental tobacco smoke (ETS) (OR 2.34; p = 0.003) and outdoor RH (OR 2.70 per 10% RH; p = 0.01) were risk factors for current respiratory infections. In dry season, mould (OR 2.64; p = 0.004) and outdoor RH (OR 1.34 per 10% RH; p = 0.046) were associated with current respiratory infections. Irrespectively of season, biomass burning inside or outside the home was a risk factor for respiratory infections (ORs 1.32–2.34; p < 0.05). Living in a wooden house decreased the risk of respiratory infections (OR 0.56: p = 0.006). ConclusionsDry season, high outdoor RH, household dampness, indoor mould and ETS can increase childhood respiratory infections. Living in a traditional wooden house can reduce respiratory infections, possibly due to better natural ventilation. Smoke from biomass burning can increase childhood respiratory infections in northern Thailand.

Common Respiratory Infections in Children Admitted to Aboozar Children's Hospital in Ahvaz City in the First Semester 2021: Frequency, Risk Factors and Clinical Subgroups

Background and Objectives The aim of this study is to determine the prevalence of respiratory infections in children admitted to Aboozar Children's Hospital in Ahvaz and the associated risk factors. Subjects and Methods A total of147 children aged 12 years and below admitted to the emergency department were selected for this case-control study, including 96 children with respiratory infections and 51 children without respiratory and/or digestive infections as a control group. Their demographic, clinical, and laboratory data were recorded and statistically compared between the two groups. Results Pneumonia (80.2%), especially pneumonia caused by coronavirus 2019, was the most common type of respiratory infection in children. The prevalence and risk of respiratory complications were significantly higher in boys than in girls (p=0.003). The mean age of children with respiratory infections was also higher than that of the control group (p&lt;0.05). In addition, high body mass index, underlying diseases, low birth weight, reduced or no breastfeeding, a family with many children, parental smoking and air pollution were significantly associated with the high risk of infection (p&lt;0.05). Compared to the control group, the children with respiratory infections had lower levels of red blood cells and lymphocytes, but higher levels of neutrophils (p&lt;0.05). Conclusion Knowledge of diagnostic markers and possible risk factors for respiratory infections in children at the beginning of admission to the ward can play a key role in timely diagnosis and treatment of patients.

The Association between Perceived Annoyances in the Indoor Home Environment and Respiratory Infections: A Danish Cohort Study with up to 19 Years of Follow-Up.

The increasing prevalence of reported annoyances in the indoor environment threatens public health. This study aimed to investigate the association between perceived annoyances from the home environment and respiratory infections among individuals with and without asthma or chronic obstructive pulmonary disease (COPD). A total of 16,688 individuals from the Danish Health and Morbidity Survey initiated in 2000 were grouped according to their patterns of perceived annoyances. Information on respiratory infections (all causes, bacterial, viral, and those leading to hospital admissions) was obtained from Danish registers up to 19 years after the survey. Poisson regression of incidence rates (IRs) was applied to estimate incidence rate ratios (IRRs). Annoyances significantly increased the IR for respiratory infections of all causes and bacterial respiratory infections in individuals without asthma or COPD, adjusted IRR 1.16 (95% CI: 1.01, 1.34) and 1.15 (95% CI: 1.02, 1.31), respectively. However, no difference was observed for viral respiratory infections nor hospital admissions. Individuals with asthma or COPD and a high level of annoyances had a non-significantly increased IR in all four analyses of respiratory infections. These findings provide support for perceived annoyances as an important risk factor for respiratory infections.

Social contacts and other risk factors for respiratory infections among internally displaced people in Somaliland

BackgroundPopulations affected by humanitarian crises experience high burdens of acute respiratory infections (ARI), potentially driven by risk factors for severe disease such as poor nutrition and underlying conditions, and risk factors that may increase transmission such as overcrowding and the possibility of high social mixing. However, little is known about social mixing patterns in these populations. MethodsWe conducted a cross-sectional social contact survey among internally displaced people (IDP) living in Digaale, a permanent IDP camp in Somaliland. We included questions on household demographics, shelter quality, crowding, travel frequency, health status, and recent diagnosis of pneumonia, and assessed anthropometric status in children. We present the prevalence of several risk factors relevant to transmission of respiratory infections, and calculated age-standardised social contact matrices to assess population mixing. ResultsWe found crowded households with high proportions of recent self-reported pneumonia (46% in children). 20% of children younger than five are stunted, and crude death rates are high in all age groups. ARI risk factors were common. Participants reported around 10 direct contacts per day. Social contact patterns are assortative by age, and physical contact rates are very high (78%). ConclusionsARI risk factors are very common in this population, while the large degree of contacts that involve physical touch could further increase transmission. Such IDP settings potentially present a perfect storm of risk factors for ARIs and their transmission, and innovative approaches to address such risks are urgently needed.

Allergen immunotherapy effectively reduces the risk of exacerbations and lower respiratory tract infections in both seasonal and perennial allergic asthma: a nationwide epidemiological study.

Allergic asthma is associated with increased risk of respiratory tract infections and exacerbations. It remains unclear whether this susceptibility is conditioned by seasonal or by perennial allergy. To investigate perennial allergy compared with seasonal allergy as a risk factor for lower respiratory tract infections and exacerbations in asthma and whether this risk can be reduced by allergen immunotherapy (AIT). This is a prospective register-based nationwide study of 18-44-year-olds treated with AIT during 1995-2014. Based on the type of AIT and use of anti-asthmatic drugs, patients were subdivided into two groups: perennial allergic asthma (PAA) versus seasonal allergic asthma (SAA). Data on antibiotics against lower respiratory tract infections (LRTI) and oral corticosteroids for exacerbations were analysed before starting AIT (baseline) and 3 years after completing AIT (follow-up). We identified 2688 patients with asthma treated with AIT, of whom 1249 had PAA and 1439 had SAA. At baseline, patients with SAA had more exacerbations (23.8% versus 16.5%, p≤0.001), but there were no differences in LRTI. During the 3-year follow-up, we observed a highly significant reduction of exacerbations with an average decrease of 57% in PAA and 74% in SAA. In addition, we observed a significant reduction of LRTI in both PAA and SAA: 17% and 20% decrease, respectively. AIT effectively reduced the risk of exacerbations and lower respiratory tract infections in both seasonal and perennial allergic asthma. Perennial allergy is seemingly not a stronger risk factor for respiratory infections and exacerbations than seasonal allergy.

PDE4 Inhibitor Reverses Alcohol Impairment of CFTR Function and Protects Against Bacterial Pneumonia

INTRODUCTIONAlcohol is a significant risk factor for respiratory infections. Excessive alcohol users suffer from more frequent lung infections, severe symptoms, and poor antibiotic response. Mucociliary clearance (MCC) is a primary lung defense mechanism against inhaled/aspirated pathogens and is impaired by alcohol use. Previously, we found diminished MCC associates with reduced CFTR‐mediated ion transport in alcohol‐fed rats. In addition, CFTR dysfunction correlated with increased cAMP degradation by phosphodiesterase‐4 (PDE4) enzymes and reduced channel gating. Here, we test whether roflumilast, a clinically used PDE4 inhibitor, can preserve cAMP levels in alcohol‐fed rats and promote CFTR function and clearance of Klebsiella pneumoniae (KP, ATCC 43816), to which alcohol users are disproportionately susceptible.METHODSAge and gender‐matched rats (CFTR+/+) were pair‐fed with Lieber‐DeCarli alcohol diet or isocaloric control diet for eight weeks. CFTR activity was assayed by Ussing chamber electrophysiology of tracheal explants. Rats were randomly treated with vehicle/roflumilast (5mg/kg/day) by oral gavage starting 7 days before the end of 8‐week alcohol diet. Airway surface liquid (ASL) depth, periciliary layer (PCL) height, mucus viscosity, and transport (MCT) on excised trachea were quantified with micro‐optical coherence tomography (µOCT) imaging. In addition, lung function was assessed by flexivent oscillometry.RESULTSAlcohol administration reduced CFTR‐mediated ion transport in rat airways. µOCT image analysis of excised trachea from these rats indicated decreased PCL depth and increased mucus viscosity. Despite the normal ciliary beating, there was a noticeable delay in MCT in alcohol‐fed rats. Roflumilast treatment significantly increased CFTR activity in both control and alcohol‐administered rats. Increased CFTR activation by roflumilast resulted in augmented PCL depth, reduced mucus viscosity, and significantly accelerated MCT rate. While roflumilast partially improved clearance of KP, there was pronounced protection against increased airway resistance and lung injury. Histopathological examination of lung sections indicates roflumilast reduced the severity of multifocal pneumonia with edema, fibrin deposition, and numerous bacteria in alveolar spaces. These improvements were more evident in control rats over those administered with alcohol. Ongoing studies are exploring how roflumilast altered immune cell recruitment and inflammatory signaling to reduce infectious injury.CONCLUSIONSAcquired (non‐genetic) CFTR dysfunction may be a suitable target to improve mucus clearance impaired by alcohol use. Administration of PDE4 inhibitors such as roflumilast may boost lung host defense against bacterial pathogens and improve pneumonia outcomes in individuals affected by excessive alcohol use.

The Effect of Smoking on the Increase of Infectious Diseases

Smoking is a well-known major risk factor for respiratory tract and other systemic infections. The World Health Organization estimates that between 2000 and 2025, about 9% of deaths will be caused by tobacco use, and more than half of all smokers die from smoking-related diseases. Smoking can damage almost all organs of the human body and is a major risk factor for respiratory infections and other infectious diseases. Smoking can increase the risk of respiratory infections through various mechanisms, which include changes in the structural, functional, and immune defenses of the host. Smoking is one of the most serious public health problems in the world. Promoting smoking cessation is the most practical and economical preventive measure to reduce the severity of tobacco-related infections. In this study, we investigated the role of smoking in increasing the risk of bacterial, fungal, viral, and parasitic infections. We also evaluated various mechanisms by which smoking increases the risk of tobacco-related infections.

Impact of body mass index on critically ill COVID-19 patients admitted in a tertiary care hospital : a retrospective observational study

Background: Increased body mass index (BMI) is a known risk factor for respiratory infection and is being recognized as a predisposing factor in the COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus‐2. Aims and Objectives: This study aimed to assess the association between different body mass index categories with severe COVID-19 patients leading to death. Materials and Methods: This retrospective study of six months included the laboratory-confirmed COVID-19 patients admitted to an ICU of a tertiary care academic health care organization. The medical records were reviewed at least 14 days after admission. Results: 484 patients were included, and BMI data were available for 306 patients. 40.19% had a normal weight, 26.79% were overweight, 17.97% had BMI 30-34.9 Kg/m2 and 15.03% had BMI ≥ 35 Kg/m2. Overall, 58 patients (18.95%) died within 14 days of ICU admission, 50.98% were discharged alive or referred from the hospital within 14 days, and 30.06% remained hospitalized at 14 days. After controlling for all covariates, there was a significantly increased risk of mortality in the patients with obesity class I (RR 2.03, 95% CI 1.07-3.85, P = 0.030) and patients with obesity class II &amp; III (RR 2.83, 95% CI 1.54–5.22, P &lt;0.001) compared with those with normal BMI. Conclusions: Obesity was associated with an unfavorable outcome among patients with COVID-19. Patients with obesity should be more closely monitored when hospitalized for COVID-19 as there is increasing evidence of relation of severity of COVID-19 and obesity which appears to be a factor in the health risks.

Associations between air pollutants and risk of respiratory infection: patient-based bacterial culture in sputum.

Air pollution is a crucial risk factor for respiratory infection. However, the relationships between air pollution and respiratory infection based on pathogen detection are scarcely explored in the available literature. We detected respiratory infections through patient-based bacterial culture in sputum, obtained hourly data of all six pollutants (PM2.5, PM10, SO2, NO, CO, and O3) from four air quality monitoring stations, and assessed the relationships of air pollutants and respiratory bacterial infection and multi-drug-resistant bacteria. Air pollution remains a challenge for Mianyang, China, especially PM2.5 and PM10, and there are seasonal differences; pollution is the heaviest in winter and the lowest in summer. A total of 4237 pathogenic bacteria were detected, and the positive rate of multi-drug-resistant bacteria was 0.38%. Similar seasonal differences were found with respect to respiratory infection. In a single-pollutant model, all pollutants were significantly associated with respiratory bacterial infection, but only O3 was significantly associated with multi-drug-resistant bacteria. In multi-pollutant models (adjusted for one pollutant), the relationships of air pollutants with respiratory bacterial infection remained significant, while PM2.5, PM10, and O3 were significantly associated with the risk of infection with multi-drug-resistant bacteria. When adjusted for other five pollutants, only O3 was significantly associated with respiratory bacterial infection and the risk of infection with multi-drug-resistant bacteria, showing that O3 is an independent risk factor for respiratory bacterial infection and infection with multi-drug-resistant bacteria. In summary, this study highlights the adverse effects of air pollution on respiratory infection and the risk of infection with multi-drug-resistant bacteria, which may provide a basis for the formulation of environmental policy to prevent respiratory infections.

Air Pollution Exposure Impairs Airway Epithelium IFN-β Expression in Pre-School Children.

IntroductionAir pollution is a risk factor for respiratory infections and asthma exacerbations. We previously reported impaired Type-I and Type-III interferons (IFN-β/λ) from airway epithelial cells of preschool children with asthma and/or atopy. In this study we analyzed the association between rhinovirus-induced IFN-β/λ epithelial expression and acute exposure to the principal outdoor air pollutants in the same cohort.MethodsWe studied 34 children (17asthmatics/17non-asthmatics) undergoing fiberoptic bronchoscopy for clinical indications. Bronchial epithelial cells were harvested by brushing, cultured and experimentally infected with Rhinovirus Type 16 (RV16). RV16-induced IFN-β and λ expression was measured by quantitative real time PCR, as was RV16vRNA. The association between IFNs and the mean exposure to PM10, SO2 and NO2 in the day preceding bronchoscopy was evaluated using a Generalized Linear Model (GLM) with Gamma distribution.ResultsAcute exposure to PM10 and NO2 was negatively associated to RV16-induced IFNβ mRNA. For each increase of 1ug/m3 of NO2 we found a significative decrease of 2.3x103 IFN-β mRNA copies and for each increase of 1ug/m3 of PM10 a significative decrease of 1x103 IFN-β mRNA copies. No significant associations were detected between IFN-λ mRNA and NO2 nor PM10. Increasing levels of NO2 (but not PM10) were found to be associated to increased RV16 replication.ConclusionsShort-term exposure to high levels of NO2 and PM10 is associated to a reduced IFN-β expression by the airway epithelium, which may lead to increased viral replication. These findings suggest a potential mechanism underlying the link between air pollution, viral infections and asthma exacerbations.

Burden of Respiratory Infection and Tuberculosis Among US States from 1990 to 2019.

PurposeTo estimate the incidence, death, disability-adjusted life years (DALYs) and attributable risk factors for respiratory infection and tuberculosis (RIT) in the US from 1990 to 2019.MethodsFollowing the methodology framework and analytical strategies used in the Global Burden of Disease Study 2019, the incidence, death, DALYs and risk factors of RIT were examined by age, gender and states from 1990 to 2019 in the US. All estimates were calculated as counts, age-standardized rates per 100,000 people and percentage change, with 95% confidence intervals (CIs).ResultsIn 2019, the age-standardized incidence, death and DALY rates per 100,000 people of RIT were 339,703 (95% CI 303,184 to 382,354), 13.6 (95% CI 12.2 to 14.4) and 384.9 (95% CI 330.6 to 458.6), respectively. Among RIT causes, upper respiratory infection accounted for the large majority of RIT age-standardized incidence rate, while lower respiratory infection constituted the highest proportion of RIT age-standardized death and DALY rates. The age-standardized incidence, death and DALY rates of RIT in 2019 and their temporal trends since 1990 varied widely across states and socio-demographic index. Among all attributable risk factors, smoking was the leading one for age-standardized RIT deaths in 2019, followed by low temperature and alcohol use (the attributable fractions were 17.7%, 15.3% and 6.9%, respectively).ConclusionOur results suggest that RIT remained a major cause of health burden in the US, with large disparities persisting between US states. Intervention efforts for RIT hotspots, high-risk populations and modifiable risk factors are necessary.

Disease burden and attributable risk factors of respiratory infections in China from 1990 to 2019

BackgroundThere was lack of data on the burdens and trends of upper and lower respiratory infections (URIs and LRIs) over the past three decades in China. MethodsWe estimated the incidence, mortality, and disability-adjusted life years (DALYs) due to upper and lower respiratory infections (URIs and LRIs) and attributable risk factors in China by a systematic analysis of the Global Burden of Disease 2019 study. Incidence, mortality, and DALYs were stratified by sex, age, and province. Risk factors for respiratory infections were analyzed from exposure data. FindingsThe age-standardized incidence rates of URIs and LRIs were 179,077 and 3926 per 100,000 persons in 2019, with a 7•52% and 35•07% decrease from 1990, respectively. Moreover, 2801 and 185,264 persons died of URIs and LRIs in 2019, respectively. DALYs for URIs and LRIs also decreased from 1,516,727 in 1990 to 928,617 in 2019 and from 38,278,504 in 1990 to 4,020,676 in 2019. The burden of URIs and LRIs were generally similar in males and females, but relatively higher in the new-borns and the elderly. Child malnutrition and low birth weight were the most important cause of age-standardized DALYs of LRIs and URIs, respectively. InterpretationFuture URI and LRI prevention strategies should focus on the maternal and child health, air pollution, and tobacco control, especially in young children and the elderly population. FundingNational Key R&D Program of China (2018YFA0606200); National Natural Science Foundation of China (82041021); Fundamental Research Funds for the Central Universities (20ykpy86) and Guangdong Basic and Applied Basic Research Foundation (2019A1515110003); Bill & Melinda Gates Foundation (No.: INV-006371).

How do air pollution and meteorological parameters contribute to the spread of COVID-19 in Saudi Arabia?

The current global health crisis is unprecedented in modern times. It has killed numerous people, caused great suffering, and turned many people’s lives upside down. This study seeks to investigate the role of some pollutants and the meteorological parameters in the transmission of the virus (SARS-CoV-2). The number of infections identified in Saudi Arabia, a country with a hot climate, was studied for a period between March 9, 2020 and November 19, 2020, which was characterized by a single wave with a peak of 4,919 cases on June 17, 2020. Based on count data models, we observed that air pollution and meteorological parameters considerably influenced the daily evolution of infections in most affected cities of Saudi Arabia (Riyadh, Jeddah, and Makkah) where the prevalence of the disease was relatively high during summer 2020. Our study suggests that air pollution could be a significant risk factor for respiratory infections and virus transmission. On the other hand, meteorological factors and high concentration of air pollutants should be taken into account by public decision-makers in Saudi Arabia when seeking to limit COVID-19 transmission.

Association between autoimmune diseases and COVID-19 as assessed in both a test-negative case\u2013control and population case\u2013control design

BackgroundCOVID-19 epidemic has paralleled with the so called infodemic, where countless pieces of information have been disseminated on putative risk factors for COVID-19. Among those, emerged the notion that people suffering from autoimmune diseases (AIDs) have a higher risk of SARS-CoV-2 infection.MethodsThe cohort included all COVID-19 cases residents in the Agency for Health Protection (AHP) of Milan that, from the beginning of the outbreak, developed a web-based platform that traced positive and negative cases as well as related contacts. AIDs subjects were defined ad having one the following autoimmune disease: rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjogren disease, ankylosing spondylitis, myasthenia gravis, Hashimoto’s disease, acquired autoimmune hemolytic anemia, and psoriatic arthritis. To investigate whether AID subjects are at increased risk of SARS-CoV-2 infection, and whether they have worse prognosis than AIDs-free subjects once infected, we performed a combined analysis of a test-negative design case–control study, a case–control with test-positive as cases, and one with test-negative as cases (CC-NEG).ResultsDuring the outbreak, the Milan AHP endured, up to April 27th 2020, 20,364 test-positive and 34,697 test-negative subjects. We found no association between AIDs and being positive to COVID-19, but a statistically significant association between AIDs and being negative to COVID-19 in the CC-NEG. If, as likely, test-negative subjects underwent testing because of respiratory infection symptoms, these results imply that autoimmune diseases may be a risk factor for respiratory infections in general (including COVID-19), but they are not a specific risk factor for COVID-19. Furthermore, when infected by SARS-CoV-2, AIDs subjects did not have a worse prognosis compared to non-AIDs subjects. Results highlighted a potential unbalance in the testing campaign, which may be correlated to the characteristics of the tested person, leading specific frail population to be particularly tested.ConclusionsLack of availability of sound scientific knowledge inevitably lead unreliable news to spread over the population, preventing people to disentangle them form reliable information. Even if additional studies are needed to replicate and strengthen our results, these findings represent initial evidence to derive recommendations based on actual data for subjects with autoimmune diseases.

Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China

The novel coronavirus pneumonia, namely COVID-19, has become a global public health problem. Previous studies have found that air pollution is a risk factor for respiratory infection by carrying microorganisms and affecting body's immunity. This study aimed to explore the relationship between ambient air pollutants and the infection caused by the novel coronavirus. Daily confirmed cases, air pollution concentration and meteorological variables in 120 cities were obtained from January 23, 2020 to February 29, 2020 in China. We applied a generalized additive model to investigate the associations of six air pollutants (PM2.5, PM10, SO2, CO, NO2 and O3) with COVID-19 confirmed cases. We observed significantly positive associations of PM2.5, PM10, NO2 and O3 in the last two weeks with newly COVID-19 confirmed cases. A 10-μg/m3 increase (lag0–14) in PM2.5, PM10, NO2, and O3 was associated with a 2.24% (95% CI: 1.02 to 3.46), 1.76% (95% CI: 0.89 to 2.63), 6.94% (95% CI: 2.38 to 11.51), and 4.76% (95% CI: 1.99 to 7.52) increase in the daily counts of confirmed cases, respectively. However, a 10-μg/m3 increase (lag0–14) in SO2 was associated with a 7.79% decrease (95% CI: −14.57 to −1.01) in COVID-19 confirmed cases. Our results indicate that there is a significant relationship between air pollution and COVID-19 infection, which could partially explain the effect of national lockdown and provide implications for the control and prevention of this novel disease.