Severe Acute Lower Respiratory Infection Research Articles

A novel combined nomogram for predicting severe acute lower respiratory tract infection in children hospitalized for RSV infection during the post-COVID-19 period.

Off-season upsurge of respiratory syncytial virus (RSV) infection with changed characteristics and heightened clinical severity during the post-COVID-19 era are raising serious concerns. This study aimed to develop and validate a nomogram for predicting the risk of severe acute lower respiratory tract infection (SALRTI) in children hospitalized for RSV infection during the post-COVID-19 era using machine learning techniques. A multicenter retrospective study was performed in nine tertiary hospitals in Yunnan, China, enrolling children hospitalized for RSV infection at seven of the nine participating hospitals during January-December 2023 into the development dataset. Thirty-nine variables covering demographic, clinical, and laboratory characteristics were collected. Primary screening and dimension reduction of data were performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, followed by identification of independent risk factors for RSV-associated SALRTI using Logistic regression, thus finally establishing a predictive nomogram model. Performance of the nomogram was internally evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) based on the development dataset. External validation of our model was conducted using same methods based on two independent RSV cohorts comprising pediatric RSV inpatients from another two participating hospitals between January-March 2024. The development dataset included 1102 patients, 239 (21.7%) of whom developed SALRTI; while the external validation dataset included 249 patients (142 in Lincang subset and 107 in Dali subset), 58 (23.3%) of whom were diagnosed as SALRTI. Nine variables, including age, preterm birth, underlying condition, seizures, neutrophil-lymphocyte ratio (NLR), interleukin-6 (IL-6), lactate dehydrogenase (LDH), D-dimer, and co-infection, were eventually confirmed as the independent risk factors of RSV-associated SALRTI. A predictive nomogram was established via integrating these nine predictors. In both internal and external validations, ROC curves indicated that the nomogram had satisfactory discrimination ability, calibration curves demonstrated good agreement between the nomogram-predicted and observed probabilities of outcome, and DCA showed that the nomogram possessed favorable clinical application potential. A novel nomogram combining several common clinical and inflammatory indicators was successfully developed to predict RSV-associated SALRTI. Good performance and clinical effectiveness of this model were confirmed by internal and external validations.

A Scoring System to Predict Severe Acute Lower Respiratory Infection in Children Caused by Respiratory Syncytial Virus.

There were several factors associated with respiratory syncytial virus (RSV) severe acute lower respiratory infection (RSV-sALRI) in infants and young children. It is vital to develop a convenient scoring system to predict RSV-sALRI in children. Pediatric patients with RSV-ALRI from January 2009 to December 2021 were recruited retrospectively. Two-third of them were randomly grouped into the development set and one-third to the validation set. In the development set, risk factors for RSV-sALRI were transferred into the logistic regression analysis, then their receiver operating characteristic (ROC) curves were built to obtain the area under the ROC curve (AUC), and regression coefficients for each predictor were converted to points. Finally, the value of the scoring system was evaluated in the validation set. A total of 1 066 children with RSV-ALRI were recruited, including 710 in the development set and 356 in the validation set. By logistic regression analysis, six factors (younger than 2 years, gestational age <37 weeks, have siblings, birth weight ≤2500 g, artificial/mix feeding, CHD) showed statistical difference and then were scored with points according to the coefficient value (OR) in the development set. In the validation set, the sensitivity of the scoring system was 70.25%, the specificity 85.53%, the positive predictive value 71.43%, the negative predictive value 84.81%, and coincidence rate 0.80. The Kolmogorov-Smirnov test showed the distribution of AUC 0.765 (SE = 0.027; 95% CI = 0.713-0.818; p < 0.001). A simplified scoring system was developed in the study with high prediction value for RSV-sALRI in children.

RSV Severe Infection Risk Stratification in a French 5-Year Birth Cohort Using Machine-learning.

Respiratory syncytial virus (RSV) poses a substantial threat to infants, often leading to challenges in hospital capacity. With recent pharmaceutical developments to be used during the prenatal and perinatal periods aimed at decreasing the RSV burden, there is a pressing need to identify infants at risk of severe disease. We aimed to stratify the risk of developing a clinically severe RSV infection in infants under 1 year of age. This retrospective observational study was conducted at the Hospices Civils de Lyon, France, involving infants born between 2014 and 2018. This study focused on infants hospitalized with severe and very severe acute lower respiratory tract infections associated with RSV (SARI-WI group). Data collection included perinatal information and clinical data, with machine-learning algorithms used to discriminate SARI-WI cases from nonhospitalized infants. Of 42,069 infants, 555 developed SARI-WI. Infants born in November were very likely (>80%) predicted SARI-WI. Infants born in October were very likely predicted SARI-WI except for births at term by vaginal delivery and without siblings. Infants were very unlikely (<10%) predicted SARI-WI when all the following conditions were met: born in other months, at term, by vaginal delivery and without siblings. Other infants were possibly (10-30%) or probably (30-80%) predicted SARI-WI. Although RSV preventive measures are vital for all infants, and specific recommendations exist for patients with high-risk comorbidities, in situations where prioritization becomes necessary, infants born just before or within the early weeks of the epidemic should be considered as a risk group.

Viral etiology of severe lower respiratory tract infections in SARS-CoV-2 negative hospitalized patients during the COVID-19 pandemic in Kuwait

BackgroundThe prevalence of respiratory infections is largely underexplored in Kuwait. The aim of our study is to determine the etiology of infections from patients who are SARS-CoV-2 negative hospitalized with severe lower respiratory tract infections (LRTIs) in Kuwait during the coronavirus disease 2019 (COVID-19) pandemic. MethodsWe conducted an observational cross-sectional study among severe LRTI patients between September 2021 and March 2022. Respiratory samples from 545 non-COVID-19 severe LRTIs patients were prospectively evaluated with FTD Respiratory 21 Plus® real-time PCR, targeting 20 different viruses and 1 atypical bacterial pathogen. ResultsAmong all 545 hospitalized cases, 411 (75.4 %) tested positive for at least one respiratory pathogen. The most common were rhinovirus (HRV) (32.7 %), respiratory syncytial virus (RSV) (20.9 %), metapneumovirus (HMPV) (14.1 %), bocavirus (13.2 %), and influenza A (12.7 %). The proportion of pathogens detected was highest in the under-5 age group, while HKU1 (44.4 %) predominated in the elderly (>50 years). ConclusionOur study reveals a high prevalence of respiratory viruses in severe acute lower respiratory tract infections among non-COVID-19 hospitalized patients in Kuwait. HRV remains the main etiology affecting the country, particularly in infants. These results underscore the necessity of employing multiplex PCR for accurate diagnosis and describing the epidemiology of infections among severe lower respiratory tract infections. This will facilitate the use of specific antiviral therapy and help avoid excessive or inappropriate antibiotic therapy.

Impact of Palivizumab in Preventing Severe Acute Lower Respiratory Infection in Moderate-to-Late Preterm Infants: A Nationwide Cohort Study

Impact of Palivizumab in Preventing Severe Acute Lower Respiratory Infection in Moderate-to-Late Preterm Infants: A Nationwide Cohort Study

Autophagy induced by human adenovirus B7 structural protein VI inhibits viral replication

Human adenovirus B7 (HAdV-B7) causes severe acute lower respiratory tract infections in children. However, neither the child-specific antivirals or vaccines are available, nor the pathogenesis is clear. Autophagy, as part of innate immunity, plays an important role in resistance to viral infection by degrading the virus and promoting the development of innate and adaptive immunity. This study provided evidence that HAdV-B7 infection induced complete autophagic flux, and the pharmacological induction of autophagy decreased HAdV-B7 replication. In this process, the host protein Bcl2-associated athanogene 3 (BAG3) mediated autophagy to inhibit the replication of HAdV-B7 by binding to the PPSY structural domain of viral protein pVI through its WW structural domain. These findings further our understanding of the host immune response during viral infection and will help to develop broad anti-HAdV therapies.

Correlation between Infantile Vitamin D Insufficiency and the Incidence of Acute Lower Respiratory Tract Infections

Background: The deficiency of Vitamin D is a common nutritional problem that is often overlooked. However, increasing evidence shows that vitamin D has a vital role in building immunity and protecting against respiratory tract infections. The researchers found that people with lower serum vitamin D levels had a higher chance of experiencing severe respiratory tract infections. It is suggested that a deficiency of vitamin D may be a risk factor for severe respiratory tract infections. Objectives: This study investigated the correlation between vitamin D concentration and the severity of acute respiratory tract infections in infants. Study design: An analytical cross-sectional study Place and Duration This study was conducted in unit 1 Civil Hospital Karachi from April 2022 to April 2023. Methodology: The study examines the link between serum vitamin D concentration and severe acute lower respiratory tract infections (ALRTI) in children aged one month to one year. The study included two groups: a case group of children with severe ALRTI and a control group of children without the infection. The primary outcome measure involved assessing the serum concentration of vitamin D in the two study groups. Results: The median age of the case group was 5 months, with an interquartile range (IQR) of 4.75 months. The median age of the control group was 4 months, with an IQR of 4 months. The baseline demographic and anthropometric characteristics exhibited no significant differences between the two groups. Nevertheless, it was observed that the median vitamin D levels in the case group were significantly lower compared to the control group (p &lt; 0.05). Conclusion: The findings of our study indicate that vitamin D deficiency represents a significant risk factor for childhood pneumonia, particularly in the context of severe Acute Lower Respiratory Tract Infections (ALRTI). We found that a significant number of infants with ALRTI had a severe deficiency in vitamin D. Notably, the deficiency was seen more in infants who were exclusively breastfed. These findings suggest that increasing vitamin D quantity in diets can help to reduce the chance of severe ALRTI. Keywords: Respiratory Tract Infections, Infants, Vitamin D

Impact of breastfeeding on the incidence and severity of respiratory syncytial virus (RSV)-associated acute lower respiratory infections in infants: a systematic review highlighting the global relevance of primary prevention

BackgroundRespiratory syncytial virus (RSV) is the principal cause of acute lower respiratory infections (ALRI) among infants worldwide, and an important cause of morbidity, hospitalisation and mortality. While infants are universally...

Biochemistry of the Respiratory Syncytial Virus L Protein Embedding RNA Polymerase and Capping Activities.

The human respiratory syncytial virus (RSV) is a negative-sense, single-stranded RNA virus. It is the major cause of severe acute lower respiratory tract infection in infants, the elderly population, and immunocompromised individuals. There is still no approved vaccine or antiviral treatment against RSV disease, but new monoclonal prophylactic antibodies are yet to be commercialized, and clinical trials are in progress. Hence, urgent efforts are needed to develop efficient therapeutic treatments. RSV RNA synthesis comprises viral transcription and replication that are catalyzed by the large protein (L) in coordination with the phosphoprotein polymerase cofactor (P), the nucleoprotein (N), and the M2-1 transcription factor. The replication/transcription is orchestrated by the L protein, which contains three conserved enzymatic domains: the RNA-dependent RNA polymerase (RdRp), the polyribonucleotidyl transferase (PRNTase or capping), and the methyltransferase (MTase) domain. These activities are essential for the RSV replicative cycle and are thus considered as attractive targets for the development of therapeutic agents. In this review, we summarize recent findings about RSV L domains structure that highlight how the enzymatic activities of RSV L domains are interconnected, discuss the most relevant and recent antivirals developments that target the replication/transcription complex, and conclude with a perspective on identified knowledge gaps that enable new research directions.

How RSV Proteins Join Forces to Overcome the Host Innate Immune Response.

Respiratory syncytial virus (RSV) is the leading cause of severe acute lower respiratory tract infections in infants worldwide. Although several pattern recognition receptors (PRRs) can sense RSV-derived pathogen-associated molecular patterns (PAMPs), infection with RSV is typically associated with low to undetectable levels of type I interferons (IFNs). Multiple RSV proteins can hinder the host’s innate immune response. The main players are NS1 and NS2 which suppress type I IFN production and signalling in multiple ways. The recruitment of innate immune cells and the production of several cytokines are reduced by RSV G. Next, RSV N can sequester immunostimulatory proteins to inclusion bodies (IBs). N might also facilitate the assembly of a multiprotein complex that is responsible for the negative regulation of innate immune pathways. Furthermore, RSV M modulates the host’s innate immune response. The nuclear accumulation of RSV M has been linked to an impaired host gene transcription, in particular for nuclear-encoded mitochondrial proteins. In addition, RSV M might also directly target mitochondrial proteins which results in a reduced mitochondrion-mediated innate immune recognition of RSV. Lastly, RSV SH might prolong the viral replication in infected cells and influence cytokine production.

Viral Aetiology of Severe Acute Lower Respiratory Tract Infection in Children from the Paediatric Intensive Care Unit at a Tertiary Care Hospital, Eastern India- A Retrospective Study

Introduction: Viral infections are the common source of lower respiratory tract infection worldwide. Rapid and accurate detection of viral infections is important that can prevent antibiotic abuse. However, there are few studies determining viral etiologies in paediatric subjects in Eastern India. Aim: To study viral aetiology in children hospitalised with severe Acute Lower Respiratory Tract Infection (ALRTI) over a period of two years and to detect the impact of co-infection on severity and duration of hospitalization. Materials and Methods: This was a retrospective study based on electronic database in a tertiary care Paediatric Intensive Care Unit (PICU) of Bhagirathi Neotia Women and Child Care Hospital, Kolkata, West Bengal, India. Data were collected for all the patients who fulfilled the selection criteria and were admitted to PICU with ALRTI from March 2018 to March 2020. The medical records were reviewed in 51 patients with positive viral Reverse Transcription Polymerase Chain Reaction (RT-PCR). Data was collected for the type of viruses infecting the subjects and whether there were single infection or co-infection. Co-infection is simultaneous infection with more than one virus. Statistical analysis was done using the IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 24.0 (Armonk, NY: IBM Corp). Student’s t-test and Chi-square test were used to compare single infection and co-infection. A p-value &lt;0.05 was considered significant assuming the confidence interval of 95% as the level of significance. Results: The highest positivity rate was 66.6% (34/51) observed in children in the age group 1-12 months. The common viruses detected were adenovirus seen in 51% of samples, Respiratory Syncytial Virus (RSV) in 31.3% and rhinovirus in 11.8%. Clustering of cases was observed for RSV and influenza A in the colder months of the year. Single infection was seen in 74.5% of samples and co-infection in 25.5%. Comparison between single and co-infection with two viruses in terms of complications (p-value=0.163), average duration of PICU stay (p-value=0.70), C-reactive protein (p-value=0.952), procalcitonin (p-value=0.198), white blood cell count (p-value=0.737), absolute neutrophil count (p-value=0.612) were not significant. Conclusion: This present study found that adenovirus and RSV were the leading viral pathogens for ALRTI in the PICU. Co-infection with multiple viruses compared with a single viral infection in a patient did not impact severity.

Correlation between pulse oximetry and the clinical profile of children with acute lower respiratory tract infection

Background. Hypoxaemia is a common predictor of mortality and a potent marker of severe illness in children with acute lower respiratory tract infection (ALRTI). Objective. To determine the mean oxygen saturation (SpO2) in children with ALRTI and its correlation with selected clinical and anthropometric variables. Methods. A cross-sectional study of 178 children, aged between 2 months and 5 years, treated in two teaching hospitals in southeast Nigeria. All patients were assessed for ALRTI, focusing on their clinical profile and sociodemographic risk factors. Student’s t-test was used to compare means of discrete variables. Pearson correlation was used to express association between discrete variables and multiple regression was used to predict dependent variables. Results. Patients with severe ALRTI had significantly lower oxygen saturation (SpO2=89%) than those with mild disease (SpO2=95%) (p=0.001). A negative correlation was found between oxygen saturation and respiratory rate. Multiple regression analysis showed respiratory rate to be the only variable predicting oxygen saturation in children with ALRTI, with a negative association between the two variables. Conclusion. Low oxygen saturation is associated with decreased respiratory rate in children with ALRTI. Oxygen supplementation should always be considered in children with ALRTI, especially those with severe disease

Association of infant and young child feeding practices and acute lower respiratory infections

Background: Suboptimal maternal–child nutrition leading to malnutrition is the major cause increasing morbidity and mortality from severe acute lower respiratory infection (ALRI) among under two children. This research compares the infant and young child feeding (IYCF) practices in children with ALRI and children coming for routine immunization to find out the independent risk factors.Methods: The study was a hospital-based case control study. Infant and young children from 6 months to two years with ALRI admitted to the pediatric ward were studied as cases. Infant and young children of same age coming for routine immunization to the pediatric immunization clinic were studied as controls. Feeding patterns, socio-demographic, environmental and parenting factors were obtained from them in between May 2019 to April 2020.Results: Mixed feeding till 6 months (adjusted OR=34.191; 95% CI, 2.158–541.801; p=0.012), early initiation of complimentary feeding (AOR=30.389; 95% CI, 1.426–647.603; p=0.029), late initiation of complimentary feeding (AOR=28.696; 95% CI, 1.217–676.566; p=0.037) and inadequate amount of complimentary feeding (AOR=14.406; 95% CI, 1.898–109.371; p=0.010) were significant in multivariate analysis.Conclusions: Interventions to increase awareness of breastfeeding and complimentary feeding practices seldom reach lower sections of the society. Feeding visits, mother support groups and community projects to provide home based counselling on IYCF are needed to improve the situation.

Cord-blood respiratory syncytial virus antibodies and respiratory health in first 5 years of life.

To determine the potential longer-term effects of maternal antenatal respiratory syncytial virus (RSV) vaccination, we examined the association between cord-blood RSV-neutralizing antibodies (RSV-NA) and RSV infections in the first 2 years of life, RSV-NA at 3 years, and respiratory health to age 5 years. Two community-based Australian birth cohorts were combined. For children with at least one atopic parent, paired serum RSV-NA levels were compared in cord blood and at age 3 years. Weekly nasal swabs were collected in one cohort and during acute respiratory infections (ARI) in the other. Wheeze history up to age 5 years and physician-diagnosed asthma at 5 years was collected by parent report. In 264 children, each log10 increase of cord-blood RSV-NA level was associated with 37% decreased risk (adjusted incidence-rate-ratio [aIRR] 0.63; 95% confidence interval [CI]: 0.40-1.01) of RSV-ARI and 49% decreased risk (aIRR 0.51; 95% CI: 0.25-1.02) of RSV acute lower respiratory infections (ALRI) at 12-24 months of age. However, higher cord-blood RSV-NA was associated with increased risk of all-cause ALRI (aIRR 1.29; 95% CI: 0.99-1.69), wheeze-associated ALRI (aIRR 1.75; 95% CI: 1.08-2.82), and severe ALRI (aIRR 2.76; 95% CI: 1.63-4.70) at age 6-<12 months. Cord-blood RSV-NA was not associated with RSV-ARI in the first 6-months, RSV-NA levels at 3 years, or wheeze or asthma at 5 years. Higher levels of cord-blood RSV-NA did not protect against RSV infections during the first 6-months-of-life, time-to-first RSV-ARI, or wheeze or asthma in the first 5 years of life. Additional strategies to control RSV-related illness in childhood are needed.

A retrospective study of demographic profile and outcome of Sever acute respiratory illness (SARI) in Iraq

Abstract&#x0D; Background Severe acute lower respiratory infection (SARI) is one of the major causes of morbidity and mortality, especially in developing countries. There is a large global variation in the epidemiology, clinical management and outcomes, including the mortality&#x0D; Aim of the study: To describe the demographic features, Province of residence, occupation and outcomes of patients SARI.&#x0D; Patients and Methods: A retrospective study of 1009 patients involved in the study, between the first of January 2019 and twenty eight of December 2019. From the medical records in Communicable Diseases Control Centre (CDC) office in Baghdad.&#x0D; Results: 1009 patients, 406 with positive for influenza A, and 603 with negative for influenza, the highest incidence was in the age group between 0-10 years for both positive (19.7%) and negative (25.0%) influenza A. Male higher (56.7%) than female in influenza A group, but female is higher (50.4%) in those with negative influenza group. The incidence in Baghdad is higher than other governments for both groups. Freelance is higher than other occupations (31.8%) for positive and housewife (32.2%) for negative influenza A. Death was 6.4% for positive and 1.5% for negative influenza A, the higher mortality rate was in male in age group 0-10 year for both positive (30.8%) and negative (18.9%)influenza A.&#x0D; Conclusion: influenza A is an important cause of SARI, childhood is a high risk for SARI who have high mortality rate especially in male. Freelance and housewife have high occupation risk for SARI. Baghdad has the higher rate than other governments for SARI In Iraq.&#x0D;

Gambaran Drug Related Problems (DRPs) Terapi Farmakologi Pasien ISPA Pediatrik di Rumah Sakit PKU Muhammadiyah Gamping Yogyakarta

Acute Respiratory Infection has become the major cause of death in children in developing countries. There were about 11.9 million episodes of severe acute lower respiratory infection that resulted in hospital admission in young children worldwide. The method of drug administered was the common Drug-Related Problems found in young children. Objectives: To evaluated Drug-Related Problems of Acute Respiratory Infection drug therapy in pediatric patients. Methods: Ninety-four pediatric patients were included in this study. Drug therapy data were obtained from medical records from January 2018 until July 2019, as this study was using a retrospective method. Drug-Related Problems of drug therapy were analyzed based on the Cipolle classification system. Results: Prevalence of female and male patients are in the same number (50%) with the highest prevalence on 2-11 years (72.34%) in young children. The number of Drug-Related Problems was found about 61.49% from 148 numbers of used drugs with improper drug selection as the major Drug Related Problems (51,65%) followed by drugs without indication and underdose by 23.08% and 15.38%, respectively.Keywords: acute respiratory infection, hospital, pediatrics, pharmacologic therapy

A safe and effective mucosal RSV vaccine in mice consisting of RSV phosphoprotein and flagellin variant.

Respiratory syncytial virus (RSV) is a major cause of serious acute lower respiratory tract infection in infants and the elderly. The lack of a licensed RSV vaccine calls for the development of vaccines with other targets and vaccination strategies. Here, we construct a recombinant protein, designated P-KFD1, comprising RSV phosphoprotein (P) and the E.-coli-K12-strain-derived flagellin variant KFD1. Intranasal immunization with P-KFD1 inhibits RSV replication in the upper and lower respiratory tract and protects mice against lung disease without vaccine-enhanced disease (VED). The P-specific CD4+ Tcells provoked by P-KFD1 intranasal (i.n.) immunization either reside in or migrate to the respiratory tract and mediate protection against RSV infection. Single-cell RNA sequencing (scRNA-seq) and carboxyfluorescein succinimidyl ester (CFSE)-labeled cell transfer further characterize the Th1 and Th17 responses induced by P-KFD1. Finally, we find that anti-viral protection depends on either interferon-γ (IFN-γ) or interleukin-17A (IL-17A). Collectively, P-KFD1 is a promising safe and effective mucosal vaccine candidate for the prevention of RSV infection.

Respiratory syncytial virus in severe lower respiratory infections in previously healthy young Ethiopian infants

BackgroundRespiratory Syncytial Virus (RSV) is the commonest cause of acute lower respiratory infections (ALRI) in infants. However, the burden of RSV is unknown in Ethiopia. We aimed to determine the prevalence, seasonality and predictors of RSV infection in young infants with ALRI for the first time in Ethiopia.MethodsWe performed RSV immuno-chromatographic assay from nasopharyngeal swabs of infants, 29 days to 6 months of age. We included the first 10 eligible infants in each month from June 2018 to May 2019 admitted in a tertiary pediatric center. Clinical, laboratory and imaging data were also collected, and chi-square test and regression were used to assess associated factors with RSV infection.ResultsAmong a total of 117 study children, 65% were male and mean age was 3 months. Bronchiolitis was the commonest diagnosis (49%). RSV was isolated from 26 subjects (22.2%) of all ALRI, 37% of bronchiolitis and 11% of pneumonia patients. Although RSV infection occurred year round, highest rate extended from June to November. No clinical or laboratory parameter predicted RSV infection and only rainy season (Adjusted Odds Ratio (AOR) 10.46 [95%. C.I. 1.95, 56.18]) was independent predictor of RSV infection.ConclusionsRSV was isolated in a fifth of young infants with severe ALRI, mostly in the rainy season. Diagnosis of RSV infection in our setting require specific tests as no clinical parameter predicted RSV infection. Since RSV caused less than a quarter of ALRI in our setting, the other causes should be looked for in future studies.

A Prospective Study on Respiratory Viral Pathogens Causing Acute Lower Respiratory Infections in Children below Five Years of Ageat a Tertiary Care Hospital of India

Introduction: The lower respiratory tract infections are a major cause of mortality in children below five years of age. Majority of the time the infection is self-limiting but often gets severe and fatal depending on various factors like age, aetiology, time of diagnosis, appropriate treatment, etc. Aim: To study viral aetiology of Acute Lower Respiratory tract Infections (ALRI) using multiplex real time qualitative Polymerase Chain Reactions (qPCR) among hospitalised children under five years of age. Materials and Methods: This was a hospital based prospective study conducted over a period of two years from June 2015 to May 2017, a throat and nasal swab was collected from 512 children ≤5 years who were being hospitalised for ALRI. The samples were tested by multiplex qPCR to detect viral and p&lt;0.05 was considered as statistically significant. Results: Out of 512 cases, 317 children were further studied. It was found that highest number of ALRI were observed in children of age less than six months i.e., 38.9% followed by 29.4%, 14.8% and 16.9% in the age group of 6-12 months, 12-24 months and 24-60 months, respectively. The one/more viral pathogens were detected in 58.3% (185/317) children. Respiratory Synctial Virus (RSV) was most common virus detected in 51.9% followed by Human Rhinovirus (HRV) in 23.2%. RSV was found to be statistically significant in infants and causes very severe ALRI. Conclusion: The use of multiplex qPCR has clarified the scenario of different respiratory viral aetiologies causing ALRI in different age group of children. The study results enhance knowledge for making strategy to prevent severity of ALRI in different age group, seasons and geographical area.

Disease and age-related inequalities in paediatric research, funding and communication: Lessons from the COVID-19 pandemic.

COVID‐19 has already caused millions of infections, thousands of deaths and countless indirect and poorly estimated consequences on other diseases and the global economy. All ages are potentially susceptible, but the virus has had a lower direct impact on children, with fewer severe cases and low mortality rates. However, the reasons for this are still unclear and we cannot rule out children’s role in transmitting the disease. The serious impact that restrictive measures have had on children’s lives have not been fully considered. Because children are less affected by COVID‐19, the scientific community, health agencies and governments have not focused much attention on them during this pandemic.